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Clinical Ethics

Is the non-therapeutic circumcision of infant boys morally permissible?

On the ethics of non-therapeutic circumcision of minors, with a pre-script on the law

By Brian D. Earp (Follow Brian on Twitter by clicking here.)

PRE-SCRIPT AS OF 25 SEPTEMBER 2012: The following blog post includes material from an informal article I wrote many years ago, in high school, in fact, for a college essay competition. I would like to think that my views have gained some nuance since that time, and indeed with increasing speed, as I have researched the topic in more detail over the past several months–specifically during the period of a little over a year since the blog post first appeared online. Since quite a few (truthfully: many thousands of) people have come across my writings in this area, and since I am now being asked to speak about circumcision ethics in more formal academic company, I feel it is necessary to bring up some of the ways in which my thinking has evolved over those many months.

The most significant evolution is away from my original emphasis on banning circumcision. I do maintain that it is morally wrong to remove healthy tissue from another person’s genitals without first asking for, and then actually receiving, that person’s informed permission; but I also recognize that bringing in the heavy hand of the law to stamp out morally problematic practices is not always the best idea. It is a long road indeed from getting one’s ethical principles in order, to determining which social and legal changes might most sensibly and effectively bring about the outcome one hopes for, with minimal collateral damage incurred along the way. Until enough hearts and minds are shifted on this issue, any strong-armed ban would be a mistake.

In the long term, however, I think the goal remains: that each child should have the same moral, legal, and policy protections regardless of sex or gender, designed to preserve their sexual anatomy in their healthy, intact form until such time as they are mentally competent to make a decision about altering them, surgically or otherwise.

The project for the meantime is to work on hearts and minds.

I am grateful to the many hundreds of individuals who have left thoughtful comments on my sequence of posts on the ethics of circumcision, and I look forward to developing my arguments in ever more sophisticated ways in the coming months and years as this important debate continues. I am especially grateful to those of my interlocutors who have disagreed with me on various points, but who have done so in a thoughtful and productive manner. May we all aim at mutual understanding, so that the best arguments may emerge from both sides, and so that the underlying points of genuine disagreement may be most clearly identified. — B.D.E.

* * *

Routine neonatal circumcision in boys is unethical, unnecessary, and should be made illegal in the United States. Or so I argue in this post.

Yet lawmakers in California, it is now being reported, have introduced a bill with the opposite end in mind. They wish to ban legislation that could forbid circumcision-without-consent. What could be going on?

Read More »Is the non-therapeutic circumcision of infant boys morally permissible?

Shocking behavior: Government scare tactics, smoking, and public health

Coming to a mini-mart near you. The FDA has just approved nine very grisly looking warning labels—to be slapped on cigarette packs throughout the USA. But will they work to cut smoking … or will they backfire?

Here are some of the top reasons why these labels may not only fail to achieve the FDA’s desired outcome, but could actually do the opposite – leading to more smoking, not less.Read More »Shocking behavior: Government scare tactics, smoking, and public health

Uterine transplants: applaud, and then shut up

By Charles Foster

It was reported this week that 56 year old Eva Ottosson is planning to give her 25 year old daughter, Sara, the uterus in which Sara herself gestated. Sara suffers from Mayer Rokitanksy Kustner Hauser Syndrome: she was born without a uterus.

Predictably the newspapers loved it. And, equally predictably, clever people from the world’s great universities queued up to be eloquently wise about the ethics of the proposal.

But if ethics are concerned with what we should do, there was really nothing worthwhile to be said about Eva Ottosson’s altruism (bar the usual uninteresting caveats about dangerousness and resource allocation), except: ‘Fantastic’.Read More »Uterine transplants: applaud, and then shut up

Knowing is half the battle: preconception screening

In a recently released report the UK Human Genetics Commission said there are “no specific social, ethical or legal principles” against preconception screening. If a couple may benefit from it, testing should be available so they can make informed choices. Information about this kind of testing should also be made widely available in the health system (and in school). The responses in the news have been along predictable lines, with critics warning that this is a modern version of eugenics or that it would lead to some people being stigmatized.

Read More »Knowing is half the battle: preconception screening

Autonomy: amorphous or just impossible?

By Charles Foster

I have just finished writing a book about dignity in bioethics. Much of it was a defence against the allegation that dignity is hopelessly amorphous; feel-good philosophical window-dressing; the name we give to whatever principle gives us the answer to a bioethical conundrum that we think is right.

This allegation usually comes from the thoroughgoing autonomists – people who think that autonomy is the only principle we need. There aren’t many of them in academic ethics, but there are lots of them in the ranks of the professional guideline drafters, (look, for instance, at the GMC’s guidelines on consenting patients) and so they have an unhealthy influence on the zeitgeist.

The allegation is ironic. The idea of autonomy is hardly less amorphous. To give it any sort of backbone you have to adopt an icy, unattractive, Millian, absolutist version of autonomy. I suspect that the widespread adoption of this account is a consequence not of a reasoned conviction that this version is correct, but of a need, rooted in cognitive dissonance, to maintain faith with the fundamentalist notions that there is a single principle in bioethics, and that that principle must keep us safe from the well-documented evils of paternalism. Autonomy-worship is primarily a reaction against paternalism. Reaction is not a good way to philosophise.Read More »Autonomy: amorphous or just impossible?

The patient vanishes

by Dominic Wilkinson

If a patient’s family refuse to allow withdrawal of breathing machines should doctors provide long-term support in an intensive care unit for a patient who is clinically brain dead? Should doctors provide heart-lung bypass (ECMO) for a child with anencephaly? Should doctors perform a tracheostomy and provide a long-term breathing machine for a patient in a documented persistent vegetative state?Read More »The patient vanishes

How to Stop the Medical Killing Spree

According to a recent study, around 350 patients die in Australian hospitals every two weeks. The figure would be expected to be much higher in the UK.

Prof Jeff Richardson, from Monash University, appropriately said, “The issue of adverse events in the Australian health system should dominate all others. However, it would be closer to the truth to describe it as Australia’s best kept secret.”

I have a personal interest in this issue. My father died as a result of a “preventable hospital error.” He was having a routine imaging procedure of his liver and bile ducts and a major artery was hit. The bleeding was not recognised til too late and he bled to death. (The autopsy report claimed he died of a heart attack! The heart eventuyally does stop when there is not enough blood.)

So what is the answer? Current debate is focussed on improving systems. Mandatory reporting of incidents, immunity from prosecution for those who report, etc.

Read More »How to Stop the Medical Killing Spree