Cutting bits off babies

Normally I can see two sides to an argument, but the circumcision debate seems like an open and shut case to me, ethically speaking.

I don’t like moral dogmas, so I wouldn’t make a commandment of it, but I think ‘Don’t cut bits off people without their informed consent’ is a good general ethical principle. We might be flexible with this principle in the case of medically necessary procedures where children might be too young to give meaningful consent, but I think it’s a good general principle. The reasons behind it are pretty easy to grasp – respect for the dignity of a person requires respect for the integrity of their body; respect for the autonomy of a person requires that they give consent for irreversible procedures affecting their body (like cutting pieces off their genitals).

Given this principle, I can’t see any reason why children under an age where they can meaningfully consent should have bits cut off them, and the judgement in Germany today that found this seems totally correct to me.

(I know some people make a medical argument for male circumcision but the health benefits of circumcision would have to be very very strong to amount to a plausible medical necessity. Instead, what few benefits are alleged for the practice are contested at best, plausibly outweighed by the disadvantages, and certainly don’t amount to enough to override the presumption that such a procedure should have consent.)

Of course some Jews and Muslims are going to be upset by a ban and I think we should be sympathetic up to a point

It’s difficult for many people to think rationally about procedures and practices that have the authority of tradition about them. It’s even more difficult when that antiquity is reinforced by the sanction of a revered religion. Any person’s most profound convictions being challenged in an unforeseen way is going to feel oppressive to the person so challenged and a severe – perhaps even traumatic – challenge to their identity. It is emotionally extremely difficult to accept that what your parents did to you and what you have done to your children is harmful and unethical. When the longstanding practices of a cultural minority are banned by the wider community, of course that minority may feel oppressed. But I’m sure that advocates of sati felt the same – this sort of psychic trauma is the cost of progress – and the rights of vulnerable people (children in this case) should always outweigh it.

More understandable is the emotional charge given to the debate by the fact that those defending it are themselves circumcised. It’s hard to think of a more personal and intimate issue that the condition of your genitals and we should remember that the Jewish and Muslim opponents of a ban are men who are circumcised, women who have circumcised husbands, parents who have circumcised their children. A ban on circumcision can feel like an implied judgement on their own physical condition and that of their children, especially when one of the arguments made by supporters of a ban is the decreased pleasure during sexual intercourse experienced by circumcised men. It’s difficult to engage in a disinterested ethical consideration of consent from this position (I’ve noticed that American and Australian friends who are circumcised for non-religious reasons can also feel this embarrassed discomfort when discussing the case for a ban on religious circumcision).

These explanations might elicit our sympathy, but they are not enough to outweigh the ethical case for a total ban on genital mutilation of either boys or girls. Hopefully the UK will one day move towards that.

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17 Comments.

  1. I was circumcised when I was about 4 or 5 I think, because I had a tight foreskin. A nurse came to the school and checked all the boys genitalia. There was at least one other boy in my class who got cut for the same reason and several others from the whole school. Honestly, I’ve never really thought of it as a big deal, and any alleged decreased sexual pleasure I guess would be lost on me, but I do know two fully grown men, almost thirty, who had the same problem with a tight foreskin and didn’t have it removed. The problems and embarrassment they have suffered on account of not having their genitalia “mutilated” without their consent has been far greater than my seeming lack of it (unless people have been secretly making a fuss over of it behind my back all these years). Obviously, both now have the option of taking it upon themselves to remove it but none of them have because one is scared and the other is embarrassed despite the fact that he first mentioned the problem to me over 6 years ago.

    These are difficult problems because men are really really sensitive about their junk, and If I’m honest I think I would have to say that I think I’m only OK with mine because it’s so common, but the reason it’s so common is because of people getting it done for religious or cultural reason. I didn’t. If that wasn’t the case, and there were no cultural or religious circumcisions I’d still need to have had it done but because most people wouldn’t I’f feel like a freak and would probably have remained a virgin the rest of my life for fear of eliciting screams of horror when I whipped it out. This is much longer than what I intended to write and I’m a little ashamed to admit it could have been shortened to “I’m glad babies have their penises chopped up because it makes it OK for mine to be the same.” It sounds selfish because it is. I imagine if I was in a minority of freaks with circumcised penises my teenage years would have been intolerable, and even though I agree with you in principle I could never bring myself to support the idea in practice because I think the damage felt by those who need to be circumcised would far out way the damage felt by those who never needed to be but were. At the moment it’s OK to be circumcised. That would change and some people would have to suffer through it. No one really suffers now, so isn’t it okay to let it be? You’re making it black and white, when it isn’t at all that simple.

