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VIDEO DEBATE LINKED TO BELOW – ARI KOHEN AND I DISCUSS THE ETHICS OF RELIGIOUSLY-MOTIVATED CIRCUMCISION
Ari Kohen doesn’t like my recent post about circumcision—the one in which I argue that it is unethical to remove healthy tissue from another person’s body without first getting his permission. I then go on to say that religious justifications cannot override this basic principle. Here’s that post again.
Ari is a professor of political theory and human rights at the University of Nebraska at Lincoln. In this blog post, he takes me to task for failing to take seriously the religious commitments of Jews in framing my arguments. And while he gets some things wrong about, for example, the relevance of “sexually-sensitive tissue” to my overall reasoning; and while he misses the point of my bringing up female genital cutting entirely (I’ve since edited my post to clear up any lingering ambiguity) – he is probably right that my approach to debating this issue is unlikely to win me any converts from within the ranks of the religious.
For a better attempt at that sort of tactic—the convert-winning kind, I mean—please read Jean Kazez’s thoughtful post here. In it, she argues the circumcision is not only unethical, but actually quite meaningless even from within a religious framework. That is, she takes the beliefs-and-values system of Judaism as a starting point, and shows how circumcision is actually inconsistent with those very ethics. It’s a wonderful post, and I hope you’ll take the time to give it a read. I also recommend Iain Brassington’s excellent reflection on the poor quality of “mainstream” arguments in favor of religiously-motivated genital cutting.
Rather than banging out a lengthy reply to Ari, though, and setting off a string of dueling blog posts (I have already hogged more than my fair share of the Practical Ethics “airways” in pressing my pet ethical project: see here, here, here, and here), I invited him to have a web-based video conversation with me, in which we talked through our various disagreements in real-time. I am very pleased to report that the resulting conversation was stimulating, fair-minded, nuanced, and even fun.
We cover male and female genital cutting; Islam, Judaism, and Christianity; we talk about multiculturalism and religious belief; we share some personal stories; and we find some common ground. I think we figured out the places where we really do disagree, and were even surprised to find that our general views are not so different as they had seemed before. Fortunately for you, we recorded our conversation and it’s available here.
What do you think?
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Here are some other excellent posts on this issue:
Robert Darby: Non-therapeutic circumcision of minors: a legal and ethical minefield
Cornelia Koch: Is the circumcision of a young boy a crime? Yes, according to a German court
Jacques Rousseau: The cutting edge of religion
Iain Brassington: More on circumcision in Germany
Jean Kazez: Religious circumcision
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See Brian’s most recent previous post by clicking here.
Brian, what do you think of the claim that circumcision should be allowed for religious purposes on the grounds that banning it would lead to greater harm, i.e. seeking to have the procedure done by unqualified individuals in a non-clinical environment and not being able to find help if anything goes wrong?
Hi Matt,
I’m starting to come around to this view. Banning things isn’t always the way to go. Prohibition didn’t work as we all know — I think in the long-run it’s going to be a change in the hearts and minds of those advocating for circumcision that will bring about the necessary change, and create a social environment in which legal strictures would be less likely to backfire and lead to greater harm.
Best,
Brian
In April 2010, the American Academy of Pediatrics’ Bioethics Committee put through a new policy on female genital cutting proposing to allow a token, ritual nick or pinprick “much less extensive than neonatal male genital cutting” (their words) with just this purpose in mind – to prevent backstreet operations. The uproar was so great that the policy was “retired” within the month. So it seems we can outlaw something completely if we have sufficient disgust for it.
That should have been “can outlaw”
I came to the same conclusion as Matt Sharp did.
It seems that we need to differentiate between a practice being morally impermissible based on its consequences incurring greater risks/harm than would otherwise have occurred and being illegal. For instance for any particular case of circumcision we can agree that it would be better if it were not performed, unless it were for medical reasons aka of interest to the infant, whilst refusing to say that this entails the practice in general should be outlawed.
An additional argument is needed to bridge the premise from the practice being morally impermissible on the grounds of incurring harm/risks and it being outlawed.
If the consequences of outlawing a practice are that the practice will continue to be performed by those less well trained, without anaesthetic and so forth which in turn will result in greater harms than had the practice not been outlawed, then a more nuanced approach might be required.
It might be right to allow circumcision to be performed in places where there is a high motivation to perform the practice i.e., places like Birmingham in the UK whilst publicly declaring that it is wrong and should not be performed.
Public rebuke of a practice and legal allowance of a practice are options here.
Cheers
Julian
Hi Julian – I think you’re probably right. Thanks for your thoughtful comment — and see my reply to Matt above.
