Brief synopsis: Male circumcision has been brought to the media and public spot light after a 4 year old boy from Turkish (Muslim) parents had to take him back to hospital because of repeated bleeding. The hospital decided to report the matter to the authorities and we had a trial in Cologne, Germany. The German court outlawed the practice in Cologne on the grounds that the child’s right to bodily integrity had been violated for non-medical reasons and the religious rights of the parents had not been severely compromised.. As a consequence the availability of circumcision in hospitals in Germany has withdrawn because surgeons want to avoid the possibility of legal action being taken against them. Religious groups were up in arms about their rights to carry on their religious traditions being compromised and Chancellor Merkel has stepped in and promised to take action from above so there may be a new parliamentary ruling that decides against the court ruling. [21st July 2012]
It has all got a bit heated and an influx of poor reasoning to justify what has been, until very recently, assumed to be kosher or morally unproblematic. Giles Fraser is perhaps a good example of the poor quality of reasoning this topic tends to generate in his attempt to justify male circumcision. Giles has tried to defend circumcision on the grounds that:
circumcision is the way Jewish and Muslim men are marked out as being involved in a reality greater than themselves.
Male circumcision is a way of marking one out as being involved in a transcendental reality of some sort but does this make it fine? It should be patently obvious to any self-reflecting adult (Giles Fraser I hope is included) that there are numerous cultural practices that mark one out as being involved in a “reality greater than themselves” including the ritual of child slaughter (still carried out in some Hindu sects), stoning of adulterers, selling children into slavery, that are not morally justified. The defenders of male circumcision, female genital mutilation, child slavery, have to do better than this.
We get a better picture of the debate if we return to the courts decision in Cologne. Here we see that there were 2 primary conflicting factors:
1:) The right of the child to bodily integrity i.e., not to have invasive surgery for non-medical reasons when no medical benefit would be likely to accrue. This is the same rationale that underlies female circumcision or more aptly genital mutilation.
We should note here that every surgical operation carries with it risks, even if the risks are low, it is still better to avoid taking a risk when there is not much chance of benefit.
2) The right of the parents to give their child a religious upbringing.
2 is defended in the UN right to religious freedom so it is not something that should be dismissed but it is not something that entitles causing significant harm to others.
I will briefly mention a third factor that seems erroneous.
3) The court claimed that the child’s right to determine whether it wanted to belong to a religion or not was violated by the circumcision since this operation is permanent (apparently there is no growing it back). However this seems to be inaccurate as there are no religions that require you to have a full foreskin (I have tried a few) and it is not a requirement for being an atheist. What should be emphasised is that this operation leaves a permanent scarring – it is the mark of a religious ritual but it does not determine one’s religious identity.
Since most of the debate to date has conflated two distinct questions, I think it is worth drawing attention to them:
A) Are parents morally justified in having their infants operated on for non-medical reasons, when in so doing the infants are harmed, and have healthy tissue permanently removed?
B) Should the state propose legal strictures and outlaw male circumcision?
The considerations against parents being morally justified in having healthy parts of their infants body removed are:
i) The general medical advice which claims that the risks incurred from male circumcision outweigh any potential benefits. This is why the practice is not generally available here on the NHS. So if the medical consequences of the practice involve more risks than benefits then the practice is not morally justified. We could put this more concretely as – we know there are known harms/risks but we do not know what (if any) the benefits of the procedure are.
ii) The permanent scarring of the male penis that involves a physical and psychological harm (the loss of a healthy bodily part and the experience of pain) and this harm takes place without consent when it could take place at a later date with consent.
In criticism of A defenders of male circumcision sometimes make the mistake of appealing to the long standing of the tradition like Giles Fraser as if this alone were enough to morally legitimise the practice. The examples of female genital mutilation and others show it is not.
The best tactic to defend male circumcision is to play down any of the harms that critics of male circumcision cite and in this respect draw a difference between male and female circumcision or mutilation. So whilst female genital circumcision or mutilation has many health costs and little if any benefits (acceptance within one’s culture that practices this being the only one) male circumcision has little costs when carried out professionally.
However regardless of whether the risks are small, if the medical benefits are smaller in comparison then this tactic will fail. Basically if the risks of performing the practice outweigh the benefits as general medical practitioners claim then the procedure will subject a child to unnecessary risks and hence will not be morally justified. It is not morally defensible to subject a child to unnecessary risks. However where these risks are small this does not entail that the practice be legislated against. A and B are distinct and a separate argument is required to move from A to B.
So what does all this mean? Where male circumcision involves an operation that involves harm, permanent marking, without consent and the medical risks outweigh the benefits then it is not morally justified. The practice may be part of a long standing religious tradition but being such does not make it morally permissible to expose infants to unnecessary harms.
However this does not entail that the practice should be made illegal. It is possible that some leeway should be given for parents to make their own moral choices even if this entails that they create unnecessary risks for their children. So long as the risks are small we may think that they are morally impermissible but legally permissible. The law need not be changed at whim where only minor harms are occurring.
CF: See Male Circumcision – The argument against legislation
There is a backdrop of medical studies on male circumcision.
On the one hand there are studies that claim evidence that circumcision reduces the risk of sexually transmitted infections such as HIV although the data may not be that strong. Meta-analysis of such trials suggest the effectiveness of circumcision is low. We should also bear in mind that circumcision is never as good as safe sexual practices such as wearing a condom, or maintaining one sexual partner at a time, or washing your penis regularly! In fact in the African studies subjects thought that circumcision meant that they did not have to take precautions like the above any more.
On the other hand there are studies that claim that circumcision is more likely to cause erectile dysfunction in older adults and there are cases of circumcisions causing profuse bleeding, scarring and other complications, including loss of penis and death! These risks are rare but still need to be factored.
There is an additional problem with citing such data as an argument in favour of male circumcision is that infants are not at risk from sexually transmitted diseases – on account of not engaging in such practices. So if there were clear benefits from circumcision they could be voluntarily chosen later in life rather than forced. Consent being a good making feature when considering important components of ourselves like our genitalia.
But whilst consent is clearly a good making feature when it comes to what happens to intimate parts of ourselves there is an additional complication in that male circumcision later in life is held to be more complicated than infants.
I am informed that in the US circumcision is carried out on approx 20% of infants (pharmaceutical companies also buy the foreskins at something like $300 dollars a piece for use in cosmetic products). In N.Europe the rate of circumcision is far smaller. However the rate of sexually transmitted diseases among men in the US is far higher than in N.Europe. So perhaps myths about circumcision such as thinking that you are less at risk from sexually transmitted infections promote more risky sexual behaviour, and as a consequence circumcision has the opposite effect?
This should at least cause us to pause before concluding that circumcision is a good way of reducing your risk of sexually transmitted infections!
Corneila Koch at Adeliade Law School in Australia presents a stronger view than I have here and argues that it is time to outlaw the practice in Australia:
…[A] procedure which started in Australia for dubious medical reasons (that it could prevent masturbation, syphilis etc) and then became culturally entrenched should not be continued simply because it has become part of mainstream culture. Most medical bodies in Western countries including Australia now agree that it is medically more risky to have a circumcision than not to have one. We should take a long, hard look at allowing parents to determine that their boys should be circumcised for no convincing rational reasons. There appears to be a societal change in Australia as the rate of circumcision is in decline. It may be time for the law to catch up and prohibit male circumcision unless it is required for pressing medical reasons, or is performed on a consenting adult. This would bring the law in line with current medical knowledge. Laws should not be based on overcome cultural ideals, particularly when it comes to the protection of the bodily integrity of a very young person.”
Brian Earp also argues for a stronger view at the Practical Ethics blog here