How Not to Argue About Circumcision
David Benatar
University of Cape Town, South Africa
Michael Benatar
Harvard University, Boston, MA
3:2 Target Article author responds to Commentators
Benatar, M., and D. Benatar. 2003. {HYPERLINK
"http://www.ingentaselect.com/nw=1/rpsv/cgi-
bin/linker?ini=ajob&reqidx=/catchword/mitpress/15265161/v3n2/s16/p35"}
This only links to the abstract.
Between prophylaxis and child abuse: The ethics of neonatal male
circumcision The American Journal of Bioethics 3(2):35-48.
A target article can be expected to draw fire. As our Target Article,
"Between Prophylaxis and Child Abuse: The Ethics of Neonatal Male
Circumcision," defended an intermediate position on circumcision, one
would have expected the fire to come from two directions.
Why? If one defended an intermediate position on child sacrifice between compulsory and forbidden, that it was up to the parents, would one have expected much support?
However, the criticism was entirely one-sided. None of our
respondents were defenders of routine neonatal circumcision.
The Benetars do not define "routine". The above seems to assume the strong definition "without consulting the parents", rather than the commoner usage, "without medical indications".
By contrast, those who take circumcision to be mutilation and child
abuse were amply represented. There are a number of possible
explanations for this,
... the main one being that non-therapeutic circumcision is the status quo in the US, which they are defending. Another could be that infant circumcision is mutilation and child abuse (and hence totally unethical).
but one of these is that those who oppose circumcision are more vocal
because they have coalesced into an activist movement.
How so? Might not lonely voices in the wilderness be more vocal?
Although opponents of circumcision took aim at our arguments (or,
more likely, at our conclusion), they missed their mark by far. They
have given a fine display of how not to argue - about circumcision,
or anything else. Non-sequiturs, appeals to authority, anecdotes,
equivocations, question-begging, and many more such errors abound in
their replies.
Cut us some slack: we're not all professional ethicists. The article made a lot of Intactivists very angry because of its pro-circumcision bias. By lumping all opposing arguments together in this way, the Benetars commit the fallacy of "guilt by association" and can write off the good with the bad.
In our response, we shall highlight these and other
errors and show how these respondents have utterly failed to engage
our arguments.
Not all the commentators on our paper were critical of what we said.
Some treated our paper as a departure point for taking the issues
further. Rebecca Dresser, for example, shows how our analysis, which
maps out the realm of parental discretion, is also relevant to family
decisions for incompetent adults (Dresser 2003). Dena Davis extends
our treatment of cultural bias in attitudes to comparable male and
female genital cutting, with a discussion of the relevant United
States law (Davis 2003).
Interesting. And do the Benetars conclude that female genital cutting should be at the parents' discretion? If not, why not?
John Paul Slosar and Daniel O'Brien show how
our analysis is compatible with a Catholic perspective (Slosar and
O'Brien 2003).
...but incompatible with the offical Catholic position.
These, and some others, are all helpful contributions
to the discussion and we are grateful for them. Our focus, however,
will be on those respondents who disagreed with us.
Mutilation
Some of our respondents, in claiming that neonatal circumcision is
mutilation, make the very errors that we exposed in our original
paper. Petrina Fadel, for example, cites the American Heritage
Dictionary definition of "mutilate": "1. To cut off or destroy a limb
or essential part. 2. To render imperfect by excising or radically
altering a part" (Fadel, 2003, W-2). The connection between (a) this
definition and (b) what she then says is lost through circumcision,
is not made explicit. We assume she thinks that the removal of the
foreskin, which she calls "a protective and sexual organ",
...but which the Benetars make no attempt to demonstrate that it is not...
is the
cutting off of "an essential part" or the rendering "imperfect by
excising … a part". However, this begs the question. It assumes that
the foreskin is indeed an essential part and that excising it renders
the penis imperfect. Simply calling the foreskin a "protective and
sexual organ" is not a substitute for the careful analysis we
recommended and undertook regarding whether circumcision is
beneficial, harmful or neither.
So did they consider each of the functions of the foreskin? Did they refer to Taylor's paper on the ridged band? Apparently not.
For instance, as should be clear from the evidence we presented, it is far from clear that the foreskin "protects the sterile urinary tract environment" (Fadel 2003, W-2). There is some evidence that the foreskin may rather constitute a
modest threat to the sterility of that environment, as evidenced by
the slightly higher rates of urinary tract infection in the
uncircumcised. It is stunning that, in response to a careful
presentation and analysis of the evidence, this commentator believes
it will suffice simply to assert a contrary conclusion.