Best,
Brian
What about the pure human rights argument that it is his body, and therefore his choice? Thanks to the Internet, more and more circumcised men are putting their heads above the battlements – in spite of rude rebukes – to say “I’m as mad as hell, and I’m not going to take it any more.”
http://www.circumstitions.com/Resent.html#other
Some have also suffered palpable harm.
http://www.circumstitions.com/Resent.html#mandatory
http://www.beyondthebris.com/2011/06/on-circumcision-authority-and.html
This is great stuff – firstly, I think it’s terrific that you’re prepared to modify your views on something about which you care so passionately. I also think it’s a good* idea to acknowledge social costs of alienating communities through the deployment of blunt and aggressive instruments like prohibition, especially where you’re short-circuiting democratic processes (via courts) or exploiting a numbers game within a democratic framework (eg where you encourage a majority to prohibit practices that are cherished by a minority).
Religious communities *do* innovate in the face of arguments, and your most effective allies are likely to be people from within religious communities who share your views about circumcision, since they’re the people best placed to persuade their broader communities of the moral problems that circumcision raises in terms that resonate with those communities. As a value pluralist I really like where you’re going with this.
*Here I mean “good” = morally virtuous and practically astute.
What happend to the rest of the debate? The video just ends in the middle of a sentence.
Hi – not sure. I’ll work on fixing the problem.
Best,
Brian
My first thought was that from within a consequentialist framework making the practice of male circumcision illegal would create greater harms than keeping the practice legal because it would likely expose the infants to a greater risk of harm through more amateur forms of circumcision carried out at home without the availability of medical aids like anesthetic etc
The analogy with prohibition is interesting because presumably making sex under a certain age illegal does mot stop teenagers having sex or getting pregnant.
In the case of sex there is an innate drive and a strong desire to copulate which makes prohibition fail. In the case of male circumcision there does not seem to be any innate drive to circumcise infants but there is a strong desire to do so in order to maintain a tradition that is associated with one’s religion. Hence presumably the strong desire to maintain the practice will continue even if the practice is outlawed and surgeons and/parents prosecuted for carrying it out. It is likely that surgeons will be the most likely to refrain from the practice as they will be the most easily caught infringing the law and have most to lose but parents and communities will go undetected or unpunished.
So the argument against making the practice illegal is that the legal strictures would only prevent circumcision being carried out by registered surgeons but it would not prevent parents carrying out the practice from within a particular cultural or ethnic community.
However, in the UK the practice is not illegal but it is not widely available on the NHS (some areas do offer it which looks ethically problematic to me because it consists in diverting public money away from areas that have known medical benefit to surgery for religious or ritualistic grounds).
It may be tempting to think that the argument we have just considered that it is wrong to make circumcision illegal because it would lead to the practice being carried out within the ethnic community where the risks of harm are greater then the same argument can be applied to making the practice unavailable on the NHS because making the practice unavailable on the NHS leads to the same consequence we have been considering.
However this would be a mistake because when the NHS directs its resources to any particular area such as circumcision, resources are taken from other areas such as heart surgery. Circumcision undertaken for religious or ritualistic reasons that provide little or no medical benefit would constitute a harm as it would involve diverting resources away from areas that provide far greater medical benefit than circumcision. So with this in mind, the strongest argument that those who campaign against male circumcision will have will be located where this is offered within the NHS as here it will not only involve a permanent scarring, harm, for non-medical reasons but it will also be contributing to diverting resources away from more important medical procedures. Since this is where the argument against allowing male circumcision is at its strongest this is where it should make its start in order to be most convincing.
Cheers
Julian
“However this would be a mistake because when the NHS directs its resources to any particular area such as circumcision, resources are taken from other areas such as heart surgery. Circumcision undertaken for religious or ritualistic reasons that provide little or no medical benefit would constitute a harm as it would involve diverting resources away from areas that provide far greater medical benefit than circumcision. So with this in mind, the strongest argument that those who campaign against male circumcision will have will be located where this is offered within the NHS as here it will not only involve a permanent scarring, harm, for non-medical reasons but it will also be contributing to diverting resources away from more important medical procedures.”
So charge parents who want to circmcise their children for the social costs of the medical procedure (the procedure, the admin, their share in expected future complications…). That sends a signal that it’s legal but not something the rest of the community wants to sanction through subsidies.
…or remove it from the list of services the NHS provides but allow it to be conducted by the private healthcare providers. That might be a better signal of of the signal you want to send, which is basically tolerance + opprobrium.