  2. However, my argument is not at all with circumcisions that are medically necessary. In the UK and in many other European countries, most boys aren’t circumcised so the argument you make is less relevant, but I understand the point you are making and the motives for making them and how difficult it is in practice (that was my point towards the end of the blog – people who are circumcised do find it difficult to be disinterested in discussion of this).

    Ultimately, however, I don’t think the negative feelings of difference that might be felt by boys circumcised for medical reasons are a sufficient reason for the unnecessary mutilation of other boys.

  3. Andy’s comments literally disgust me.

    //”I think the damage felt by those who need to be circumcised would far out way the damage felt by those who never needed to be but were”//

    And what about the damage felt by anyone else who has to undergo surgery when they never needed it?

    Should we perform labiaplasty on all girls just in case anyone who “needs” it feels self-conscious? Should we give all people appendectomies so that those who do need them won’t feel bad about having a scar?

    No-one who is healthy should undergo unnecessary surgery so that YOU can have better self-esteem.

    //”No one really suffers now”//

    That is simply untrue.

    http://www.mendocomplain.com/

    http://www.norm.org/

    Both those sites are FULL of men who are suffering as a result of circumcision, and wish it had not been done to them.

    http://menmedia.co.uk/manchestereveningnews/news/s/1491640_salford-nurse-to-go-on-trial-charged-with-manslaughter-of-oldham-baby-who-died-after-circumcision

    That link is to a story of a boy who bled to death because he was circumcised. Hundreds of other cases exactly like this exist.

    And you have the nerve to lie and say that people don’t suffer? Open your eyes!

    It IS black and white. Surgery should be performed on people who NEED it or people who CONSENT to it. It should NOT be performed on those who neither need nor consent.

    What’s really sad to note is that the reason you give for your support of forced genital cutting is because you yourself needed to be circumcised for a “tight foreskin”.

    You should educate yourself regarding phimosis. Such a condition is NOT POSSIBLE to diagnose in pre-pubescent children. Your “tight foreskin” was probably perfectly normal, and would have resolved itself (or could easily have been resolved with stretching) if you had been left alone.

    Yes, the sad fact is, you almost certainly did not need to be circumcised at all, yet here you are, promoting doing the same thing to others who also don’t need it. Willful ignorance at its worst.

    And cowardly, so very very cowardly.

  4. I have a Jewish heritage, and until my son was born I didn’t have a strong stance either way about circumcision.
    Then I had my son. My partner and I had discussed our son being circumcised and he was content to let me decide.
    If anyone had come near my baby with a scalpel for anything which wasn’t a strict medical necessity I would have ripped their throat out.
    The distress my son had during his inoculations was enough to convince me that I’d not allow anything that hurt more than that, for less reason, it just wasn’t going to happen.
    If it is medically required (for a tight foreskin for example) then fair enough, but if it is done as a religious practice then let it be a rite of passage for an adult male not for a child.
    There may be good reasons for a man to be circumcised but that should be his decision.
    Not because his parents believe that their invisible friend in the sky demands it. Even more baffling is why it is the norm in the USA.
    I think it is a very brave ruling by the German courts and I would hope it is a ruling which will become universal.

  5. Susanne, I’m sorry if my post disgust you, but you have the benefit of looking at it from a very different perspective that is somewhat removed. I don’t. Nonetheless, I feel your response is disingenuous.

    I never “had the nerve to lie” though maybe I’m poorly informed. I read the post and responded immediately without spending any time researching the topic. It was my honest initial thoughts on the subject and I think that’s helpful to put out there. Even if just for people to understand the problems people who are circumcised have with the issue, even if it doesn’t ultimately hold up. I already said that I agree in principle and that I was “ashamed to admit”. I was just being honest.

    I’m perfectly happy to look at the links and hear what people have to say and reconsider my feelings on the subject if people can be a least remotely civil.

