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Should the circumcision of boys be illegal?

Robert Darby's picture

When a German court recently ruled that religious circumcision was a criminal act it flared an international outcry. Dr Robert Darby says Australia needs reasonable regulation and a change of attitude to bring more clarity to the issue.

The judgement of a district court in Cologne – that medically unnecessary circumcision of a four year old boy constituted bodily harm and was thus unlawful – has revolutionised the debate about male genital cutting and brought to a head the controversy that has been simmering since the passage of the United Nations Convention on the Rights of the Child (1989).

The argument is no longer about whether boys should be circumcised for so-called “health reasons”, but whether any non-therapeutic circumcision (NTC) of minors should be permitted.

The case has generated enormous comment worldwide, both from Muslim and Jewish organisations which (given that they are composed of adults) have naturally deplored the decision, and from bioethical and legal authorities who have largely welcomed it. These have included an Australian legal expert and a Jewish columnist in the journal World Affairs.

Such is the impact of the judgement that even the ultra-conservative New York Times felt obliged to include a critic of circumcision among the contributors to its debate.

I have argued that NTC of minors is morally wrong because it violates accepted principles of bioethics and human rights and there is no “compelling” health case to force the operation on normal children who cannot give informed consent.

Because NTC of minors violates all five of the principles of bioethics formulated by Beauchamp and Childress – non-maleficence, beneficence, proportionality, autonomy and justice – it should not be done. Since it is not the role of the law to enforce morals, this does not mean that the practice should necessarily be illegal. The law does, however, have an interest in preventing people from harming other people, and there can be little doubt that NTC is sufficiently harmful (both physically and morally) to warrant legal regulation.

The current situation in Australia is so unregulated that it would be perfectly possible for a stranger to grab a baby from a pram or a boy in the street, take him to a circumcision clinic or “specialist” and have him cut on the spot, no questions asked. This is not far removed from what happened in Bundaberg in 2004, when an estranged father got away with kidnapping two boys (aged 5 and 9) and having them circumcised by a compliant surgeon against both their own and their mother’s wishes.

The murky legal status of NTC has been exposed in a discussion paper by the Tasmanian Law Reform Institute, and Warwick Marshall has deplored the prevailing “open slather” and recommended both tighter regulation of the practice and prohibition of NTC in the case of incompetent minors, with exceptions for conscientious objection on religious grounds.

As I have already remarked, when it comes to religiously motivated circumcision we are dealing with two sets of conflicting rights: of adults to practise their religion, and of children to bodily integrity and their own religious freedom. It is thus very difficult to find a legal formula that will protect the majority of boys while allowing those with strong convictions to follow their traditions. In view of the religious passions involved, a blanket ban is unlikely to be contemplated by politicians, and would not be accepted by the circumcising sub-cultures even if it were. A prohibition with exceptions for Jews, Muslims and certain Indigenous Australian communities would give rise to the paradox that their children enjoyed fewer human rights and legal protections than everybody else. A general law privileging the existing situation – unfettered parental choice – would be even worse, as it would allow any parents to circumcise their boys (and why not girls?) with no valid reason at all.

Given that NTC is already of borderline legality, what is needed is not so much a law prohibiting it, but a change of attitude. The prevailing “she’ll be right” approach holds that circumcision is always OK unless something goes disastrously wrong. This is such a contrast with the ultra-protective attitude to girls (with fierce laws against female genital mutilation in all states) that we can reasonably see boys as victims of sexist discrimination. This attitude must change to the point where NTC of male minors is regarded as generally unacceptable but permitted in certain circumstances for valid, specified reasons.

Medically unnecessary circumcision of male infants and boys is morally wrong and sufficiently harmful to warrant intervention by the state. Since attempts to ban it outright are not likely to succeed, other means to discourage the practice must be found. The choice is not between open slather and total prohibition, but between unfettered parental power and reasonable regulation.
 

Dr Robert Darby is the author of A Surgical Temptation: The Demonization of the Foreskin and the Rise of Circumcision in Britain (University of Chicago Press, 2005) and numerous articles on the history and ethics of male and female circumcision. His websites are The History of Circumcision and CircInfo.

 

Comments

Forced genital cutting of children

Dr. Darby,

Your work to educate about this important human rights issue contributes greatly to help bring the needed change of attitude. Genital cutting of chidlren is a severe violation of our most basic human rights.  Thank you for speaking out.