Interesting, I’m intrigued by the practicalities of private circumcision clinics for these procedures; these could even be based within the communities themselves. In a more litiginous society there is a risk that a child could sue their parents for subjecting them to a procedure that try may view as unnecessary and/or harmful (especially, say, if complications arise); secondly what of the drive for mass ‘medical male circumcision’ and its greater-good applications in a context with high HIV rates? Here ethnic groups promoting circumcision (as initiation rites-of-passage) are being supported because of now perceived clinical benefit, which divides dissenting groups further.
Thanks Dave, that was the idea I had in mind, but then I realised that is pretty much exactly how it is at present in the UK (with the odd exception where the NHS performs it).
Private medical companies promote male circumcision. The clinic in London claim it reduces certain health risks (HIV). On the other hand the NHS tend to discourage it.
http://www.circumcisioncentre.co.uk/
However, I am not picking up much sense of opprobrium from the existence of such practices. So long as private medical clinics can promote the benefits of circumcision they will be seen as legitimate authorities for approval of the practice. The London clinic claim to be experiencing an upsurge in demand and plan to open new centres. Would you agree that toleration and opprobrium don’t seem to be working very effectively here?
Phillipa: I don’t see too much moral difference in parents taking their child to a clinic for religious reasons and parents taking their child to a clinic for health reasons when the consequences are the same. Nor does it make much of a difference whether the doctor who performs the operation does this for economic reasons or the health of the patient. Where the consequences are the same it is plausible to say that intent becomes negligible.
If people focus on the intent or purpose of male circumcision then they will see that it is being done as part of a religious ritual which then ignites feelings of disapproval because the practice appears to originate out of an attempt at controlling the religious identity of the child or other outdated values like preventing masturbation. The problem is that the debate may get sidetracked down the opposing atheism/religion dimensions and the practice results in being objected to because it belongs to an outside culture to the one that we inhabit, or supported because it has been part of our culture for centuries. According to the research on moral reasoning from people like J Haidt once the initial emotional reaction and intuition that this practice is wrong sets in people have a hard time shifting their view.
I wouldn’t rule out making the practice illegal other than for medical purposes (after all why rule out options when in the process of thinking a topic through). I suppose a more litigious society whereby parents can be sued for any botched operation that they have performed this would motivate some circumcisions to be undergone in clinics. Further, if the moral principle upon which male circumcision is objected to is the same as that which female circumcision is objected to, and the consequences in terms of benefit/harms are comparable in both cases, then if the one is made illegal then the other should too. It would be hypocritical to support the one and not the other on these grounds.
No doubt things are not that simple
“Phillipa: I don’t see too much moral difference in parents taking their child to a clinic for religious reasons and parents taking their child to a clinic for health reasons when the consequences are the same. ”
If the “health reasons” are genuine – a diagnosed disease – the moral difference is great (though diseases actually requiring circumcision are very rare, and far too many unnecessary circumcisions are done).
The bogus “health reasons” for circumcising a healthy child to prevent some rare ailment of late onset that can be better prevented by other means or treated if and when it occurs, are actually a variety of religion, scientism, and can be treated ethically just like religious circumcision – as a human rights violation.
Let’s come back to first principles. In the absence of consent, it is a serious assault to take a blade to a restrained individual without immediate and pressing medical need; whether an adult or a child. There is no valid argument to make an exception for the still-developing sexual organs of male children.
The ruling out of Cologne should be taken as an urgent wake-up call by Muslim and Jewish leaders, who should have long-ago found a way to consign this profoundly abusive and damaging blood ritual into history, but have failed to do so.
Anyone found guilty of restraining and cutting children should be prosecuted under relevant criminal and child protection laws. Anything else is a complete failure of justice and an abandonment of the most vulnerable members of society. This is not an area for equivocation, religious tolerance or negotiation, it is an area where civilised societies need to take a firm stand against child abuse.
Arguing that forced genital cutting is abusive and is unacceptable is morally sound and on the right side of history. Momentum is building across the world and this is no time to waver, Brian.
Hi Brian,
Interesting stuff. I have a couple thoughts I was surprised to see neither you nor Ari make. Thank you for letting me jump into the conversation.
First off, let me introduce myself. My name is TD Smith, and I’m an office administrator and theater artist in Washington, DC. I met Brian when we were both undergraduates at Yale University. I’m not an expert in ethics, religion, law, or on the specifics of the Cologne case; I’m just a guy whose interested in parenting and religion and civil society and who had way too many dining hall debates about circumcision in college. So thank you again for letting me participate here. Please forgive any major faux pas on my part.
My goal here is to hopefully advance the discussion by providing a bit of a different point of view than either you or Ari (or any of the commenters that I’ve read here) and to see if I can make a case for circumcision that isn’t based on a specific religious framework, but rather the general ethical principles that you and I share and some of my own feelings about the obligations of civil society. My goal is to do this without resorting to a “religion is special” argument, or falling back on anything that resembles “God said so.” So here goes nothin’.
