Announcement: Journal of Medical Ethics – Special Issue on Circumcision

The Ethics of Male Circumcision

by Brian D. Earp. Special Issue Edited by Julian Savulescu, Brian D. Earp and Bennett Foddy.

The Journal of Medical Ethics is pleased to announce the forthcoming release of a Special Issue, ‘The Ethics of Male Circumcision’ — to be published in full in the coming days. Selected papers have already been posted Online First and can be seen by clicking here. Contributions cover a wide range of perspectives, and were invited from leading legal scholars, bioethicists, political theorists, pediatricians, and medical historians with expertise in this area. All essays were subjected to rigorous peer review. A list of main contributors and highlights from the arguments showcased in this Special Issue can be found below.

Background

Recent events have re-ignited controversy around the oft-debated issue of the moral and legal permissibility of infant male circumcision.

According to a recent German court ruling, circumcising minors on religious grounds amounts to grievous bodily harm. The court held that children have fundamental rights to bodily integrity and self-determination that cannot be outweighed by the right of parents to practice their religion and raise their children as they see fit. German chancellor Angela Merkel suggested that the ruling was an affront to religious liberty, while anti-circumcision groups as well as a number of ethicists hailed it as a victory for child rights. In December of 2012, the German parliament passed a law to protect religious circumcision from future legal threats.

Meanwhile, in New York City, health officials recently succeeded in enacting a consent form requirement for circumcision after it was revealed that dozens of infants have contracted herpes in the last decade from a form of the surgery practiced by some Orthodox Jews. This form, called metzitzah b’peh, involves the sucking of blood directly off of the infant’s penis. Disagreements about the relative importance of religious tradition versus health concerns have shaped the ensuing controversy there.

Finally, in late summer of 2012, the American Academy of Pediatrics (AAP) issued a new circumcision policy statement and technical report, in which the child health organization suggested that the possible health benefits of circumcision outweigh the risks and complications. This pronouncement was cited favorably by some commentators, while other groups, such as Doctors Opposing Circumcision, issued harsh criticisms. The Journal of Medical Ethics announces today that it is hosting a continuation of this debate in the pages of its Special Issue, publishing a further critique of the AAP report and policy statement, alongside a formal reply by the AAP.

Ethical issues

Given the controversy following the Cologne ruling mentioned above, as well as the discussion surrounding metzitzah b’peh in New York City, the main focus of the Special Issue on circumcision is on religiously-motivated forms of the procedure, although “health benefits” and secular circumcisions as performed in the United States are also addressed.

Justifications for ritual circumcision are sometimes given in terms of parental rights or religious freedoms. Of course, few would argue that parental rights—religious or otherwise—are boundless. Parents may not, for example, withhold life-saving medical care from their children, whether on the basis of their spiritual beliefs or for other reasons. The question, then, is not whether a court or legislature may ever justifiably prohibit, restrict, or regulate a religious- or culturally-motivated practice, but under what conditions it may do so, for which reasons, concerning which practices, on what legal, ethical, or health grounds, and so on.

A 2004 symposium on circumcision in the Journal of Medical Ethics covered a wide array of issues, ranging from health justifications for the procedure to professional guidelines for medical practitioners. For this new symposium, we welcomed in particular papers that sought to address the ways in which medical harm and benefit are weighed against the array of non-medical goods and harms associated with the practice of male infant circumcision. We invited submissions from both religious and secular perspectives which we think will move the conversation forward, both in favor of and opposed to the position that non-therapeutic circumcision is either morally permissible or legally tolerable in pluralistic, contemporary societies.

