Circumcision Ethics

The simple case against circumcision says the procedure harms children (since the costs exceed the benefits), and parents shouldn't harm their children.  To make this case, you've got to stress the pain of the procedure plus the lost sensitivity. And then compare the benefits: lower risk of various problems, advantages of conformity (if most other boys are circumcised), etc.  This is a tricky calculation, so it's understandable that some opponents of circumcision would want to go another route.

The open future of an uncircumcised boy
For example, in a recent issue of the Journal of Medical Ethics, Robert Darby says circumcision violates a boy's right to an open future.  In other words, boys shouldn't be preempted from making this choice for themselves when they're older.  But why must they make this particular choice for themselves?  In Joel Feinberg's seminal article on this right, he doesn't just hold up an open future as a self-evident good (because the more possible futures the better), but says an open future is good because "self-fulfillment" requires making your own choices.  I find that term rather opaque, but "self-fulfillment" is basically "self-actualization," or "becoming who you are," in Nietzsche's phrase.  If your parents choose your career for you at age 10, you may wind up a lawyer when the real you is a doctor.  Using that reasoning in the present context, the opponent of circumcision has to say newborn circumcision can stop a boy from coming into his real self--if it so happens it would have been truer to the boy's self to have his foreskin.  

A compelling argument? I can certainly see that newborn surgeries sometimes conflict with later self-fulfillment--for example, in the case of female "circumcision" and surgery for inter-sex states.  But is it really self-defining to have or lack a foreskin?  For the vast majority of men, I would think not.

Perhaps the best case against circumcision simply has to do with sovereignty and self-determination, where the body is concerned.  My body is my birthright, not to be irreversibly tampered with except in cases of true medical necessity.  It may not be terribly harmful to circumcise and may not get in the way of self-actualization, but it's an intrusion upon the boy's private territory, without a good enough reason.  When all is said and done, this is the thought I find most compelling.


Anonymous said...

How about the strapped to a board part, and screaming and writhing in ungodly pain? How about the very real risk of penile amputation? Do quick search for the boy in Pittsburgh who just had his penis cut off, and almost bled to death. It just happened.



Rhys said...

I think you're right that self determination is the best argument against infant circumcision. However, I think that's at least somewhat contingent on foreskin having advantages and circumcision having disadvantages (which I think is the case). If circumcision had nothing but benefits and foreskin was nothing but a burden -- and everyone agreed on this -- then I would see no reason why a commitment to self-determination should get in the way of making an inevitable procedure more tolerable by doing it involuntarily at a younger age.

But since that's not the case, and there are in fact multiple costs and benefits to weigh, it makes sense to leave that decision up to the person most affected by it. Some people who aren't circumcised will wish they had been circumcised as a child, but it is technically possible for them to be circumcised as adults if that's what they really want. The reversal is not true for those who were circumcised and wished they hadn't been.

Wayne said...

Its strange to say its self-determination here, since children typically aren't given autonomous rights. We make medical decisions for children, and we don't typically think its wrong for us to wait, even if waiting is a plausible option like in vaccinations. In fact the vaccination analogy is a pretty good analogy for the stated benefits of circumcision.

So I think there is some benefit to talking about open future of boys, rather than to talk about their autonomy. If its just autonomy, then we have legitimate rights to over-ride autonomy considerations when it comes to children and infants.

Rhys said...

There seem to be some significant differences between vaccination and circumcision. For one thing, vaccinations are more obviously beneficial, and what are the downsides of them? As far as I am aware, vaccines are basically pure benefit and no harm, which isn't true for circumcision. I thought this article by a relatively neutral physician reviewing the latest study on circumcision was informative:


The best medical reason he could see for circumcising was to prevent UTIs in boys and men, but he didn't think this was a good enough reason for routine circumcision: "However, while circumcision will lower risk of UTIs (I have never personally treated a circumcised male for one), the number of circumcisions needed to prevent a single UTI has been calculated as 111. Given that the vast majority of these infections are uncomplicated and easily treated, I do not look on those numbers as an unambiguous reason to recommend the procedure."