In your dialogue, I heard you and Ari go back and forth a lot along the axis of “this act is central to our religious identity” vs. “this act conflicts with all of our pluralistic secular society’s ethics in generalized domains.” I was surprised that no one got more specific about the complications that exist ethically, legally, and religiously in the connection between parents and children. There is precedent in all three domains for the proposition that the relationship between parents and children is fundamentally different than other relationships, and that on the basis of that difference, different standards can apply, both in terms of obligations of the parent on behalf of the child and also in terms of prerogatives of the parent over the child.
You did briefly mention that we no longer accept the proposition that children are the parent’s religious property, and I certainly wouldn’t challenge that position. However, I think leaving it at that overlooks several complications of direct significance to the permissibility of circumcision. As a general starting point, I think everyone can accept that parents have some authority over their children, especially when those children are infants. As a way of moving beyond this baseline premise, I would argue that the nature of the relationship between parent and child is one of responsibility, both for protecting the interest of the child and for the shaping of that child’s character, but also one of privilege of having certain prerogatives on behalf of the child. I would further argue that this relationship merits both legal and ethical distinction.
At minimum, parents have some rights to raise children as they see fit and guide their children’s moral and ethical development. Parents have a moral, and to an only slightly lesser extent legal, obligation to raise their children. They can’t just walk away. Practically, fulfilling this obligation requires parents to make myriads of choices on behalf of the child during the long years in which the child develops into consciousness and the capacity to consent. Moreover, we recognize that this development of the ability to consent is a gradual process rather than a bright line. There is no one moment when a child can be said to be capable of consenting before which all of the responsibility lies with the parent (the traditional American dividing line of 18 years-old notwithstanding). Thus, both legally and ethically, parents have traditionally been given broad discretion over the raising of their children.
On the other hand, the child also has rights. As I see it, in a free society, we would expect the government’s role to be to preserve the rights and interests of the child with minimal interference to the parent’s right, and seemingly natural role, to raise that child.
In a pluralistic society, we accept that people will have a diversity of opinion about not only how best to raise their children, but also about appropriate domains for their authority over their children. Or, to put it another way, about the issues over which the government has any reasonable say over how people can raise their children. At one end of the spectrum, it would be neither practical, nor desirable for the state to dictate everything about how a parent raises his/her child. At the other extreme, the government has a legitimate duty to protect the rights and basic welfare of the child from parental decisions. For example, we have the moral and legal right to stop severe emotional or physical abuse, and we rightly view with abhorrence the idea that children are the religious property of their parents, and thus, subject to honor killing or ritual sacrifice. These practices violate both the child’s right to life and self-determination as well as our sense of the parent’s duty to the child.
Between these extremes, where do we draw the lines? First, let’s identify where exactly we find the rights of the parent and the rights of the child in conflict. When it comes to male circumcision, it seems to me that three main conflicts have been presented on the child’s behalf, against the parents right to practice this procedure on their children: 1) religious freedom, 2) self determination, and 3) bodily integrity. I think you and Ari nailed the religious freedom argument. If a child is circumcised, he can still grow up and decide to be atheist, Protestant, Muslim, culturally Jewish, or just about anything else. This issue is a red herring. While there may be further interesting ground in the details, we both agree that this is red herring, so we can be excused for moving on.
Self determination. You raised the point that to circumcise an infant who has no ability to consent goes against our principle of self determination. I accept the generalized critique that circumcising a person without their consent goes against our idea that people should be able to consent to procedures that will have a permanent affect on their bodies and to the religious commitments in which they are engaged. That said, I’m not inclined to give that theoretical argument much shrift in the real world. That’s because in practice, the infant has lost very little in the way of future self-determination. The only choice the child is unable to make for his own future (once he gains the ability to consent and choose for himself) is to have foreskin. I don’t want to be glib about this; I can conceive of several circumstances that would lead a circumcised boy to later wish he had not been. He could be the victim of bullying for his difference. He could later come to not only reject but despise his parents or their religion and suffer mental anguish at the permanent physical reminder of their choice for him. However, I find little evidence of these harms or their prevalence. We hear horror stories about the anguish undergone in female circumcision. Perhaps I’m just not listening to the right stories, but I hear very few male infant circumcision horror stories of the nature of what took place in the Cologne case. Complications and truly horrific errors do occur, but as they are not statistically significant to the practice as a whole, I would like to restrict them from the generalized ethical debate for the moment. This limiting of the debate should be justified by the fact that you aren’t arguing against circumcision on a pure harm/benefit basis, but rather from a more general ethical basis.
