025. Circumcision

A discussion on health, tradition, and mutilation

Questions to ponder on circumcision.

  1. If circumcision did not already exist, would it be necessary for our society to invent it?
  2. Christopher Hitchens once quipped, “Religion forces nice people to do unkind things and also makes intelligent people say stupid things. Handed a small baby for the first time, is it your first reaction to think, ‘Beautiful, almost perfect, now please hand me the sharp stone for its genitalia that I may do the work of the Lord’?” Do you think circumcision is inextricably bound up in religious tradition? Should the practice/procedure be secularized?
  3. Should biomedical procedures only ever be performed to the reasonable biomedical benefit of the patient (or at the very least to the minimal harm of the patient)?
  4. What do you find to be the most convincing reason to alter the genitals of one’s children and/or the children of others? 
  5. As Earp points out, “The official position of such influential bodies as the World Health Organization and the United Nations is that any kind of medically unnecessary, non-consensual alteration of the female genitalia – no matter how minor the incision, no matter what type of tissue is or is not removed, no matter how slim the degree of risk, and no matter how sterile the equipment used – is by definition  an impermissible “mutilation.”” Why do you think this is the case for procedures on female children and not male children?
  6. Generally, there are four types of ‘female genital alteration’: Type I includes removal of the prepuce or clitoral hood with or without clitorectomy; Type II is the removal of the entire clitoris as well as part or all of the labia minora; Type III, known as infibulation, involves the removal of the labia majora and/or labia minora, possible removal of the clitoris, and stitching together of the vulvar tissue to cover the urethra and introitus, leaving only a small opening for urine, menstrual flow and intercourse; Type IV includes pricking, nicking or incisions of the external genitalia, stretching of the clitoris or labia, cauterization or the introduction of corrosive substances into the vagina. Are any of them acceptable in the sort of society you want to live in?  Do you agree with Arora and Jacobs recategorization based on the outcome of the procedure, rather than what is specifically done?
  7. “After a comprehensive review of the scientific evidence,” the American Academy of Pediatrics punted the bioethical conclusion by finding that “the health benefits of newborn male circumcision outweigh the risks, but the benefits are not great enough to recommend universal newborn circumcision.” If the benefits are not great enough to recommend for all children, how should we categorize the medical procedure describing the physical alteration of children’s genitals? Enhancement? (Pre-)Treatment? Cosmetic?
  8. Often the medical benefits of (particularly male) circumcision are made, as done ad nauseam by Morris and Cox in their “Current Medical Evidence Supports Male Circumcision”, use studies that fail to disentangle lots of socio/cultural/economic/ethno/religious lines inherent in asking a question such as “is male circumcision medically beneficial?” We note here in passing that most of the benefits of circumcision come hand in hand with Christendom on a map. And so how much do you really “trust” studies and even meta-analyses such as these on the topic of changing the way children’s genitals look/function?
  9. What do you find to be the most convincing reason not to alter the genitals of one’s children and/or the children of others?
  10. In the United States, a general legal and ethical standard when dealing with children is the ‘best interests standard’ wherein “the best interests of a child are determined by judicial and quasi-judicial decisions in individual cases, rather than arising from an established heuristic that would almost always predict the decision prospectively.” Three key Supreme Court cases triangulate the balance interests of a child against parental beliefs and rights: Meyer v. Nebraska (1923);  Pierce v. Society of Sisters (1925); and Troxel v. Granville (2000). How do you think the ‘interests’ of children ought to compared against the ‘rights’ of parents?
  11. To what degree ought we as citizens of this nation and/or budding biomedical professionals respect cultural traditions of our centuries-long multicultural experiment? If someone told you they wanted to cut the tip of child’s penis off and have a leader in their community suck the blood off, with his mouth, all because it said somewhere that “circumcis[ing] the flesh of your foreskin […] shall be a token of the covenant betwixt” the gods and their community, what would you think? If that community held that all eight day olds “must needs be circumcised” lest his “soul shall be cut off from his people”, what would you think? If they told you that a ninety-nine year old man cut off a portion of his penis and a portion of the penis of his thirteen year old son that same day, because he heard the gods telling him that such a genital alteration would “make thee exceedingly fruitful” and “indeed” lead to “a child be[ing] born unto him that is an hundred years old”, what would you think? Do you think that is a practice we, ourselves, living the noble lives of the good citizens of the Great Society, ought to adopt as our own and that of [y]our future children?
  12. If we didn’t circumcise children, do you think we would have circumcised adults?

 

Essays of possible interest

  1. Male circumcision
  2. Female genital alteration: a compromise solution
  3. Female genital mutilation and male circumcision: toward an autonomy-based ethical framework
  4. Rationalising circumcision: from tradition to fashion, from public health to individual freedom
  5. Current medical evidence supports male circumcision
  6. Circumcision: case against surgery without medical indication