It is stunning that these ethicists think "some evidence" is sufficient to maintain a conclusion contrary to a fairly simple piece of physics: the foreskin acts as a flap valve to the urethra.
Both Michelle Mullen (2003) and J. Steven Svoboda (2003) take
exception to what we say, in our discussion of mutilation, about such
surgical procedures as breast reduction, liposuction and rhinoplasty.
They deny that these are analogous to infant circumcision because the
latter is performed without the patient's consent, whereas the former
cosmetic surgeries are performed with consent. This objection is off
the mark - not because these procedures are analogous with respect to
consent, but because the consent issue is entirely irrelevant to the
point we were making. We referred to breast reduction, liposuction
and rhinoplasty to illustrate the point that not every appearance-
altering surgery constitutes mutilation. Consent is irrelevant to
that (limited) point - unless one believes that all non-consensual
appearance-altering surgery constitutes mutilation.
Consent is certainly not irrelevant when the whole point of appearance-altering surgery is to improve the appearance from the point of view of the person on whom the surgery is being performed. A person on whom non-consensual breast reduction, liposuction or rhinoplasty was performed might very well consider the result to be mutilation, and who could gainsay them?
On this latter
view, reference to a lack of consent would have to be incorporated
into the definition of "mutilation". But this stipulation would
depart substantially from ordinary usage and would be susceptible to
counter-examples.
And if someone circumcised an adult with no medical indications and without their consent, anyone - especially the adult - would legitimately regard it as mutilation.
Michelle Mullen also takes exception to our reference to the
amputation of a gangrenous leg (2003). She denies that this is
analogous to circumcision because a gangrenous leg, unlike an
ordinary foreskin, is not healthy tissue. Here again, however, she is
inattentive to the particular point we were making. Our claim was
that disfiguring surgery can be morally justified even if it
constitutes mutilation.
So do they grant that circumcision is disfiguring surgery?
Thus, demonstrating that a procedure constitutes mutilation is
insufficient to show that it is morally wrong. Further argument is
necessary. Perhaps Dr. Mullen thinks that such an argument would
include a premise that all (non-consensual) disfiguring surgical
removal of healthy tissue is wrongful mutilation. But to this it
might reasonably be objected that if the disfiguring surgical removal
of healthy tissue were to bestow a net benefit on the person on whom
the procedure is performed, it is highly implausible to claim that
the mutilation is wrongful. Dr. Mullen may think that there can be no
such benefit, but that is a matter to be established by argument
rather than by stipulative definition.
It'd be interesting to see a case where a disfiguring, non-consensual surgical removal of healthy tissue from an adult was claimed to confer a net benefit and succeeded in court at being demonstrated to be non-wrongful. A circumcision under anaesthetic
during another operation to facilitate that operation might be a case
in point. Such a case happened in Louisiana in 2000.
Nicholas Lund-Molfese objects to the definition of "mutilation" that
we discussed. He takes that definition to be a "neutral physical
description devoid of ethical conclusions" and prefers instead a
value-laden definition, such that the word "mutilation" cannot be
employed except in cases where the referent is morally wrong (Lund-
Molfese 2003, 64). A few observations are in order here. First, the
definition of mutilation to which we referred was not entirely value-
neutral. It incorporated the notion of "disfigurement", which, we
noted, was value-laden. Second, value-laden definitions have their
advantages, but also their disadvantages. One of the latter, at least
where the relevant value is moral in nature, is that a moral judgment
has to be made before the definiendum can be used in reference to
some practice. Put another way, in the context of circumcision, a
morally value-laden definition of "mutilation" cannot be used in
reference to circumcision unless one has already established that
circumcision is wrong. To establish that circumcision is wrong, one
cannot simply describe circumcision as mutilation (which would be
circular).
Well the fact that an exactly parallel operation on females is called "mutilation" without controversy has some bearing. One might conclude is that the only reason male circumcision is not called "mutilation" is because it is already customary.
