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Journal of Medical Ethics – Special Issue on Circumcision

19 Mar, 13 | by BMJ

Guest Post by Brian Earp

The Journal of Medical Ethics is pleased to announce the forthcoming release of a special issue – “The Ethics of Male Circumcision”  – to be published in full in the coming days.  Selected papers have already been posted Online First and can be seen by clicking here. Contributions cover a wide range of perspectives, and were invited from leading legal scholars, bioethicists, political theorists, pediatricians, and medical historians with expertise in this area. All essays were subjected to rigorous peer review. A list of main contributors and highlights from the arguments showcased in this Special Issue can be found below.

Background

Recent events have re-ignited controversy around the oft-debated issue of the moral and legal permissibility of infant male circumcision.

According to a recent German court ruling, circumcising minors on religious grounds amounts to grievous bodily harm.  The court held that children have fundamental rights to bodily integrity and self-determination that cannot be outweighed by the right of parents to practice their religion and raise their children as they see fit. German chancellor Angela Merkel suggested that the ruling was an affront to religious liberty, while anti-circumcision groups as well as a number of ethicists hailed it as a victory for child rights.  In December of 2012, the German parliament passed a law to protect religious circumcision from future legal threats.

Meanwhile, in New York City, health officials recently succeeded in enacting a consent form requirement for circumcision after it was revealed that dozens of infants have contracted herpes in the last decade from a form of the surgery practiced by some Orthodox Jews. This form, called  , involves the sucking of blood directly off of the infant’s penis. Disagreements about the relative importance of religious tradition versus health concerns have shaped the ensuing controversy there.

Finally, in late summer of 2012, the American Academy of Pediatrics (AAP) issued a new circumcision policy statement and technical report, in which the child health organization suggested that the possible health benefits of circumcision outweigh the risks and complications.  This pronouncement was cited favourably by some commentators, while other groups, such as Doctors Opposing Circumcision, issued harsh criticisms.  The Journal of Medical Ethics announces today that it is hosting a continuation of this debate in the pages of its Special Issue, publishing a further critique of the AAP report and policy statement, alongside a formal reply by the AAP.

Ethical issues

Given the controversy following the Cologne ruling mentioned above, as well as the discussion surrounding metzitzah b’peh in New York City, the main focus of the Special Issue on circumcision is on religiously-motivated forms of the procedure, although “health benefits” and secular circumcisions as performed in the United States are also addressed.

Justifications for ritual circumcision are sometimes given in terms of parental rights or religious freedoms.  Of course, few would argue that parental rights – religious or otherwise – are boundless.  Parents may not, for example, withhold life-saving medical care from their children, whether on the basis of their spiritual beliefs or for other reasons.  The question, then, is not whether a court or legislature may ever justifiably prohibit, restrict, or regulate a religious- or culturally-motivated practice, but under what conditions it may do so, for which reasons, concerning which practices, on what legal, ethical, or health grounds, and so on.

A 2004 symposium on circumcision in the Journal of Medical Ethics covered a wide array of issues, ranging from health justifications for the procedure to professional guidelines for medical practitioners.  For this new symposium, we welcomed in particular papers that sought to address the ways in which medical harm and benefit are weighed against the array of non-medical goods and harms associated with the practice of male infant circumcision.  We invited submissions from both religious and secular perspectives which we think will move the conversation forward, both in favor of and opposed to the position that non-therapeutic circumcision is either morally permissible or legally tolerable in pluralistic, contemporary societies.

Highlights

  • A defence of circumcision by political theorist Joseph Mazor.  Mazor argues that appeals to parental rights and religious freedom are not necessary to show that infant male circumcision is morally permissible.  Instead, Mazor proposes that the best interests of the child himself, especially if the child is being raised in a religious environment, can reasonably serve to justify the procedure in most cases.
  • Bioethicist Dena Davis suggests that it may be time to re-open the conversation on the most mild forms of female genital cutting, on the assumption that analogous interventions on infant male genitals might also be justified.  However, Davis shows concern about the metzitzah b’peh form of circumcision in particular, asking whether the risk of harm to the child (i.e., transmission of herpes) is consistent with other tolerated risks.
  • Political scientist Matthew Johnson argues that religious circumcision should be permitted in secular, multi-cultural societies, but that religious groups must “bear the burden and consequences of belief” and that mechanisms should be put in place so that children who are harmed by, or come to resent, their circumcisions can raise a complaint and seek damages against the community.
  • Medical historian Robert Darby assesses the narrow question of whether the principle of the child’s right to an open future applies to non-therapeutic, infant male circumcision.  By drawing analogies with the case of “designer deafness” (in which deaf parents deliberately seek to have children with diminished sensory capacity), Darby argues that circumcision is indeed in violation of this principle, and hence is objectionable from an ethical and human rights perspective.
  • The Israeli philosopher Hanoch Ben Yami sees religious circumcision as a barbaric custom, rooted in superstition and a pre-Enlightenment worldview.  However, he argues that to ban circumcisions outright would bring about more harm than good, and proposes instead a series of gradual reforms, including the prohibition of metzitzah b’peh, mandatory anaesthesia, and age limits on when the procedure can be performed.
  • Pediatrician Robert Van Howe considers the normative basis of the doctrine of parental rights—sometimes used to justify circumcisions in both the secular and religious case—and argues that parental rights are a “dead dogma” that have outlived their usefulness for conceptualizing the relationship between parents and their children. Instead of rights, Van Howe suggests that parents have an obligation to preserve and protect their children’s rights, including those of bodily integrity and the preservation of an open future.
  • Human rights lawyer J. Steven Svoboda goes a step further and argues that circumcision is a clear-cut human rights violation, whether it is performed on boys or girls, and whether for religious or secular reasons.  Surveying the basis of human rights law in Western societies, Svoboda shows that circumcision may be considered inconsistent with the most widely accepted interpretations of key human rights documents, including the Universal Declaration of Human Rights and the United Nations Convention on the Rights of the Child.
  • Leading German legal scholars Reinhold Merkel and Holm Putzke provide an in-depth analysis of the now-notorious Cologne court ruling, and criticize the normative foundation of the later law passed by the German legislature to enshrine a religious right to circumcise.  Merkel and Putzke also point out a number of troubling internal inconsistencies in the new law, and suggest that these inconsistencies are emblematic of the sorts of logical difficulties any circumcision-protecting law is bound to face in Western constitutional democracies.
  • The Special Issue will also include two editorials, one by Julian Savulescu, Editor-in-Chief of the Journal of Medical Ethics, and one by Brian D. Earp, Guest Associate Editor of the Journal of Medical Ethics.  Associate Editor of the Journal of Medical Ethics Bennett Foddy will provide the “concise argument” summarizing and analyzing the entire issue.  Additional commentaries have been invited from the philosophers David Benatar and David P. Lang, and will be published following internal peer review.  Be sure to keep an eye on this Journal of Medical Ethics Blog for further announcements, additional postings on this topic, and any updates on the Special Issue.
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  • Kevin Elks