    I think your appendectomies analogy is pointless and little more than a straw man. There’s not a man alive who is even remotely as self conscious of having a scar on his abdomen as they are of having an abnormally disfigured penis and that’s the way things are. You might think that people should just grow up and get over it (so do I) but it doesn’t mean they will.

    I don’t know if my condition would have resolved itself or been “cured” through stretching, but as I mentioned I know people personally where that is not the case who might find your certainty a little insulting and your anger a little unjust.

    It is not willful ignorance it is something that was never a big deal. I’m thankful for that. I don’t care that I was circumcised. It has never in my life caused a problem. I’m not sad about it. It is not a sad fact. As Andrew suggested, I am a little a taken back by people being sad on my behalf.

    It is not black and white, and simply saying otherwise with occasional caps-lock doesn’t support your insistence that it is. The way I feel about it is quite complex and I feel like you’ve either dismissed or missed my main point in favor of getting your anger on and calling me names. I will look at the links you posted, but it’s a sensitive issue and it wouldn’t hurt you to be sensitive to that if you respond again. It’s easier to see another persons point of view when they aren’t yelling at you and insulting you.

  6. Andy,

    I do take your point that men are far more invested in their penis than in their abdomen.

    Nevertheless, it IS valid to state that, whatever level of self-consciousness person A feels, person B should NOT be subjected to surgery in order to alleviate it.

    My certainty is based on medical literature that has proven that in 90% of cases of phimosis, circumcision is NOT necessary, and simple stretching will suffice. For those cases where stretching alone is not sufficient, topical steroids can also be used.

    It is also a biological fact that in infants the foreskin is fused to the glans underneath, and is therefore MEANT to be tight. This makes it impossible to diagnose phimosis in infants. This is a fact, not an opinion, and not something for any right-minded person to be upset by. Anyone who diagnoses phimosis in a pre-pubescent individual is either mistaken or dishonest.

    I do not think it is less worrying that your comments are made without research – that you feel it right to support amputation of healthy tissue from children when you’ve never researched it is concerning.

    There is no legitimate justification for cutting healthy tissue from a non-consenting infant.

    If you can present just a single reason that it might be legitimate, then you would be in a position to claim that it is not black and white. Until you can do that, then I’m afraid ethically it remains one of the clearest situations ever – surgery should not go ahead without need or consent.

    It is a very emotive topic, and let us not forget that I, like many others, regard this as an issue of human rights. Children have DIED because they have been subjected to this procedure. Lives have been ruined because of this procedure.

    To have someone disregard that suffering is offensive. You obviously felt in a position to claim that “no-one suffers now”, though you’ve now admitted to not having found out if that’s the case.

    So if I upset you a little, or come across as insensitive, just remember the context that it’s in – that I’d rather see an adult with hurt feelings than see a child bleed to death, or see a man’s sex life damaged, for no reason.

  7. Andrew, thanks for your reply. Again, I want to agree with you and I feel like I do, but it makes me very uneasy. The fact is, even in Europe, everyone knows what a circumcised penis is and what it looks like. Even in the UK it is more likely to be a surprise than a shock.

    When I was a teenager I was coming to terms with being gay which was harsher in the 90s than it is now and I think if my circumcision had been another hurdle to deal with sexually (as if adolescence wasn’t difficult enough) I think I would have just thrown my hands up and called it a day. as it was I barely had to think about it. Of course it doesn’t seem like a good enough reason, it’s a ridiculous reason to support cultural circumcisions, but it’s a reason a lot of teenage boys would gladly cling to if faced with the alternative of having freaky junk that frightened girls away. It makes it an issue and it would be a big one. Not now but in the future when it is mostly unheard of, it would be a harsh thing to deal with.

    I do accept that my justification is absurd, but I’m not looking at it from the point of view of unnecessary religious baby surgery. Obviously, it only seems OK because we’re so used to it and perhaps it shouldn’t be OK, it just seems like a ban would cause a lot of upset for boys in the future who otherwise wouldn’t have had to deal with it. But maybe I’m wrong and circumcision can cause a lot of problems that I’m not aware of, and if that’s the case then I guess I’d eventually have to agree that it should be stopped.

  8. Andy, it does seem that circumcision can indeed cause many problems so I do think that your arguments needs to be outweighed by that.