Steps of ritual Jewish circumcision, Brit Milah

For us to have a debate about circumcision, let's first consider the steps of Jewish ritual circumcision, Brit Milah. The steps are as follows: 

1. The Sandak who has the 'honor' of holding the baby while the procedure is performed on his genitals, holds down the baby's legs so the mohel can do his job.

2. The mohel (traditional circumciser) forces a metal rod into the baby's foreskin opening and in a circular motion tears the tissue that connects the foreskin to the head of the penis (the foreskin in 8 days old babies is fused to the glans because the foreskin's function in this age is to protect the head of the penis and especially the urethral opening.)

This tearing of the connecting tissue is performed so the foreskin can be pulled and cut (you can't pull it if it's fused to the penis, right?)

3. The mohel then pinches the loosed foreskin with his fingers (usually the procedure is done without gloves, because gloves, so mohels say, just makes their work much harder) and puts it through a narrow slit in a metal shield called mogen. The purpose of the mogen is to ensure that the head of the penis will not be damaged when the knife cuts the foreskin.

4. The mohel then cuts the flesh of the foreskin with a sharp double edged knife. The head of the penis, covered with blood, is now exposed (the head of the penis, as nature intended it is supposed to be internal and protected by the foreskin).

5. With the *fingernails* of his thumbs the mohel then *scrapes* the remaining inner tissue of the foreskin that was left on the head of the penis, to make sure that nothing from that tissue remains stuck to it.

6. And for the grand finale: the mohel takes the bleeding wounded penis in his *mouth* and sucks the blood.

Now if your'e still reading, let me ask you, how can anyone support such a practice? 

This practice has nothing to do with freedom of religion and everything to do with violating the basic human right of all: the right to bodily integrity, the right to be safe from pain and harm and risk.

Eran Sadeh

Protect The Child

Israel

www.gonnen.org

Circumcision

I support all religions in following their practices. I oppose any religious or other practice that hurts and damages another human being. See the JAC website.

This makes the issue very clear. I would like to see promoted the similar position held by some parts of Islam (it seems that circumcision is not mentioned in the Qur'an).

PS:

I previously mentioned I wanted to hear from Muslims (as well as Jews) against circumcision. Well, I found the link on Facebook. A case very well put:

May we be guided by our humanity.

Ronald

Religious persecution by any other name ...

 In proposing a scientific reasoning and rationale for a religious belief, Dr Darby has done little more than create a rationale for religious persecution, which is of itself contrary to the same UN resolutions that he claims justify his stance. He talks of violation of the 5 principles of bioethics - non-maleficence, beneficence, proportionality, autonomy and justice - without any consideration whatsoever of the value of religious belief, community, family, autonomy of the parent and guardian, or, in fact, any of the reasons why the practice of non-medical reasoning for male circumcision is undertaken.

In fact, having at least had first hand experience, I can guarantee that at no time in my life have I had any recollection of pain, suffering, denial of human rights, denial of autonomy, or any other negative impact of having been circumcised very early in life. As a research series of one, this may not be convincing, but perhaps surprisingly, I have been in close contact with many hundreds of Jews and Moslems over the years, and this has never been an issue. Hence, not only has Darby presented a one sided, highly subjective, and unfortunately extreme view of the theoretical issues, entirely overlooking any of the scientific or moral argument that balances (at a minimum) his hypothesis, but he has conveniently ignored the practical evidence that the procedure has been in practice for millenia, and for reasons of belief alone, and of continuation of faith that precedes the morality of Christianity, there is no evidence that male children have come to harm beyond the reported occasional adverse outcomes, and there has never been any science or even ethical and moral case that has reasonably tried to balance the impact of adverse medical outcomes against the benefits of the family and community affiliations that have been associated with the procedure. There is a clear tenet that we must look at the balance between harm and good in evaluating any medical procedure. If we did not do this, then no medical treatment could ever be offered, as there is potential harm in all interventions.

Darby also proposes that the scientific evidence is clear. Again, it is uncertain what the scientific evidence being reviewed might be, but that which I have reviewed poses both a degree of direct harm from occasional adverse outcomes, but in balance, a degree of protection against the transmission of sexually transmitted diseases, including HIV, and some diminution of the risk of cancer of the organ being discussed. I do not need to try to enumerate whether the balance of scientific argument falls on one side or the other, as much of that assessment will depend on how much one puts a value on protection of others over protection of self, or whether a small risk of cancer is something that is acceptable if it avoids a small but larger risk of adverse outcomes from the procedure. One does have to question, however, whether the apparent scientific approach taken by Darby, and that fails to even mention this controversy or balance in scientific argument, is purposefully ignoring the science in order to make a subjective, ideological point. And if it ideological, then it is most unfortunate, or intentionally mischievous, that the corollary of making the argument as he does has the effect of creating an argument for religious persecution which is of itself immoral and unethical.