    As a victim of this type of sexual abuse as a baby, I had to live all my long life bearing the consequences to something that as an adult I would not have consented. As far as I am concerned I was abused as a child and also abused as an adult. This sexual abuse was the catalist of the ruination of my life, even (as I now know) being turned into a timmid wretch of a child that seriously contemplated suicide at a very young age. An adult cannot have human rights if as a child those rights are taken away by paedophiles that children should be protected from.

    It beggars belief that in a so called civilised society we allow these vile crimes to go unpunished.

    I feel so strongly about this I would (if I had the power) declare open hunting season on those that sexually mutilate children.

    Kevin Elks, Dover, Kent, England.

  • http://www.youtube.com/user/whatUneverknew Aubrey Terron

    Looking forward to this professional challenge to an unethical and archaic position on circumcision. Americans apparently need the sane rest of the world to hold them accountable for their lack of ethics and shoddy objectivity.

  • professormorris

    It seems quite illogical that a simple intervention in infancy that has such enormous health benefits and no adverse effect on sexual function or pleasure has detractors, when a common, painful, expensive cosmetic intervention having no medical benefit — i.e., orthodontics — is applauded by society. I approve of both, despite the pain to my hip pocket from the astronomical fees charged by the orthodontist for my kids. One has to ask what the real motive is behind the fervent opposition to childhood male circumcision (and vaccination) by certain individuals. Prof Brian Morris, School of Medical Sciences, University of Sydney.

  • Ron Dempsey

    The above article rightly appears in a journal of medical ethics because, as evidenced by both the AAP statement and Brian Morris’ comment, medical personnel pay little to no attention to ethical or human rights issues when they discuss infant circumcision. They seek to hide behind what they describe as “evidence based science’ while ignoring what are even more crucial elements in the discussion. Is it ethical, in the absence of any disease or deformity, to remove perfectly healthy genital issue from a minor who, for all anyone knows, would rather retain that particular sensitive body part when he grows up to adulthood? What adult male wants to have less penis? If given a choice as an adults, how many men opt to have penile reduction surgery (circumcision)? Of the 70% to 80% of intact males in the world, far less than 1% ever need to be circumcised for any medical reason. And these intact males are not suffering any dire health consequences from retaining their foreskins. In fact, mortality statistics indicate that men in countries where circumcision is rare have longer life expectancies. Even if infant circumcision were a painless (it’s not) surgery with no possibility of complications (up to and including death), it is still unethical to perform unnecessary, elective surgery on a minor.

    Irrespective of how many potential medical benefits are claimed for circumcision, an ethical medical professional will recognize that he/she must not violate the most basic of human rights i.e. the right to bodily integrity, in the name of prevention of hypothetical diseases to which any given male may never be exposed. Doctors in every other western nation understand this issue and act accordingly. Only in the United States do doctors ignore medical ethics and human rights as they stubbornly seek to rehabilitate a surgery that was long ago abandoned by medical professionals worldwide.

  • http://twitter.com/TCullinsClark Traci Cullins-Clark

    This is an ethical issue that begs philosophical discussion. Personally, I can envision a parent’s quandry with circumcision. Professionally, the practice is a matter of preventive personal healthcare. I look forward to more discussion

  • KOTFrank

    Journal of Medical Ethics – Special Issue on Circumcision continues to be part of the medical institution’s lack of ethics by not tackling the most basic inquiry, is circumcision medically necessary to infants and to all children, male, female, and intersex? How about applying equal standards and research to all because so far females are being shorted equal respect and concern? How and why would a medical ethics journal be concerning itself only with males, without first looking at the benefits for all children. Wouldn’t this be ethical? Shouldn’t the starting point be covering the medical aspect? Instead of focusing on the religious implications above all else, well you may as well call this the Journal of Religious Ethics (or would that be morals?). Of what concern is religion to an infant? What other invasive procedures are done to infants? Isn’t there a law that prohibits any adult from applying their mouth to a child’s genitals or anus with no exceptions? Does a consent form now bypass such laws? Where’s is the lifetime satisfaction guarantee for recipients? Who backs and makes good this guarantee?

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