Highlights

 

  • A defense of circumcision by political theorist Joseph Mazor. Mazor argues that appeals to parental rights and religious freedom are not necessary to show that infant male circumcision is morally permissible. Instead, Mazor proposes that the best interests of the child himself, especially if the child is being raised in a religious environment, can reasonably serve to justify the procedure in most cases.
  • Bioethicist Dena Davis suggests that it may be time to re-open the conversation on the most mild forms of female genital cutting, on the assumption that analogous interventions on infant male genitals might also be justified. However, Davis shows concern about the metzitzah b’peh form of circumcision in particular, asking whether the risk of harm to the child (i.e., transmission of herpes) is consistent with other tolerated risks.
  • Political scientist Matthew Johnson argues that religious circumcision should be permitted in secular, multi-cultural societies, but that religious groups must “bear the burden and consequences of belief” and that mechanisms should be put in place so that children who are harmed by, or come to resent, their circumcisions can raise a complaint and seek damages against the community.
  • Medical historian Robert Darby assesses the narrow question of whether the principle of the child’s right to an open future applies to non-therapeutic, infant male circumcision. By drawing analogies with the case of “designer deafness” (in which deaf parents deliberately seek to have children with diminished sensory capacity), Darby argues that circumcision is indeed in violation of this principle, and hence is objectionable from an ethical and human rights perspective.
  • The Israeli philosopher Hanoch Ben Yami sees religious circumcision as a barbaric custom, rooted in superstition and a pre-Enlightenment worldview. However, he argues that to ban circumcisions outright would bring about more harm than good, and proposes instead a series of gradual reforms, including the prohibition of metzitzah b’peh, mandatory anaesthesia, and age limits on when the procedure can be performed.
  • Pediatrician Robert Van Howe considers the normative basis of the doctrine of parental rights—sometimes used to justify circumcisions in both the secular and religious case—and argues that parental rights are a “dead dogma” that have outlived their usefulness for conceptualizing the relationship between parents and their children. Instead of rights, Van Howe suggests that parents have an obligation to preserve and protect their children’s rights, including those of bodily integrity and the preservation of an open future.
  • Human rights lawyer J. Steven Svoboda goes a step further and argues that circumcision is a clear-cut human rights violation, whether it is performed on boys or girls, and whether for religious or secular reasons. Surveying the basis of human rights law in Western societies, Svoboda shows that circumcision may be considered inconsistent with the most widely accepted interpretations of key human rights documents, including the Universal Declaration of Human Rights and the United Nations Convention on the Rights of the Child.
  • Leading German legal scholars Reinhold Merkel and Holm Putzke provide an in-depth analysis of the now-notorious Cologne court ruling, and criticize the normative foundation of the later law passed by the German legislature to enshrine a religious right to circumcise. Merkel and Putzke also point out a number of troubling internal inconsistencies in the new law, and suggest that these inconsistencies are emblematic of the sorts of logical difficulties any circumcision-protecting law is bound to face in Western constitutional democracies.
  • The Special Issue will also include two editorials, one by Julian Savulescu, Editor-in-Chief of the Journal of Medical Ethics, and one by Brian D. Earp, Guest Associate Editor of the Journal of Medical Ethics. Associate Editor of the Journal of Medical Ethics Bennett Foddy will provide the “concise argument” summarizing and analyzing the entire issue. Additional commentaries have been invited from the philosophers David Benatar and David P. Lang, and will be published following internal peer review. Be sure to keep an eye on the Journal of Medical Ethics Blog for further announcements, additional postings on this topic, and any updates on the Special Issue.

 

 

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20 Responses to Announcement: Journal of Medical Ethics – Special Issue on Circumcision

  • Gary Harryman says:

    Why is it nobody ever talks about the anatomical realities of what is being discussed?
    What we call “male circumcision” amputates the mobile portion of the penis and thousands of the most specialized pressure-sensitive cells in the human body; Meissner’s corpuscles for light touch and fast touch, Merkel’s disc cells for light pressure and texture, Ruffini’s corpuscles for slow sustained pressure, skin tension, stretch, and slip, and Pacinian corpuscles for deep touch and vibration are found only in the tongue, lips, palms, nipples, fingertips, the clitoris, and the Ridged Band of the male foreskin. These remarkable cells process tens of thousands of information impulses per second! These are the cells that allow blind people to “see” Braille with their fingertips. Cut them off and it’s like trying to read Braille with your elbow. Information from tactile sensitivity gives humans environmental awareness and control. With lack of awareness comes lack of control. Luckily, for those who have them, Nature has mandated that these four types of mechanoreceptors do not age-degrade like the rest of the body’s cells. To say that amputation of the clitoris or the mobile roller-bearing-like portion of the natural penis and consequently thousands of these specialized nerve cell interfaces does not permanently sub-normalize one’s natural capabilities and partially devitalize one’s innate capacity for tactile pleasure is grossly illogical denial of the bio-mechanical and the somatosensory facts of human genital anatomy. The foreskin also forms an organic seal keeping natural lubricants inside the vagina during intercourse. Millions of years of trial and error evolutionary forces have synchronously engineered the human sex organs. The natural penis perfectly compliments the natural female body. Like some other organs and limbs, a man can live without it, but he’s certainly better off with it – all of it. And so are his sexual partners.

    • Jackieno says:

      Thank you for making this point. It is almost funny that the dynamics of the natural penis is never mentioned. The fact that these discussions fail to mention the THOUSANDS of specialized nerve endings and their connection to BRAIN is outrageous. Some of these folks are somewhat like color blind people advocating a shut off of color sight or one eyed people speaking of the ethics of the removal of an eye without understanding 3D sight.

      The nerves are real. The dynamic action of the NATURAL genitals is real. The discussion as to this topic needs to get REAL. This practice is a real WOUNDING, it is real harm to the baby and the man he becomes.

  • Liki Fumei says:

    The sole fact of such ‘ethical’ debate taking place nowadays certainly enlightens the (religious) quicksand in which human train of thought is bogged yet.

    I agree -at least- with the commentary by Gary Harryman, but… what a damn do they give about people sensibility/sensitivity? They only talk (and understand) about Power and its back rooms…

  • Mary says:

    I’m so glad this is being discussed in academic forus though. I truly believe that it is HERE that will lead to a shift in thinking toward the practice. If it’s being grappled with in these forums, at least SOMEONE is thinking critically about it. And it is the kind of thing that really cannot stand up to critical thought.
    I soooo hope that this will be one of those things that my son looks back on when he is grown and thinks, “people actually did that??”

  • Troy Davidson says:

    It is up to parents to determine whether their boys should be circumcised. This is a decision that is to be made between a boy’s parents and their doctor. It also appears to be the emerging consensus in North America as to where the medical community is moving on this issue. When it comes to the medical policy on circumcision for boys, it has recently been reported that the Canadian Pediatric Society will now be following the lead of the American Academy of Pediatrics by dropping its previous opposition to male circumcision. The new Canadian policy will recommend that parents be informed of both the benefits and risks of circumcision for boys and leave the decision up to the parents.

    • Jackieno says:

      Will we also revisit female circumcision? Will it be up to the parents to to determine whether their girls should be circumcised?

      If parents and their doctor have no reference as to the THOUSANDS of specialized nerve endings and their connection to BRAIN, can they really make a decision as to the importance of this sensory input in the life of another human? Are you saying parents should make a decision as to what nerves are connected to another human’s brain, just because the human is their child?

      The AAP should withdraw its circumcision policy the way it withdrew its female circumcision policy (it recommended a ritual nick to baby girls, a much LESS extensive wounding than neonatal male genital cutting).

      Shame on the AAP for not considering the harm! Have they no sense of decency? Especially pediatricians should First do no harm!

    • Marc says:

      What right do the parents have to make such a body altering decision like that? Mine did and I HATE them for it, and don’t speak with them anymore. Its sick and barbaric. The individual should chose. Its his body. Its there for a reason, and doctors over the world have proved it. It needs to be outlawed, period, be it preference or religious.

  • Malcolm says:

    My parents had me circumcised as a baby out of love, in that dad did not want me to experience circumcision as an adolescent, like he had for medical reasons. Even though I wouldn’t do it to a son of mine, I don’t resent them making the choice that seemed the best for me at the time. On the flipside, I’ve had no hassles with cleanliness and never had complaints from partners about being pre-mature.