I would not like to digress here as to whether there are religious teachings and practices other than circumcision that, according to investigations internationally, could be proposed as resulting in a far more direct harm to children, but I am drawn to question why Darby has selected out this particular religious belief alone, and presented it in this way. 

I am somewhat disturbed that this view should find its way into Open Forum, but I suppose it at least suggests that the concept of freedom of speech is supported. I myself would balance that freedom against the risk of fermenting religious vilification by stealth, but that is only a personal opinion.

 

From the Editor

Thanks for your comments Stan. At Open Forum we like allow our community to share a wide variety of ideas. This is a senstive topic that has a range of views, as evidenced by your comments and those by other members. In fact this was one of the most read blogs of 2012. We also have moderation guidelines in place to ensure the integrity of the site.

Forcible circumcision of infants and children is immoral

Perhaps the most telling replies to Mr Goldstein’s comments are from Jewish commentators

(1) Moses ben Maimon (Maimonides) (12th Century)

"With regard to circumcision, one of the reasons for it is, in my opinion, the wish to bring about a decrease in sexual intercourse and a weakening of the organ in question, so that this activity be diminished and the organ be in as quiet a state as possible. It has been thought that circumcision perfects what is defective congenitally. This gave the possibility for everyone to raise an objection and to say: How can natural things be defective so that they need to be perfected from outside, all the more because we know how useful the foreskin is for the member? In fact this commandment has not been prescribed with a view to perfecting what is defective congenitally, but to perfecting what is defective morally.

"The bodily pain caused to that member is the real purpose of circumcision. None of the activities necessary for the preservation of the individual is harmed thereby, nor is procreation rendered impossible, but violent concupiscence and lust that goes beyond what is needed are diminished. The fact that circumcision weakens the faculty of sexual excitement and sometimes perhaps diminishes the pleasure is indubitable. For if at birth this member has been made to bleed and has had its covering taken away from it, it must indubitably be weakened."

Guide of the perplexed, Part III, Chapter 49

(2) Dr Eugen Levitt (19th Century)

“What cultivated people would ever consider regarding bloody, mutilated genitals as a divine cultural symbol? Indeed, whenever I have attended this ceremony I have never perceived a devout, solemn attitude in any participant. … I have seen the pale, trembling father offering his sacrifice to the mohel, while the shocked, delicate mother awaits in anxious agony the return of her passionately loved infant. I have seen many of those in attendance fall in a faint – yes, even a coarse, simple peasant servant girl, the wet nurse, shedding tears at the scene she witnessed. … A ceremony dripping with blood, eliciting cries of pain and agony, arousing pity and dread in some, revulsion in others … only fanatic Oriental zealots could call such an event a consecration.

“Fanatical zealots, supposedly honouring God  or from a sense of guilt, may punish their own bodies with fasting, waking vigils, lashing, all sorts of self-denial and mortifications; but to impose asceticism on the body of someone else, especially an innocent, defenceless child – that no one has the right to do.”

Eugen Levitt was an Austrian Jewish doctor whose first son died after having been circumcised. When he declined to have his second son circumcised he was expelled from the local Jewish community. His pamphlet, “Israelite Circumcision Elucidated from a Medical and Humane Standpoint” was published in Vienna in 1874. His experience, and that other nineteenth century German-Jewish critics of circumcision, is discussed in Leonard Glick, Marked in your Flesh: Circumcision from Ancient Judaea to Modern America (Oxford University Press 2005)

(3) Orthodox rabbi Hershy Worch (21st Century)

When making Cut, his documentary film on circumcision, Jewish film-maker Eliyahu Ungar-Sargon interviewed Orthodox rabbi Hershy Worch about circumcision practices. Among other comments, the rabbi said:

“It’s painful, it’s abusive. It’s traumatic, and if anybody who’s not in a covenant does it, I think they should be put in prison. I don’t think anybody has an excuse for mutilating a child. … Depriving them of [part of their] penis. We don’t have rights to other people’s bodies, and a baby needs to have its rights protected. I think anybody who circumcises a baby is an abuser, unless it’s absolutely medically advised.”

