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Iceland is considering becoming the first country in the world to ban infant circumcision, the practice of removing a newborn’s foreskin f […]
Thank you, Rebecca! When I was doing my Family Practice residency, we were told we had to learn the techniques of circumcision, even if we did not intend to perform the practice after graduation. “Well”, I said, “How on Earth can I learn the technique without doing it?” You can’t, I was told. “Forget it”, I said. There was a stink, policy was changed, and to this day I have not performed one (and never will, unless medically necessary).
Did routine male circumcision ever catch on in Iceland? The US situation had nothing to do with Judaism or Islam, rather with frantic anti-masturbation crusades by John Harvey Kellog etc.
Jewish circumcision is outside medical control, and is demanded in the first few days or weeks of a boy’s life. I believe there are active Jewish anti-circ groups around already. It shouldn’t be such a huge issue for people who want real reform. My stepson’s mother kept him intact, and his, at least cultural, Judaism has never been in doubt.
And, how did you cover this topic without mentioning Islam? There are hundreds, maybe thousands, of Muslim boys getting cut for every Jewish boy. Though not with the pressure to do it on any particular schedule.
This is an ethically fascinating topic.
According to all the usual principles of medical ethics, permanently changing an infant’s body, in a way that will influence it throughout life, before it can give consent, is highly dubious.It is, some claim, a breach of the child’s human rights. My gut feeling is that this is wrong; my instinct, like (I think) Everington’s, is that it is right to ban circumcision.
However, we do also allow parents to make any other decisions for their children, in what they perceive as the child’s best interests. The case they put forward for circumcision is (often) that without circumcision, the child will not feel or be, properly, a part of the community; and/or that it is important for the child’s spiritual welfare.
These are not medical rationales; but I’m not sure that, as doctors, we are entitled to dismiss them.
Some also put a medical case for circumcision, citing evidence that in sub-Saharan Africa, circumcision may be associated with a reduced rate of HIV and other infections. I am not particularly impressed by these studies – partly because I am not confident that they are generalizable from African to US/UK populations; also because I suspect they may have been done with the intent of finding benefits to justify circumcision. However, perhaps my reservations reflect my prejudices rather than the realities.
Climbing down from the ivory tower, however, male circumcision is extremely widely practices, and a matter of huge importance to people of faith from a number of religions. While, as an atheist, I find this bewildering, I cannot deny that this is genuinely important to many people.
I note that in some cultures religious practices previously considered essential have changed and, over a generation or two, this has ceased to be felt to matter – cannibalism in pacific island cultures, for example.
There are small pressure groups – men who believe that they have harmed or suffered from non-therapeutic circumcision; and there are some well-established (and very serious, some fatal) complications of this practice (especially some ritual forms of circumcision).
However, I fear that any such ban on “human rights” grounds may not be acceptable in a UK population – too many people would object, and there are too many circumcised men who believe it has done them good, and no harm.
I think it may be “right”, all things being equal, to ban non-therapeutic circumcision; but I’m not entirely convinced.
And, on pragmatic grounds, this is not a battle that I would choose to fight at present.
A few non-systematically selected citations from my bibliographic database:
Baeten JM, Celum C, Coates TJ. Male circumcision and HIV risks and benefits for women. Lancet 2009;374(9685):182-184 (http://www.sciencedirect.com/science/article/B6T1B-4WSHMKY-4/2/066772de35db4833316d19e37beffc8e).
Lu B, Wu Y, Nielson CM, Flores R, Abrahamsen M, Papenfuss M, et al. Factors Associated with Acquisition and Clearance of Human Papillomavirus Infection in a Cohort of US Men: A Prospective Study. J Infect Dis 2009;199(3):362-371, DOI: doi:10.1086/596050 (http://www.journals.uchicago.edu/doi/abs/10.1086/596050).
Gray RH, Wawer MJ, Serwadda D, Kigozi G. The Role of Male Circumcision in the Prevention of Human Papillomavirus and HIV Infection. J Infect Dis 2009;199(1):1-3, DOI: doi:10.1086/595568 (http://www.journals.uchicago.edu/doi/abs/10.1086/595568).
Gray RH, Serwadda D, Kong X, Makumbi F, Kigozi G, Gravitt PE, et al. Male Circumcision Decreases Acquisition and Increases Clearance of High-Risk Human Papillomavirus in HIV-Negative Men: A Randomized Trial in Rakai, Uganda. J Infect Dis 2010 PMID: 20370483, DOI: 10.1086/652184 (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=20370483)
Svoboda JS, Van Howe RS, Dwyer JG. Informed Consent for Neonatal Circumcision: An Ethical and Legal Conundrum: William & Mary Law School Scholarship Repository, 2000; (http://scholarship.law.wm.edu/cgi/viewcontent.cgi?article=1166&context=facpubs).
Male circumcision. Pediatrics 2012;130(3):e756-85 PMID: 22926175.
Circumcision policy statement. Pediatrics 2012;130(3):585-6 PMID: 22926180.
Lerman SE, Liao JC. Neonatal circumcision. Pediatr Clin North Am 2001;48(6):1539-57 PMID: 1173212
Moses S, Bailey RC, Ronald AR. Male circumcision: assessment of health benefits and risks. Sex Transm Infect 1998;74(5):368-73 PMID: 10195035.
Ungar-Sargon E. On the impermissibility of infant male circumcision: a response to Mazor (2013). J Med Ethics 2013 PMID: 24014632, DOI: 10.1136/medethics-2013-101598 (http://jme.bmj.com/content/early/2013/09/06/medethics-2013-101598.full).
Prodger JL, Hirbod T, Gray R, Kigozi G, Nalugoda F, Galiwango R, et al. HIV Infection in Uncircumcised Men Is Associated With Altered CD8 T-cell Function But Normal CD4 T-cell Numbers in the Foreskin. J Infect Dis 2014;209(8):1185-1194, DOI: 10.1093/infdis/jit644 (http://jid.oxfordjournals.org/content/209/8/1185.abstract).
Earp BD. In defence of genital autonomy for children. J Med Ethics 2016;42(3):158-63 PMID: 26792817, DOI: 10.1136/medethics-2015-103030 (http://jme.bmj.com/content/42/3/158.long).
Tangent: occasionally well known sci if authors will have a character go off on a quick screed about some moral issue.
In 3001: A space Odyssey, the main character hooks up with a woman, and she goes off on how they can’t actually have sex because he is mutilated.
Always amused me, and less offensive than the random gay guy talking about how glad he was he married a woman and had kids in one of the Bean sequels to Enders Game.
What I have trouble getting my head around is the fact that somewhere, several thousands of years ago some twisted thinking person did this for the first time …