George Hill adopts a different approach. He says that the relevant
question is not whether circumcision is "mutilation", but whether
parents may decide to remove "extremely sensitive genital tissue from
an infant for any reason other than unquestionably urgent medical
necessity" (Hill 2003, W-1). We argued that the mutilation question
is indeed not the relevant one. And we agree with Dr Hill's
assessment of what the relevant question is. Unlike Dr Hill, however,
we do not think that merely asking the question constitutes an answer
to it. Our entire paper was devoted to considering the relevant
evidence and arguments that must be examined in order to answer the
question. Simply re-asking the question does not undermine the
outcome of that deliberative work.
The difference between the Benetars' and George Hill's approach to this question is that the Benetars regard the foreskin as being guilty until proved innocent, as having to prove its worth. There is certainly a prima facie case that the foreskin is "extremely sensitive genital tissue": it has been so considered for centuries in cultures where most men still have it.
One of our respondents, Wayne Hampton, makes the same sorts of errors
in speaking about "child abuse" as other respondents made in speaking
about mutilation. He says that "permanent injury is part of the
definition" of "child abuse" and that since circumcision involves
permanent injury, it constitutes child abuse (Hampton 2003, W-1).
However, not all permanent injuries inflicted on a child constitute
child abuse. If a child with a gangrenous foot has this limb
amputated, the surgeon inflicts a permanent injury on the child, but
it does not follow that the surgeon abused the child.
It is debatable whether the removal of a gangrenous foot constitutes "permanent injury" since the gangrene has already caused equivalent permanent injury and the amputation is only to prevent worse injury. An intact foreskin does not present anything like the same kind of threat as gangrene. The question is whether circumcision fits all the other elements of the definition of child abuse. It could be argued that child abuse differs from circumcision in its malicious intent - but some abusers, like all circumcisors, claim to be acting "for the child's own good".
This is because some injuries - damage to tissue - do not constitute
a harm, all things considered.
The Benetars proceed to beg the question that circumcision is one such injury - by failing to consider all things.
Informed consent
In our paper we considered (and rejected) the view that circumcision
must be wrong because it is a medically non-essential procedure to
which neonates are unable to consent. A number of our respondents
simply repeated this view without engaging or undermining the
arguments we advanced for its inadequacy. This is not progress, but
is instead reassertion.
For example, Paul Ford simply asserts that "surgery is impermissible
for incompetent patients unless it offers clear and significant net
medical benefits" (Ford 2003, W-1).
This is certainly true - or at least defensible - where adult patients are "incompetent".
Rio Cruz and colleagues are happy
merely to reassert that an "individual's right to bodily integrity"
may not be abridged unless there is "compelling, rational,
demonstrable benefit" (Cruz et al. 2003, W-1). These restatements of
the view we reject, ignore the arguments we provided for an
alternative view. We defended the view that parents have the right to
authorize some medical interventions for their children even in the
absence of clear and immediate medical necessity - generally, those
(possibly beneficial) medical interventions that are not clearly
harmful, particular if they yield some other (non-medical) benefit.
One assumption here is that all medical procedures (including circumcision) have only the beneficial effects claimed for them. It assumes that all circumcisions go according to (the doctors') plan. It ignores that the penis's owner may just prefer it to have been left whole. The Benetars are unquestioningly resistant to the idea that the foreskin has intrinsic merits and that replacing it with a ring of scar tissue necessarily creates a deficit.
Our argument invoked the analogy of vaccination which, where herd
immunity obtains,
Parents have no way of knowing whether "herd immunity obtains" when and where they are, but they do know that vaccination provides major benefit - signification protection from deadly diseases - overall. "Herd immunity" applies to circumcision only to the extent that circumcision protects against infectious diseases - a question the Benetars do not address. (Claims that circumcision protects against STDs have been disproved.)
does not clearly provide a benefit and does carry small but serious
risks to any individual child that is immunized.
Well, plenty of people maintain that vaccination is wrong. It is not a given that it is right. In any case, this is, as they admit, an analogy, which is only ever as good as the similarity of the things compared, and circumcision differs in many material ways from vaccination. Perhaps the greatest difference is that every vaccination is highly specific to a particular disease, while the benefits claimed for circumcision change with the phases of the moon.
Wayne Hampton denies that vaccination is analogous (Hampton 2003, W-2). First, he says, it constitutes a gain, rather than a loss. This claim is ambiguous. If by "gain" and "loss" are mean "benefit" and "harm", then his claim
begs the question. If, instead, he means literally an addition (of
biological material) and a loss (of genital tissue), then it may be
countered that this gain-loss distinction is morally uninteresting.