If infant circumcision is such an intrusion on future self-determination, where are the cries of the men whose ability to set their own course in their life has been taken away by having had their foreskins removed in infancy (see post-post-script)?
When weighed against the damage that would be done to pluralistic tolerance of religious practice and the loss of parental autonomy that would result from a ban (ethical or legal) on circumcision, not to mention the serious harm this would represent from a traditional Jewish or Muslim perspective that takes more seriously than our secular ethics do the significance of God’s commandments, I don’t find these claims on behalf of the child against circumcision compelling.
Finally, let’s address the issue of bodily integrity. This, I think is the real nut of the issue. To most opponents of circumcision that I’ve read, it isn’t the religious freedom of the child that most arouses antipathy, but rather the visceral reaction to mutilation of the human body, a much more generally despised set of phenomena than religious persecution.
Fundamentally, a child has a basic human right to bodily integrity. This is, as far as I can see, the only underpinning for your comment about how religiously based ritual genital cutting goes against our western ethical progression. Your baseline rule is that it is ethically impermissible to permanently remove significant healthy tissue from another person without their consent. That feels generally right to me. I’m not sure I have an argument against it, other than a simple observation that biomedical ethics don’t seem to me to be as clear in the real world as your position makes them sound.
I’m no legal expert, but I think there are several permanent and semi-permanent medical procedures that aren’t necessary for the survival of the child that parents have the legal authority to consent to on the child’s behalf. What about removing tonsils? I understand that it is common, or at least used to be, to remove tonsils even before they became infected. That’s removing healthy tissue, although I suppose one could make the case that this procedure is justified as beneficial for the child’s health because it can prevent potentially serious infection. What about snipping connected earlobes or other similar cosmetic surgeries? That happens sometimes. It’s not necessarily removing much tissue, but it is a mutilation on roughly the same scale as circumcision. Recently it’s been trendy for Korean parents to get their kids vocal surgery (usually cutting of the lingual frenulum) because it’s supposed to improve the child’s ability to develop a good English accent. How do you feel about these practices?
Some other questions that I would be interested to know your answers to, and that I feel are important to any discussion of this topic:
• Does an infant, who can’t feed or clean itself, who couldn’t physically survive without his/her parents, really have bodily autonomy in the same way we understand it for adults? Are there degrees of bodily autonomy? If so, and if the child only has some bodily autonomy, how much do they need to have before it’s no longer acceptable for a parent to remove some healthy tissue? Is the amount of tissue that can permissibly be removed proportional to the child’s amount of bodily autonomy? How much bodily autonomy must a child have before his assent to circumcision would be acceptable to us as true consent? How can one go about measuring bodily autonomy?
• Are we prepared to accept a default position that before a child is ethically or legally deemed capable of consenting for themselves, that absolutely no one can consent to permanent choices about his/her body? If so, are you prepared to argue that we should ban tattoos for minors? If so, what about dietary decisions that can have permanent consequences for a child’s physical or mental development? Are you prepared to legislate nutritional requirements? Can we identify a reasonable limiting principle?
• What if the tissue we’re removing isn’t “significant” tissue? What is an appropriate definition for “significant tissue” in this context? At some point in the video, you say that circumcision is cutting “a significant part of the genitals.” Is foreskin significant? If so, is it significant medically? Ethically? Religiously? Sexually?
• Would the answer to any of the above questions change if we had evidence that being circumcised had some quantifiable benefit for the child? Could we justify the procedure as in the child’s best interest? Would the nature of that benefit matter? Would it be justified as being a standard medical procedure in the child’s interest (perhaps akin to an apendectomy or a vaccination) if there was solid scientific evidence that circumcision prevented the transmission rate of STDs? What about if a significant percentage of women found circumcised penises more sexually desirable? What if I just thought it would bring my son closer to God? Should the nature of the benefit or the preponderance of evidence that can be produced to demonstrate that benefit affect our ethical decision?
• Are these questions totally unreasonable? If they are reasonable, whose answers get to matter when we disagree?
To me, these questions are really hard. I think they should be hard for anyone. And I think there’s a reasonable ethical principle that in our pluralistic, free society, we should be suspicious of banning activities about which there are this many reasonable questions unresolved; that the bar for banning activities outright or claiming that they are ethically impermissible should be set higher, should require compelling evidence of significant harm.
Sincerely,
TD
Post Script
I wrote the above comments after only watching your video dialogue with Ari. I added this post-script after I had a chance to read your original post, which covers some of my arguments above. I won’t belabor the points by re-writing the entire post, but I did have some further thoughts as I read your written argument.