After a moment of what many viewers perceive as stunned silence, Eliyahu asks: "How does this covenant alleviate your ethical responsibility that you just so articulately posed? How is it that being in this covenant exempts you from that term. How can you not call yourself an abuser?" The Rabbi actually cuts him off and says:

“I am an abuser! I do abusive things because I am in covenant with God. And ultimately God owns my morals, he owns my body, he owns my past and future, and that’s the meaning of this covenant – that I agreed to ignore the pain and the rights and the trauma of my child to be in this covenant.”

Such honesty is rarely found among circumcision advocates.

http://www.cutthefilm.com/

 

Cherry-picking and the art of misinformation

And there we have it.

An argument by anecdote as a way to establish the science and logic. Impressive, but unconvincing in the extreme. Sorry. So on the subject of quotes, I refer to an excerpt from Crikey, the Australian online publication to which Dr Darby has already objected, and note that his views are not shared by all and sundry ...

"A kind or unkind cut? An editorial published online in the Journal of the American Medical Association this week has come out strongly in favour of male circumcision. The editorial was prompted by two new states in the US recently joining 16 others in eliminating Medicaid insurance for male circumcision and possible ballot initiatives to ban male circumcision.

Johns Hopkins health epidemiologist and pathologist Aaron Tobian, MD, PhD, and health epidemiologist Ronald Gray, MD, highlight the most recent medical research showing the considerable life-long health benefits of circumcision performed during infancy and the potential disadvantages associated with waiting until adulthood before undergoing the procedure.

Our goal is to encourage all parents to make fully informed decisions on whether to circumcise their infant boys based on medical evidence and not conjecture or misinformation put out by anti-circumcision advocates,” says Tobian, an assistant professor at the Johns Hopkins University School of Medicine.

Among the research cited by Tobian and Gray, a professor at the University’s Bloomberg School of Public Health, are multiple studies conducted within the past five years showing that in heteros-xuals, circumcision reduced HIV infection risk by 60%, genital herpes by 30% and cancer-causing human papillomavirus (HPV) by 35% in men. Females benefit from a 40% or greater reduced risk of bacterial vaginosis or parasitic trichomonas spread during s-x, as well as HPV infection, which causes cervical cancer.

In addition, the experts say the data clearly show that having the procedure in infancy reduces the risk of urinary tract infections, as well as inflammation in the opening or head region of the p-nis. Risk of infection from surgically removing the for-skin, considered a minimal and simple surgery, is already low overall but even lower during infancy, at between 0.2% and 0.6%. In adults, infection and complication rates are higher, between 1.5% and 3.8%.

In contrast to what circumcision’s opponents claim, Tobian and Gray say that research shows no reduction in s-xual satisfaction or male performance. Indeed, they add, circumcised men in the trials, the gold standard of medical evidence, reported no difference or even increased penile sensitivity during inte-course and enhanced org-sms compared to uncircumcised men. The majority of female partners also reported either no change or increased s-xual satisfaction, largely because of improved hygiene."

And so I ask again whether it is free speech that we protect or the validity of science and the right of religious belief?

Apparently fully informed decisions are in the eye of the beholder.

Mr Darby

 Sorry, last but not least:

I didn't notice that Mr Darby referred to me as Mr Goldstein. For the record, I am a medical doctor, a lecturer in public health, a clinical researcher, and as a result of this series of blogs, a Jewish commentator. I review health research frequently and regularly and have been chosen by health ministers to contribute to national health technology assessment processes as an outcome of my perceived expertise. I am not ultra-religious, nor even particularly orthodox or reform. What I also am, however, is offended by the use of selective attention deficit disorder, the misuse of scientific evidence by pejorative selection, and the use of pejorative terms like "mutilation" and in general taking the opinion of 3 or 4 philosophic commentators, or even 300 or 400, and linking that to an argument on scientific evidence.

You know what? In 1874 this argument was much more valid. Today ... not so much.

Without any research, I

Without any research, I personally know of two cases of babies seriously damaged by circumcision. I cannot justify exposing a child to possible harm needlessly. And few people remember trauma that they experienced as babies. There can also be problems for the elderly. I have heard jokes in the US Jewish community about circumcision going wrong. I used to laugh at them.

There is research suggesting that circumcision could have been a replacement for the sacrifice of the first-born male. In any case, Judaism has taken a humane approach to many of the self-harming traditions within which most religions were born - why not this one? Read more at: jewsagainstcircumcision.com