Is Circumcision Ethical?

I. Introduction

The term “ethics” has esoteric meanings in the fields of law, medicine, philosophy, science, and others. In answering the question of whether circumcision is ethical, it would behoove us to focus on the meaning of “ethics” in everyday life. In normal parlance, ethics simply means: doing what is right, living by the golden rule of “do unto others as you would have them do unto you,” not causing harm to the innocent In this essay, I will argue that, based on this definition of ethics, circumcision of non consenting minors is unethical. I base my conclusion on several, but certainly not all, of the ethical quandaries implicated by infant circumcision.

In this country, circumcisions are most commonly performed by physicians. Therefore, the first question before us is whether it is ethical for doctors to circumcise infant boys. In addition, there are parents who are aware of the reality behind circumcision and still choose it for their sons, or who submit their children to circumcision for religious reasons. Their decisions must also pass ethical scrutiny.

Circumcision was introduced into the United States as a means to curb masturbation. It has been marketed as a prophylactic for countless infirmities, such as penile and cervical cancer, poor hygiene, urinary tract infections, and HIV. None of the supposed “benefits” of circumcision has withstood scientific scrutiny, and the pattern seems to be that when one justification is disproved, another replaces it.

The American Academy of Pediatrics does not recommend routine circumcision. No medical association in existence deems circumcision medically necessary.

Circumcision involves the permanent amputation the foreskin, which is an erogenous sheath of skin that serves many essential functions. The foreskin covers the glans, and prevents bacteria from entering the urethra. The foreskin also keeps the glans moist and sensitive, and ensures proper sexual function. It is estimated that the foreskin contains 10,000 to 20,000 nerve endings. Circumcision is extremely painful. Most circumcisions in the United States are performed with either minimal or no anesthesia. he newborn boy is strapped down onto a bed called a Circumstraint. Because the foreskin is adherent to the glans during infancy, the foreskin must literally be torn off.

II. Informed Consent

If “ethics” means doing “the right thing” doctors should obtain consent for any procedure they perform. Consent to a medical procedure is only valid if it is “informed.” Doctors obtain in-formed consent if they openly disclose to a patient the benefits, risks, consequences, and alter-natives of any procedure they seek to perform. Deception or coercion negate informed consent.

Are doctors in fact obtaining informed consent from parents in regards to their sons’ circumci-sions? Often times, women “consent” to the circumcision immediately after having given birth, when they are still incapacitated from the trauma of delivery. Doctors rarely counsel expecting parents about circumcision in a manner that discloses the four elements that I have mentioned above. It is a rare case, indeed, when a parent is told what the foreskin is; what will happen to their baby during circumcision; and the loss of sensitivity, penile mobility, and protection that is a direct consequence of circumcision.

It is deceptive for nurses to tell parents that circumcision is quick and painless, that it is medically necessary, or that a circumcised penis is cleaner. It is coercive for aggressive doctors to pressure parents into circumcising their sons, or to make parents sign circumcision refusal forms, the latter creating the impression that not circumcising is tantamount to child neglect.

What would constitute informed consent for circumcision? Doctors should tell parents that the foreskin is an important part of the male anatomy, and educate parents about its function. After all, parents have the right to know what it is that they are considering amputating from their son. Doctors should mention not only the “benefits” of circumcision, but also the fact that the existence of these benefits is highly controversial. Although some hospitals do mention “risks,” this discussion seems to limit itself to those risks inherent in the procedure itself, such as bleed-ing, infection, and death. The life long consequences of circumcision must also be disclosed. Admittedly, the loss of sensitivity is still being debated. Nevertheless, it is a fact that the foreskin covers and protects the penis, and that a circumcised penis loses this protection. It is also a fact that a circumcised penis lacks the mobility of an intact penis. These consequences of circumci-sion should be candidly disclosed. Parents also have the right to know that their child will feel severe pain.

III. Is substitute consent valid?

Children do not consent to be circumcised. Instead, their parents consent on their behalf, using what can be called “substitute”consent. Can substitute consent be valid in light of the fact that circumcision is a medically unnecessary (and arguably harmful) procedure? If it is not, doctors are performing the procedure without consent, and are therefore acting unethically.

Some believe that parents should be given full control over their children’s bodies. This view-point sees children as property of their parents, and would give parents full authority to decide whether or not to submit their children to circumcision. In reality, however, some limits are placed on parental autonomy to avoid child abuse. One rule of thumb would require that, for “substitute” consent to be valid, a procedure must be in the child’s best interest.

One could argue that a procedure is in a child’s best interest if it provides him concrete medical benefit. But how do we define “benefit?” Using an overly broad definition opens the door to child abuse. Removing breasts of young girls would eradicate the possibility of breast cancer. Yet this would be considered abusive by many, because the preventive measure would be patently extreme. One way of properly defining “benefit” would be to require that a procedure pass a cost benefit test, in which the benefit gained by the procedure would outweigh any costs or harms caused by the procedure. Also, there would need to be a tight nexus between the proce-dure and the problem it sought to solve. In other words, the procedure would have to be highly successful at eliminating the problem it was meant to alleviate.