    • David says:

      The chance that you would have needed a circumcision later in life are 1 in 17,000. The chances that your circumcision could have gone horribly wrong are higher than that. That being said, we don’t know what was the medical reason for your father’s circumcision, but chances are that it was totally unnecessary. The only thing US doctors are taught about the foreskin in school, is how to cut it.

    • David says:

      The chance that you would have needed a circumcision later in life was 1 in 17,000. The chances that your circumcision could have gone horribly wrong are higher than that. That being said, we don’t know what was the medical reason for your father’s circumcision, but chances are that it was totally unnecessary. The only thing US doctors are taught about the foreskin in school, is how to cut it.

  • Charles T says:

    It amazes me men that were circumcised as infants don’t stop and think “wow, part of my penis was cut off and no one asked me how I felt about it”! WTF. Guys, seriously. I am uncircumcised and a huge anti circ advocate. This procedure is so wrong on so many levels. I’ve NEVER had an issue with my foreskin and would rather my arm be cut off than my foreskin. How can you guys NOT question the 20,000 nerve endings that were cut from your penis? How can you not question and wonder what sex would be like with no lube because you have a gliding foreskin and intact frenulum that causes you to produce copious amounts of precum? Any man who is not wondering or asking these questions are clueless idiots. You deserve to lose 50% of your sensitivity by age 40 and be on ED meds. Thank you!

  • sutharsan says:

    It is an un arguable question that ¨How a sensitive part of male body can be removed without his consent?¨ when answer is ¨It should not be¨. The word ¨Sensitive¨ should be addressed only by the people who has foreskin. People like Bill Gates , Bill Clington and Hillary do not have any background to comment about this.

    There have been billion of men already lived in the world and currently living with foresking without any visible problem

    Any new deceases and their medical prevention should be considered alternatives only.

    But I am worrying about how much the world is dominated by the religious scientist.

  • Chris says:

    I’m glad this is finally being taken seriously and discussed. It’s been far long overdue with far too many of us being mutilated against our free will.

    I grew up in a strict religious home and was circumcised against my free will as a child and have resented my parents for it for most of my life. I could never afford therapy for depression over it or restoration surgery to help give me back a sense of wholeness, however given that current restoration surgery doesn’t give you back a real foreskin I’ve grown to not want the surgery. I can only hope that the surgery advances some day so a foreskin can be grown from my own DNA perhaps so the results will be natural looking and have all the nerve endings a normal foreskin has.

    We’re not cows to be branded to belong to any religion. We only live once, and the fact is this mutilation has seriously limited my one and only human experience to not know what natural full real sex is, to not know what real natural masturbation is. To rely on lubricants just so I don’t get a rash from masturbation. For far to long have I constantly wondered why I can barely feel anything and having erection problems at such a young age even though I’m perfectly healthy. Wondering why I feel so totally and utterly unsatisfied with sex and masturbation, it’s so utterly desensitized I just don’t even care for sex that much which has led me to not really care to have a wife or children. When you experience such problems with no one telling you why, its very depressing to think you’re the only one. Only in recent years have I learned that it was the circumcision that I was upset about most my life that was the culprit, making everything clear. I can’t afford Viagra so I don’t really have anywhere to go, I don’t want stretched shaft skin or surgery as they are unnatural looking and don’t restore a fully natural real foreskin.

    The only thing I can do is have unresolved anger and frustration and hope some day the world will change so perhaps some day boys will be able to have the full human experience as nature intended, the life I will never know.

  • Nikolas Schaffer says:

    I have a foreskin and though it’s a nice enough thing, to suggest that it’s more important than one of my arms seems somewhat unhinged. While I’m opposed to the medically unnecessary circumcision of children and agree that it should be prohibited, there does seem to be an edge of hysteria creeping into this discussion.