  9. //”it just seems like a ban would cause a lot of upset for boys in the future who otherwise wouldn’t have had to deal with it”//

    And not banning it will continue to cause a lot of upset for boys in the present and future who look at their penis every day and every day are reminded that they no longer have their entire member.

    Now, to do that and know it was medically necessary is one thing. To look at that scar, that keratnisation, and know that it was done for no reason other than because someone else, who never consulted you, thought it looked nicer that way, or that it would please their god? Why should any man ever have to do that?

    Why should any man have to carry a scar that’s there because of someone else’s beliefs?

    Circumcision ALREADY causes problems – it takes away men’s right to decide what happens to their own bodies.

  10. As Andrew suggests, there are cases like a tight foreskin (including in infants) where the medical case is genuine and circumcising is better than not circumcising (or so we’re told). These cases may well be an exemption to the general imperative not to cut “bits” off boys without consent.

    Another medical argument is made that infants, and men, should be circumcised for HIV prevention. The argument is different for a few reasons. One; it’s not individual medical need, but a generalised policy in response to a perceived reduction in HIV transmission in circumcised men. Two; (I could be wrong about this, but) the science isn’t settled and the benefit seems to be marginal when compared to taking precautions, minimising partners in endemic areas, educating people about STI transmission, etc.

    Nevertheless, mass circumcision has a lot of advocates in parts of Africa, presumably because condoms are not always available or affordable (or at least, that’t the perception). There’s been a spate of forced circumcisions in parts of Uganda recently, where gangs of men forcibly cut other men, in public, in a wholly irresponsible and medically unsafe way.

    My point is that this is another form of ‘medical necessity’ argument which is made. But, I don’t think it is a necessity, because if circumcision does reduce sexual pleasure and can lead to further problems of its own, then there are better ways of minimising infection.

    (Some figures showing that circumcision is *more effective*, or significantly enhances, a programme of education coupled with wide availability of condoms etc, might change the equation in areas with high HIV prevalence. But even if the benefit is real, significant and well-established, I still wouldn’t say you should make it compulsory.)

  11. Phimosis – the non-retractable, tight foreskin – is natural in babies.

    The foreskin is fused to the glans beneath by synechia – the same sort of tissue that links the fingernail to the nailbed below.

    This is to protect the glans, and is regarded as a male equivalent of the female’s hymen. In the majority of infants it is not possible to retract the foreskin, any more than it is possible to retract a fingernail.

    It is not possible for any medical personnel to diagnose phimosis in an infant because it’s impossible for them to know if a child is simply undergoing natural separation at a slower rate or if he has a problem.

    Phimosis can only be diagnosed in adults, who are then able to choose for themselves if they think circumcision is an appropriate solution.

    In 90% of cases, phimosis can be cured by stretching alone. Any doctor who suggests circumcision as a first course of action to cure phimosis is misinforming his patients.

    It’s also perfectly possible to live a healthy, happy life WITH phimosis. I know men who have never once been able to retract their foreskin, but have never had an issue with it – no infections, no hygiene problems, no pain. It is up to the man to decide what should and shouldn’t happen to his body.

  12. I cant help but think there is something in an argument for ‘pre-emptive consent’ – similar to the medical case for it.
    If we take it as a given* that the parents will indoctrinate a child into the religion then by the age of, say, 5 the child – now able to speak and express desires – will affirm consent to the circumcision that was already performed at 8 days old.
    Shouldn’t this religiously motivated pre-emptive consent be honoured in the same way medically motivated pre-emptive is?

    *I know bringing up a child in a religion is arguably abuse but that is a different issue.

  13. I don’t know what the statistics are like in other countries, but in the UK a child raised by two religious parents only has a 50% chance of sharing their religion in adulthood. If only one of the parents is religious, it’s even less likely. So, the argument for ‘pre-emptive consent’ is certainly not a strong one in UK.

  14. Kungfuhobbit – no. That presumed consent should not be “honoured”.

    Because what then will you say to the man who, aged eighteen, says “I don’t believe in the faith of my parents – why did you allow this to be done to me?”.

    Circumcision permanently alters the sex organ. It is a decision that should only ever be made by an adult. We don’t let children consent to getting tattoos, why would we let them consent to having purely cosmetic surgery?