Poison may be added and malignancy may be removed. But gaining poison
is clearly morally worse than losing a malignancy. Clearly it is not
gain and loss but rather benefit and harm that are of interest.
However, nothing Wayne Hampton says undermines the analogy, in this
regard, between circumcision and vaccination.
They are being deliberately obtuse here. The old "circumcision ~ vaccination" line has been tried many times. Circumcision is unlike vaccination in permanently depriving the penis' owner of something he may well prefer to keep. That is what Hampton meant by "loss". (There is no "immunological integrity" movement.) The Benetars offer an analogy (foreskin ~ malignancy) but do nothing to back it up.
Steven Svoboda has different objections to the vaccination analogy.
First, he says, the public health benefits of circumcision are
"incomparably miniscule compared to" those of immunization (Svoboda
2003, 53). Here we see that Mr. Svoboda chooses to compare the public
health benefits of circumcision and immunization. Our analogy,
however, was between the individual health benefits of the two
interventions (because we were not defending routine neonatal male
circumcision).
It seems they are now using what should perhaps be called the "strong" definition of "routine" -
circumcision of all babies without regard to parental choice. It
might also be called "straw-man routine" because there is always
(since 1972) the pretence of informed consent.
The individual health benefits of neonatal circumcision are also miniscule compared to those of immunisation, because circumcision at its "best" confers only a statistically significant (i.e. reliably detectable in large samples) reduction in the rare ailments it claims to prevent, not "significant" as the term is ordinarily understood (readily detectable in individual cases).
More specifically, we compared the benefits of circumcision to an
individual with the benefits of immunization to an individual where
herd immunity obtains (and thus the public health benefit has already
been secured).
This seems to mean that where nobody in a region has a disease, vaccination against that disease does no good but no harm either, and they compare circumcision to this state of affairs. This is a most extraordinary way of arguing.
It is true that circumcision does differ from immunization, as he
says, in that "circumcision constitutes a much more serious invasion
of the individual's body" (53). However, two considerations are
relevant here. First, even if circumcision is more invasive than
vaccination,
IF? Removal of a substantial body of tissue is much more invasive than scratching the surface.
it does not follow that it is excessively invasive.
(Notice that a vaccination administered by injection is in turn more
invasive than an orally administered vaccination.)
(Notice that no vaccination, however delivered, is as invasive as circumcision.)
Second, the severity of this invasion has to be weighed against the potential
benefit, and the benefit of circumcision to an individual may be
greater than the benefit of immunization is to that individual where
herd immunity obtains.
This assumes that the invasion and loss of circumcision and immunisation are exactly equivalent.
Mr. Svoboda offers what he takes to be a better analogy to
circumcision - prophylactic double mastectomy of girls whose family
history suggests that they are at high risk for breast cancer (2003).
He argues that although such mastectomies would much more likely save
lives, nobody seriously suggests that such prophylactic surgery be
performed (on young girls). However, this analogy is not very
compelling. The psychological effects of performing double
mastectomies on girls would generally be considerably worse than (a)
performing this procedure on adult women; and (b) circumcising infant
males. Put another way, if one were to have prophylactic
mastectomies, most people would prefer to have them later in life,
What is the basis for this extraordinary claim? If many girls were mastectomised as neonates - and especially if most girls were - it can certainly be argued that there would be no psychological ill-effects. In this parallel universe, one can even imagine men going "Eeew! Gross!" at whole-breasted women.
whereas if one were to be circumcised most people would prefer to
have this done in the neonatal period.
The Benetars make this claim without evidence. Most intact men in the non-circumcising world would like to retain their complete penises for as long in their lives as possible.
Paul Ford correctly notes that "a neonate still has to develop his
own values and choices" (Ford 2003, 58) but seems to think that
because informed consent cannot be obtained from the neonate, non-
therapeutic circumcision must therefore be wrong.
Well it would certainly be wrong to perform a medical procedure with no therapeutic function on an adult who was temporarily incompetent to give informed consent, so it is hard to see how it can be right to do so to a child who will eventually be able to give it - or withhold it - after a longer time span.
But again, this simply constitutes an unsubstantiated rejection of a conclusion for which we argued - that parents may, subject to certain constraints, make decisions on behalf of their incompetent offspring.