  • kia el babili says:

    the herpes thing is just wrong, tho my sister & i got oral herpes from my mom at some point when we were kids. but diseases are communicable. that’s life. are we going to make it a crime to accidentally pass someone a non-life threatening virus? give the baby anesthesia & let the vampires have their party. if we ban that on account of herpes, should we ban parents from giving their little ones a swack on the lips for the same thing- a fear of herpes transmission? If we want to protect kids from harm & unnecessary physically altering procedures, should we ban ear-piercing of infants as well? and what about the improved hygiene of a circumcised member, and the reduced risk of STD’s, HIV contraction in particular? Our governments push vaccines on infants to reduce the risk of contracting disease, despite the potential negative side effects. A few dozen cases of herpes dwarfs the damage done by vaccines- the neurological damage, autoimmune diseases, SIDS, autism, etc.
    My son was born with hypospadia- his urethra ended half way up the shaft, & his stream came out at a 90 degree angle. The corrective surgery resulted in circumcision, which was what my husband & i wanted anyways. however, it was elective. my son could relieve himself just fine. but if we left him how he was born, & he decided he wanted corrective surgery as adult, the impact on his life would have been much greater. the procedure would have been more complicated, the pain would be worse, & not soon forgotten. the healing time would be longer, it would impact his sexual life, possibly his relationship, & there would be the temptation to continue normal practices before the wounds were fully healed. it was less traumatic for my son to have the surgery in infancy. that was our choice to make, as his parents.
    i am absolutely sick of the way parental rights are being scoffed at & trampled upon from every possible angle, using this “best interest of the child” or child’s rights platform. Whether it’s the “life starts at conception” notion, or spanking, or the insane practice of the Dutch with their child euthanasia without the parent’s consent, or the kidnapping for profit circuit ran by child protective services & broken courts, or forced vaccinations & medical interventions, or the government’s campaign against home schooling, the total disregard of parents’ rights to raise there own children the way they see fit must end now.
    why was it illegal for african american slaves to marry? why were slave families punished, and their children routinely separated from mothers and sold off? why were native american children taken from their families and sent away to years of boarding school? because we draw strength from our family.when we take away parent’s power to make decisions for their children, we leave the family, & thus the individual, increasingly powerless & more easily enslaved by the “powers” that be, and that is never a good thing.

    • Catherine de Mondragon says:

      You really answer yourself why the rights of the child, adult man to his own FULL body are rendered powerless.. permanently enslaved to another’s, parents or anyone at custody during his first 18 years of life. It aint parents rights but boys own dick.

    • Catherine de Mondragon says:

      You answer your own paradigm. By cutting a boy/man off his own full body, he is left powerless and permanently enslaved to another’s imMORAL choice, parents or anyone at custody during his next 18years. It isnt against parents rights, but boys OWN hide.

  • james says:

    Circumcision makes it harder to masturbate as there is no foreskin to move up and down. Consequently the penis can become sore due to friction, and the extra pressure can cause damage to the spongy inside structure. This can lead to loss in penile length and girth and also erectile dysfunction.

    The AAP should retract their statement as their position is untenable. First, do no harm.

  • Victoria Adkins says:

    This argument can be looked at from many different angles. The most obvious seems to be the parental rights v the rights of the child, however I think more attention should be given to the impact that religion has had. After all, this is where it stems from. I understand that religions should be respected and everyone has a right to follow whichever religion they choose from but surely a line must be drawn. The right is a right to choose and a choice should not be forced upon anyone, even a child.

    Circumcision may be more painful and harder at an older age but if a person feels strongly enough about their religion then surely they would go through with it anyway?

  • Sutharsan says:

    Whatever procedures happening in the name of Religion cannot be acceptable. For example, in india, still some religious gropus kill animals to sacrifice for god.
    This has been prohibited by some states and governments.

    So Circumcision cannot be right procedure, could be comparable to animal sacrifice, since religions do not have any proper concept behind it.

    I think it is time to take regid action against circumcision.

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