You quote Sandberg saying, “…what is really is going on is status quo bias and the social capital of religions. We are used to circumcision in Western culture, so it is largely accepted. It is very similar to how certain drugs are regarded as criminal and worth fighting, yet other drugs like alcohol are merely problems: policy is not set based on actual harms, but based on a social acceptability scale and who has institutional power. This all makes perfect sense sociologically, but it is bad ethics.”
Is it?
Sure, I’ll grant that as a general rule, just because something has been done, or because a lot of people like it, isn’t, in and of itself, a viable ethical defense. But is there no ethical weight to a conservative approach to the status quo? Are there no ethical benefits that result from a stable social environment and/or strong social institutions, including traditional religions? Notice that this question doesn’t rely on any special distinction for religion, merely an acknowledgement of religion as equal to other important social institutions in creating a cohesive society. Is there absolutely no ethical upside to an approach that says, “People have been doing this for a long time. Maybe there’s something to it?”
I’d like to reiterate: I’m not claiming that just because circumcision is a tradition that it should be accepted. Again, you mention how we’ve covered this ground already with slavery, etc. The point is too easy to make. But I think the example of slavery is instructive. To abolish slavery, it was necessary to demonstrate clearly and consistently that the institution was fundamentally, at its core, abhorrent, both morally/ethically and in practice. It was shown to be abusive and degrading even in its milder forms, when practiced “humanely,” etc. Can any such claim be made for the social institution of circumcision as we currently know it? I don’t really think so, and you yourself acknowledge in your video discussion with Ari that you aren’t prepared to consider circumcision abuse.
Given that you aren’t prepared to label standard, well-executed Jewish circumcision as abuse, it seems to me that your argument for circumcision’s impermissibility hinges on an assumption that for something to be ethically impermissible we need only show that, on balance, it is ethically negative. I think this is a mistake. All else being equal, our values of pluralism and of liberty require a bit higher standard before we deem something impermissible. There is, and should be, some distance between what is negative and what is impermissible. Barring evidence that the kinds of harm we saw in the Cologne case (where, correct me if I’m wrong, I believe there was some other negligence on the part of the man who performed the circumcision), or some compelling argument that other harms are prevalent, or at minimum are more than abstract and speculative, I think circumcision is not only ethically defensible, I would venture so far as to say that it’s almost a moral obligation to defend it from the ethical overreach of an outright ban.
That said, if circumcision really is significantly harmful, finding evidence of that harm shouldn’t be a difficult task for society. How significant the harms of circumcision are, both objective (e.g., rates of deaths or other medical complications per 1000 procedures) and subjective (e.g., the attitudes of men circumcised as infants about their circumcisions), are empirical questions with no significant ethical barriers to research. Because the status quo is that these procedures are already happening, there is a wealth of opportunity to collect data and no shortage of interview subjects. If it turns out I’m wrong, and a significant fraction of circumcised men really do feel harmed by their parents’ choice to circumcise them, we can adjust our approach and develop appropriate harm-reduction strategies, up to and including the relatively aggressive option of a ban on the practice. While I’m unaware of such evidence or statistics, I readily admit that I’m no expert, and would be interested to see any data that you or your commenters have and would like to add to the discussion.
Lastly, does circumcision, which doesn’t feel extreme to me, really merit the term “mutilation?” It certainly meets the denotation. But the connotation of horror, disfigurement, and/or extreme pain and suffering that you casually conjure in your argument just don’t seem to match up to me for anything but a vanishingly small percentage of cases. You quote Symons’, “If only one person in the world held down a terrified, struggling, screaming little girl, cut off her genitals with a septic blade, and sewed her back up … the only question would be how severely that person should be punished.” First, this strongly emotional depiction is only valid if we ignore that circumcision removes only a small portion of the genitals or we don’t accept any gradation of genital mutilation at all. That’s a reasonable positon, I supposed. But how seriously do we take the image of a baby boy about to be circumcised as “terrified, struggling, screaming”? Even if the baby exhibits these feelings/behaviors, how different are they from the behaviors that baby exhibits when his car seat is uncomfortable? Part of the emotional response evoked by an image of a “terrified, struggling, screaming” child comes from recognition of that child’s apprehension at what is about to happen. Can we really accept than an infant of 8 days has any concept of what is about to happen to him, let alone an apprehension of it? Do we take that infant’s pain as seriously as we do that of an older child? Can men remember this pain later in life (see PPS)? Does it matter if they can’t? After all, a forgotten mutilation is still a mutilation, and perhaps a victim’s memory shouldn’t carry significant weight in an ethical analysis of any trauma.
Have I made a rookie’s ethical mistake in minimizing the right of the child to bodily integrity by suggesting that this right is relative rather than absolute? Looking forward to hearing your, always eloquent, thoughts.