Ah, good old "decisions for" where no decision needs to be made - as no decision is made in most of the developed world. What, one wonders, are the "certain constraints" that allow parents to remove part of the penis - but no other healthy body parts - from their incompetent offspring?
Wayne Hampton charges us with seeing "no value in a patient's
personal autonomy and freedom of choice" (Hampton 2003, W-1). But
this ignores the complexities generated where patients do not yet
have the capacity for autonomy. Decisions sometimes have to be made
on behalf of such patients.
What makes this a decision that "has to" be made?
It is true that the future autonomy of a currently incompetent
patient must be a guiding value. This, however, does not constitute a
decisive consideration against circumcision. First, what evidence
there is for the beneficial nature of circumcision suggests that the
benefit is greatest when circumcision is performed in infancy.
"what evidence there is...suggests that..." is a very weak reed on which to hang a decision to override an individual's choice about how much of his own genitals to retain. "Greatest" in the case of urinary tract infections (the only case in which circumcision's supposed benefits are confined to infancy) should perhaps rather be "least miniscule". And the Benetars neglect the possibility that the "evidence" (such as now-discredited claims about cancer of the penis) was specifically generated in order to justify infant circumcision.
Second, it is far from clear that non-circumcision leaves open a
future person's options in every regard. It does preserve the option
of future circumcised or uncircumcised status. But it makes other
options far more difficult to exercise. Transforming from the
uncircumcised to the circumcised state will have psychological and
other costs for an adult that are absent for a child.
Only if they choose to so "transform". The Benetars beg the question that they will. Clearly, choosing not to "transform" - as the vast majority of intact men "choose" - has no such costs.
You could use the same argument - it would be harder for them to decide to have it done later - to justify cutting off any other non-essential part of the baby's body, such as a little toe joint or an earlobe.
Steven Svoboda (2003) misunderstands what these costs are . The
relevant cost here is not pain - a problem that can be adequately
resolved by appropriate analgesia in both children and adults.
False. Much more adequately in the adult, who can self-medicate and regulate their own level of pain relief. And a pain one has chosen to undergo is invariably easier to control than one that is imposed on one.
Instead the relevant costs can include (1) the embarrassment of
having one's genitals exposed and operated upon, (2) having one's
genital alteration become the subject of curiosity and discussion by
one's acquaintances and co-workers;
Oh diddums! So in order to protect the feelings of the tiny minority of men who (a) want to be circumcised and (b) are embarassed about being operated on or talked about - presumably not the same men who want to be circumcised in front of an audience - an unknown but large number of babies should be circumcised in infancy whether they will ever want to be circumcised later or not. The outrage of those men who were circumcised in infancy and wish they had not been is ignored. The Benetars' bias is showing.
(3) the possible difficulties of
adapting to the new appearance of one' genitals (no matter how much
one wants the change),
So an unknown but large number of babies should be circumcised because later they might grow to be men who want to be circumcised but have difficulty adjusting to looking circumcised? This is called straining out gnats and swallowing camels.
and (4) a recovery period that interferes with
the pursuit of one's other projects. An infants suffers no
embarrassment from circumcision, has none of the anxieties of a knife
being taken to his penis, is immune to gossip, has no difficulty
adjusting to the new appearance of his genitals, and does not need to
take off time from work (or school) to recover.
Nor does an adult who does not get circumcised! Duh! What an extraordinary line of argument - yet it is commonly presented in informal form as a circumstition.
Given the costs of adult circumcision, many uncircumcised adult males
who would wish to be connected with religious and cultural
communities in which circumcision is a central tenet would have
circumcision stand in the way of their exercising this option. These
men would face a significant obstacle to religious and cultural
expression.
Are they seriously suggesting that gentile/infidel babies should be circumcised in infancy IN CASE they might want to convert to Judaism or Islam in adulthood? (Actor/director Stephen Fry is one such, but in the event, he didn't want to.) Since religious circumcision was instituted in order to set its members apart, it was deliberately made difficult for adults and hence an obstacle to conversion. And conversely, if the babies grow up to want to become Sikhs, being circumcised would be an impediment.