    If you leave a man intact and he later becomes part of a faith that preaches circumcision, he can make that decision then. No man can ever undo a decision made for him as an infant.

  15. Blaise F Egan

    I would take issue with your statement that “what few benefits are alleged for the practice are contested at best”. There is evidence from 3 well-conducted randomised controlled trials in Africa that circumcision reduces the female-to-male transmission rate of HIV by about 50%. It’s quite plausible that it might also reduce the transmission of other STIs as well, which would account for its adoption by earlier civilisations. Circumcision might well be a rational choice for an adult male in a place where HIV is endemic and where barrier contraceptives are unavailable (or he is unwilling to use them).

    I certainly agree that in our modern world there is no excuse for routine circumcision of babies.

    In fact, sexual disease must have been truly devastating to early societies with no drugs or other treatments, because thousands of years later the draconian public health rules that they imposed upon themselves are still widely enforced:

    You pick ONE partner for life
    You have a public ceremony, so everyone is clear about who is with who
    You brutally punish people engaging in pre-marital sex
    You brutally punish people engaging in adultery
    You execute people who don’t accept the rules (apostates)
    You tell people sex is for procreation only, thus minimising intra-marital sex

    In the modern world we are in an utterly different situation.

  16. Blaise – the studies you’re referring to – are they the same ones that have been criticised in the medical literature for poor sampling, poor conduct, and undue extrapolation?

    Those randomised trials in Africa that people love to quote are extremely methodologically flawed. Firstly, the researchers selected only countries that already showed the bias they wished to find (higher rates of HIV among intact communities), even though such countries made up a minority (in 10 of the 18 countries in the pilot study, higher rates of HIV were found among circumcised men, yet none of these countries was included in the study).

    Secondly, on top of this selection bias, there is the added bias that the only men who would volunteer would be men already willing to be circumcised. This creates even more bias in the sample.

    Thirdly, the men in the circumcised group were exposed to medical personnel and were drilled in safe sex practises before and after their circumcision. They were also advised to not have sex while healing. The control group received no safe sex advice, and were not told to refrain from sex for any period.

    The researchers behind the study were also people who produce clamps specifically designed for circumcising – an undeclared vested interest.

    The statistics used also continue to use relative reduction risk – that wondrous 50% figure you cite – instead of actual reduction risk (which is around 1% – not so impressive, eh?). And they don’t use the number needed to treat (which would mean admitting that if they circumcise 100 men, of those 100, only one would have contracted HIV if left intact, and one other will still contract HIV anyway).

    They also ended their research early (while the results were still in their favour) and failed to publish their parallel study regarding transmission from males to females (which found that any reduction in risk of F-M transmission was negated by an increase in risk of M-F transmission among circumcised men).

    These are the studies you think are “well-conducted”? Really? Or had you just heard that they were well-conducted and taken that as gospel?

    As for the opinion that circumcision may be an option for men who don’t want to use condoms – they would be at virtually exactly the same risk as their intact counterparts (owing to the fact that the actual reduction of risk is actually closer to 1% than the 50% figure you are basing your claims on).

    It’s also documented that circumcised men are already less likely than intact men to use condoms, and more likely to engage in riskier sexual practises, such as anal sex. Giving such men a false impression of protection from STIs is highly dangerous, and is already showing increases in rates of HIV in places where these big circumcision pushes have taken place.

    I really do wish that people would actually research these studies before they trot them out as evidence that circumcision is beneficial. Especially since even those studies have not given any proposed mechanism for how this “protection” they claim works, and since current medical knowledge shows that the prepuce organ produces lysozymes that protect against and even kill HIV.

    So, once again I have to ask exactly what leads you to the conclusion that these studies were “well-conducted” or are remotely relevant in a discussion about infant circumcision?

  17. Christopher Shell

    How about ‘Don’t kill people without their informed consent’? Those who have bits cut off them (not pleasant, I agree) still have the opportunity to live their lives and make millions of subsequent choices. The babies you are happy to see aborted have ther entire life and their entire sum of choices taken away at a stroke. My position is consistent: both practices are negative, and the practice that takes away the more is the more negative of the two. I don’t see consistency in your position (but maybe I am wrong?).

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