TD
PPS
After reading several comments to your original post, I see that there are many commenters here who express genuine pain and anguish at having been circumcised in infancy. First off, I’d like to apologize to them, and to anyone else, if I came off as glib or dismissive of their suffering. I am not. I will be the first to admit that I don’t hear this point of view very frequently, and I acknowledge the very real possibility that this point of view is both prevalent as well as under-represented/under-appreciated because of cultural attitudes that need changing. I am open to the possibility that I am the one who is both wrong and insensitive here.
My goal in writing this post was to confront these issues both seriously and directly, and to engage in a good-willed debate about what exactly is ethically defensible when weighing the various rights, obligations, and harms related to (specifically male) circumcision, and the public policy surrounding the practice.
For what it’s worth, I am not, personally, pro-circumcision. I was raised in the Episcopalian church, and as such, the practice has no traditional significance for me. As such, I assent to the position that in the absence of any powerful claim in favor of circumcision, the right of the child not to be genitally cut is clear.
However, and I think my post demonstrates this fairly clearly, I don’t find the issue simple or clear cut at all. Whatever your particular beliefs about the harms of circumcision to children or the importance of religious tradition in general or circumcision specifically to families and cultures, the gradient of parents’ responsibilities for and rights over their children resist broad generalization and are not compatible with over-simplification.
As an example, I would feel comfortable saying that as an adult, I have the right not to have my anus touched by another person without my consent. For another person to put their hand on my anus without my consent would be a relatively minor, but still serious sexual assault. When applied to parents and infants, however, this general principle is ridiculous. Not only do we casually accept that parents will wipe their children’s bottoms, including the anus, when changing diapers; but for a parent not to ever wipe their child’s behind, and for him/her to claim that doing so would be equal to sexual assault on the child, would be tantamount to child abuse and possibly criminal negligence.
None of this is to say that I believe the this a settled issue, even within my own mind. I only want to suggest that if we are to decide that circumcision is impermissible, we are ethically obligated to decide so in a way that is consistent with the totality of our views about the appropriate relationship between parents and children as well as our views of individual rights and religious freedoms, and not to do so based only on our views about the rights of the child.
TD
Hey TD your comments are very thought out and I hope I can add something to the discussion.
1. As far as medically, we have to look at the evidence. The evidence says there is absolutely no reason to recommend or perform prophylactic surgery removing foreskin in the neonatal period. For that reason alone, the ‘medical benefits’ are obsolete. I’m sure if we tried hard enough, and it was as psycho-sexually important that we do so, we could find medical benefits for prophylactic surgery of any kind. What makes the foreskin significant is that it’s erogenous tissue. There better be damn compelling evidence to justify removing erogenous tissue from a child. There isn’t. The medical benefits of prophylactic foreskin excision is flimsy at best.
2. Concerning relative & absolute bodily autonomy, we can’t divorce bodily autonomy from human development, as you recognised. However, having foreskin doesn’t affect the likelihood of a child’s survival. If an infant is neglected and not fed or changed, that child will die from any number of complications arising from that neglect. A child’s health is not at risk with having a foreskin. This is the main argument against the old ‘I make health decisions for my children, for example vaccines.’ No child has ever died because he had an attached foreskin, so in the case of bodily autonomy, it’s not a parenting duty or “right” to remove it. The supposed *risk* of having intact genitals is not great enough to warrant a relative breach of bodily autonomy.
3. Concerning pain, trauma, and overall dissatisfaction with circumcision being unheard in mainstream discussions is a symptom of many factors, as you recognised, sociological factors. However, I would also include psycho-sexual factors as being an unconscious driving force behind needing to continue to justify cutting boys. For one, society places a significant amount of importance on the penis, male sexual performance, and the penis is central to sexual identity of men and women alike. This need to affirm the circumcised anatomy in our own minds, both for cut men and their partners, is why the discussions of harm, trauma, PTSD, botched circumcisions, death and other horrific stories are absent from mainstream consciousness. We have made the circumcised penis the physical marker of male sexual identity, and shamed (both latent and overt) victims of botched and mutilated circumcisions. The internet has allowed a community of people to come together, to find solace and comfort, and to speak out. This is a powerful survey: http://www.circumcisionharm.org/
4. Lastly, this is a gender equality issue. Obviously no amount of medical research, cultural significance, or psycho-sexual needs would be compelling enough for western/civilised nations to adopt female genital mutilation, no matter how physically benign or insignificant the damage. Why? Because it violates bodily autonomy. If we can so readily agree that even a small pin-prick on the vulva is a violation of bodily autonomy, then we must adopt the same attitude about cutting penises. It would require a great deal of cognitive dissonance and denial not to.