As far as penile cancer, he says it would take over 900 circumcisions to prevent a single case. Circumcision might also help avoid prostate cancer, but the science on that still seems unclear. The rest of the medical benefits apparently have to do with STDs that vaccines and safe sex can prevent. Aside from UTIs, foreskin risks mainly lurk in adulthood. So why not let men decide to get circumcised as adults if they want, as some men in some African countries are doing now?

Does anyone who was vaccinated as a child wish they were unvaccinated? Maybe so, but there's good reason to believe that waiting to vaccinate them until they could consent might have seriously harmed them. Are there men who are circumcised and wish they weren't? Yes, and it's not clear that waiting to circumcise them until they were old enough to choose it for themselves harmed them other than the harm of the the procedure itself, which they would have endured as a baby anyway. (Aside from any additional risks that having a foreskin entails, which they would be tacitly accepting if informed about them as an adult.) Most men in Europe, South America and Eastern Asia are not circumcised. I don't think this has caused any apparent health crisis like we might expect to see in countries that didn't vaccinate.

Since it is the case that it's easier to circumcise than to uncircumcise, and it's also the case that many men who are circumcised wish they weren't even if they are informed of the potential risks of foreskin, why the rush to circumcise as a baby? That makes sense with vaccines, where the risk vs. benefit is clearly in vaccines' favor, and they are preventing diseases that can be caught before the age of consent. I don't think the argument works as well for infant circumcision.

Aeolus said...

Re. the analogy with vaccination: Presumably in many parts of Africa, because of the risk of HIV/AIDS, it would be irresponsible of parents NOT to opt for circumcision.

TLC Tugger said...

But any medical intervention can be ethically forced upon a child only if waiting for their informed input and consent would lead to harm and when less destructive options are exhausted. Circumcision of children fails this test decidedly.

Circumcision alters sex dramatically. Foreskin feels REALLY good.

Jean Kazez said...

Anonymous, Thanks for the mention of the Pittsburgh case. That was useful to me in the class I'm teaching--where we're discussing circumcision ethics.

The third approach I'm suggesting would be more easily stated if I just said people own their body parts. In that case, parents would have to have not just a pretty good reason to circumcise (benefits a little greater than costs), but an overwhelmingly good reason. Circumcision would be different from vaccination, because it takes away a body part and vaccination doesn't.

Instead of putting it in this simple way, I talked about "intrusion upon the boy's private territory" and "self-determination, where the body is concerned" because I am actually nervous about the idea of self-ownership. I don't know that a baby literally owns his foreskin but he has some sort of ownership-LIKE prima facie entitlement to it. No taking away irreplaceable bits and pieces of your child without abundantly good reasons. That's the idea--which isn't simply a claim about costs/benefits or the right to an open future.

Rhys said...

Now, is pre-sentience fetal circumcision okay since a fetus doesn't own his or her own life, much less his own foreskin? (If it were possible.)

If no one could possibly regret being foreskin-less later in life, but there was no good reason to circumcise either, I think it would be okay to circumcise (albeit pointless), since it would be totally neutral either way. The problem is not that circumcision is the removal of a body part, but that it's the removal of a body part that someone might later want. And since it's easier to remove it later than to get it back later - and since there aren't normally bad consequences to leaving it intact until the person born with foreskin is old enough to decide for himself whether to cut it or keep it - it just makes sense to leave it.

You don't have to see it as a human rights issue to side against circumcision for that reason. It's more like not circumcising is a safer bet for parents who don't want to harm or upset their children who could later grow up to have strong opinions about foreskin. In general, it's probably better to let people make their own irreversible decisions when they are the main party affected by the decisions. And if someone grows up to really really wish they had been circumcised, then they can be.

Deepak Shetty said...

advantages of conformity (if most other boys are circumcised), etc
Why is conformity in your calculations? By that logic everyone should follow the majority religion and all us vegetarians would have to start eating meat.

Craig Urias said...

Re conformity, I can understand the point. Until I was about nine I wasn't even aware of what circumcision was. I just thought some kids had a tragically deformed penis -- a birth defect, like a stump arm or leg or something. It was a great surprise to learn later that I was missing something, not them.

Elaine seems to have made a point about conformity.

I would be less upset if my parents chose circumcision for conformity reasons (which have some validity) instead of religious reasons (which have no validity).

Deepak Shetty said...

Since Im a minority living in the US think about what you are implying about how I should raise my children