Circumcision fails this test. Let us assume for argument’s sake that circumcision has a slight prophylactic effect on cancer and urinary tract infections. Even so, these ailments can be pre-vented or cured much more conservatively. So the benefit of circumcision is eviscerated. The costs, however, remain substantial: severe pain, total loss of an important, functioning body part, and decreased penile flexibility. Also, the nexus between procedure and problem is weak. Unlike breast removal, which would have a virtually 100% success rate at eliminating breast cancer, circumcised men still get UTI’s, penile cancer, and HIV. The United States – with millions of circumcised men – is proof of this.

We must not deny that some parents, even when confronted with the facts regarding circumci-sion, still choose to circumcise their children to have them “look like their father.” Is it ethical for a parent to superimpose their aesthetic tastes on a child’s body in a way that is irreversible and arguably harmful? Circumcision is not like a parent choosing their children’s clothes, or the food they eat. If improper choices are made in these latter areas, they are reversible once the child reaches maturity and is independent. Hence, parents who submit their child to genital cutting to have him “look like his father” are acting unethically, because they have selfish rather than therapeutic intent.

Because parental “substitute consent” is not valid, doctors are performing circumcisions without consent. This is not “the right thing to do.” his is unethical.

IV. Religion and Equal Protection

Jewish and Muslim men are religiously commanded to circumcise their male children. This raises several concerns. Circumcision brands a child. What if he later wants to convert to a religion that condemns genital cutting? Or simply resents that an important part of his body was taken away from him to fulfill someone else’s religious pact? Also, his right to choose his own religion has been violated. Therefore, it is unethical for parents to submit their children to per-manent genital alteration based on religion.

Society as a whole must also question how to ethically deal with this dilemma. How do we as a nation deal with religious minorities who have practices that are arguably harmful to children? Must we protect the children or respect the parents’ religions?

Some have advocated banning circumcision but allowing a religious exemption for Jews and Muslims. I would argue that, in light of the total ban on female circumcision, doing this would run afoul of equal protection under the Constitution. Essentially, the exemption would create a situation where sons of Jews and Muslims would not be protected, whereas all females and non Jewish/Muslim males would be protected. Sons of Jews and Muslims would be doubly discriminated against. They would suffer religious, and in the case of Jews, ethnic discrimina-tion. (Were they non Jewish/Muslim they would be protected). They would also suffer sex dis-crimination – for where they born female they would be protected regardless of their parents’ religion. Allowing this kind of disparate treatment would be unethical of society.

V. Conclusion

In this paper, I have argued that circumcision is unethical, because it violates the dictum of “do the right thing.” It is unethical for doctors, because they are not, and cannot, obtain valid con-sent. It is unethical for parents to harm their child to make him “look like his father.” It is un-ethical for parents to use their children’s body to fulfill the parents’ religious obligations. And it is unethical for society to protect girls from genital mutilation, while not offering boys this same protection. How can advocates of children’s rights bring an end to circumcision in America?

The genital integrity movement has made great strides in the last few decades by acting in a multi faceted fashion. Advocates have been educating the general public – person to person – about the truth regarding infant circumcision. They have been lobbying both state governments and insurance companies to end coverage for circumcision. Recently, there have been a growing number of lawsuits brought against physicians by parents who were not given complete informa-tion when they agreed to their son’s circumcision. Lawsuits are also being brought by the grown children themselves. It is only a matter of time before constitutional equal protection claims appear in the United States.

The genital integrity movement has also reached out to the medical community. Realizing that some doctors are innocently ignorant about the value of the foreskin, children’s advocates have begun educating doctors, so that the latter can give correct and complete information to parents. We must continue making physicians our allies in the advocacy of children’s rights.

But the most important thing that the genital integrity movement must do is to change the American culture. Lawsuits will not be won, insurance coverage will not end, and equal protec-tion will not be obtained if the current cultural bias that ignores the immorality of male circumci-sion continues. The movement must also anticipate resistance from the religions that support circumcision. Child advocates who belong to those religions should work tirelessly from within to make those religions more foreskin friendly, and to help adherents of those religions realize that protecting baby boys from genital mutilation is pro Jewish and pro Muslim.

To be sure, bringing about a cultural shift will be no easy feat. But focusing on ethics, as the term is used in daily parlance, will serve the purposes of the genital integrity movement well. The average person can understand that strapping a baby down and tearing off an important part of his body, without medical justification, is wrong. We must continue persuading the general public about the correctness of our views on the medical issues surrounding circumcision that it is unnecessary and harmful. And we must also strive to bring about the day when the word “circumcision” elicits a reaction of repulsion and disgust in the general public.