Maria, I liked your comments. I offer this reply by way of developing the ideas. You say:
“Lastly, this is a gender equality issue. Obviously no amount of medical research, cultural significance, or psycho-sexual needs would be compelling enough for western/civilized nations to adopt female genital mutilation, no matter how physically benign or insignificant the damage. Why? Because it violates bodily autonomy. If we can so readily agree that even a small pin-prick on the vulva is a violation of bodily autonomy, then we must adopt the same attitude about cutting penises. It would require a great deal of cognitive dissonance and denial not to.”
The problem with this is that the bio-medical councils in different parts of the world came to the conclusion that symbolic female cutting was morally and legally permissible. It was the public outcry and feminist groups that over-turned the decision made by medical moral experts. Of course it might be that the masses were right and the medical experts had missed something, but it might be that the masses conflated distinct kinds of female genital cutting into one category and so the objection is based on a conceptual confusion. It is hard to tell without examining the arguments and the media doesn’t do that well.
The other problem is the so called right to bodily autonomy unless there is urgent medical need is that this is pure invention rather than some principle of biomedical ethics. Further it doesn’t cohere with our current accepted practices either given the range of elective and semi-elective surgery carried out on children (by definition this is non-urgent surgery) and there is no general consensus that operations on children for non-medical reasons is some moral taboo in our culture. Parents have their children operated on for aesthetic reasons all the time i.e., Asian double eyelids, bat ears, webfeet, dentistry, ear piercing, and sometime it is more medically based and precautionary i.e., tonsils removed, ear tubes to prevent risk of infection. You say that a child’s health is not at risk from having a foreskin but in some contexts it might be if there is a higher risk of HIV infection with foreskin than without and there is not widespread use of other measures like condoms.
So if aesthetic and precautionary surgery are permissible on children then perhaps so should male and female genital surgery – so long as it did not involve significant harm. Alternatively maybe we shouldn’t really be allowing operations on children for aesthetic reasons or for precautionary reasons?
Maria, Julian,
Thank you so much for your responses. Both are very thoughtful and instructive.
Maria, I think you’re getting me/us closer to the correct question for drawing an appropriate line in the ethical spectrum when you make the distinction that parental authority needn’t be recognized for elective (i.e., non-necessary for survival) procedures. Of course, no sooner is that said than I must acknowledge Julian’s point that there are several elective procedures that parents consent to on behalf of their children that aren’t so controversial (probably in large part due to the factors Maria cites in her third point), and that there is little in the way of global consensus on the proper ethical framework by which to judge these procedures.
I’d just like to reiterate two key points about my argument. 1) It doesn’t necessary require circumcision to be medically beneficial. Of course any potential medical benefit or risk of the procedure will be ethically relevant, and I brought up the issue because it affords many interesting hypothetical situations through which to investigate the ethics. My main argument, however, isn’t invalidated by any finding that infant circumcision has no medical benefit. 2) my argument doesn’t primarily seek to defend circumcision as POSITIVE but rather as PERMISSIBLE. We needn’t find something beneficial to believe that banning it would be worse than allowing it. Drug use is a good example that is relatively well-understood by the public. Some “problems” we can agree are bad, but still not agree as to whether the “solution” is worse.
I would stand on the side of needing consent from the individual for any cosmetic procedure and non-therapeutic surgery. As for the argument of HIV, that is a non-issue since children are not sexually active and their individual risk is impossible to know in the neonatal period. The HIV argument is absolutely baseless as a justifiable reason to cut children, as is any other benefit of genital cutting that doesn’t present itself until adulthood. I’d also recommend you read Brian’s critique on this argument as he does a superb job explaining how thinking circumcision prevents HIV will only increase the spread of HIV/AIDS.
Anytime we start using terms like ‘significant harm’ we are entering gray areas of bioethics since ‘significant harm’ is ambiguous and varies from culture to culture. Binding feet could be viewed as justifiable if we allowed cultural relativism to supersede autonomy of children. From an anthropological point of view, humans must help to expose certain harmful practises, for the betterment of a pluralistic society.
Most importantly, genital modifications are in a class all their own due to the significance of our genitals to sexual identity, and the intense psychological harm that can result, even for those who have no ‘complications.’ Many people who are circumcised deal with a lifetime of depression, anger, grief, and recovery similar to any victim of sexual assault. Minimising this psychological complication (as has been done in all cutting cultures) further exacerbates this psychological pain and slows recovery.
Genital cutting isn’t only about physical harm, but also the potential and very real psycho-sexual repercussions and risks non-consensual, non-therapeutic genital cutting has on victims.
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