Critics of circumcision might wish to dismiss this impediment by
noting that such men would still have the option of religious and
cultural affiliation by undergoing circumcision. This retort is too
quick, however. Consider the following analogy. Many people,
presumably including many opponents of circumcision, support
compulsory primary and secondary education for children. Those
children who elected not to go to school would be able, later in
life, to gain the education they had missed, if they decided to
pursue a career that required a higher level of education than that
which they had obtained. So their option for education would be
preserved if primary and secondary education were not compulsory, and
their autonomy would thereby be respected. Yet it is clear that an
adult's choices would be severely constrained, in practice, if he or
she lacked primary or secondary education.
This is an extraordinarily strained argument. It is generally agreed that any education is better than bone ignorance. It is not generally agreed that all religions requiring circumcision are better than other religions or none. And the Benetars don't seem to know that children learn many things, such as languages, much better and faster than adults, so the costs of leaving a child uneducated are inevitable. Circumcision is mandatory in some religions only because most adherents think it is. Small but growing Intactivist movements within those religions make it quite possible to be an adherent without getting circumcised.
Now rectifying an
education deficit would certainly take much more time and effort than
would subjecting oneself to circumcision, and thus we are not
suggesting that these two constraints on options are equally strong.
All we are suggesting is that being uncircumcised can limit options
in practice and thus erring on the side of a child's autonomy is not
without cost.
Nor are these costs "negligible", as Wayne Hampton (2003, W-1)
suggests they are. (A fortiori, they are not "zero" as he elsewhere
says they are.) At the very least, they are not more negligible than
the risks and costs of circumcision.
Oh really? Isn't THAT question-begging?
Wayne Hampton's claim that the negligible costs of waiting are
preferable to "making a permanent ethical mistake" (2003, W-1) is
question-begging.
Costs and Benefits
Mark Sheldon correctly notes that much of our argument about
circumcision depends on whether the empirical evidence about the
medical costs and benefits of circumcision is as we suggest it is.
Had the risks and harms of circumcision been much greater, and if
there were clearly no benefits, then the balance of considerations
would have been against circumcision. Mark Sheldon does not take
issue with our presentation of the actual evidence, which he
describes as "dispassionate, thoughtful and apparently fair" (Sheldon
2003, 61).
But the question arises, is it up to them to weigh the evidence? This is just another instance of unilaterally and permanently withdrawing the choice from the person most directly involved, who, when he reaches adulthood, is perfectly capable of weighing the evidence himself, and may well come to the opposite conclusion from the Benetars.
Indeed we attempted to present the evidence as clearly and
as fairly as possible. Some of our respondents, however, have taken
issue, either explicitly or implicitly, with our discussion of the
costs and benefits.
Steven Svoboda criticizes our analysis of the costs and benefits of
circumcision for "ignoring the elephant in the room - the inherent
value of the intact penis" (Svoboda 2003, 53) What he fails to
realize, however, is that the very point of contention is whether
there is indeed an elephant in the room or whether this pachyderm is
instead an artifact of circumcision opponents' virtual reality.
The Benetars' attempt at humour is as ponderous as the "pachyderm". Just because something may be an "artifact" of Intactivists' "virtual reality" does not mean that it should be ignored, or assumed not to exist. The Benetars use their little "joke" to do both.
In other words he begs the question. The value of an intact penis cannot
be fully assessed without knowing the benefits and costs of a
circumcised penis. It will not do simply to assume the value of the
intact penis.
Well, actually it can. There are plenty of benefits that derive entirely from the presence of a foreskin, that it can safely be
concluded that circumcision deprives one of. Some intrinsic value should be assigned to an intact penis, just as to an intact hand, tongue, ear or
clitoris, without regard to the alternatives. Some inherent demerit should be attached to the inevitable scarring associated with cutting off a healthy body part. And in any ethical calculus, some (considerable) inherent merit should be attached to the person most concerned making his own determination of the value of his own body parts.
Wayne Hampton accuses us of not doing a proper calculation of the
costs and benefits of circumcision (Hampton 2003). He seems to think
that we underestimate the risk of death and dismemberment by noting
the infrequency of these complications. On his view, any risk of
death or dismemberment, no matter how small, is unacceptable. But
this trumping weight can be granted to rare death and dismemberment
only if there are no benefits to be derived from circumcision. Once
there are some benefits, the complications need to be weighed against
these. Then the rarity of the complications becomes relevant. Wayne
Hampton also seeks support for his claim that we underestimate the
costs of circumcision, by referring to the elevated risks of death
and dismemberment characteristic of traditional Xhosa circumcision.
But it is manifestly inappropriate, when considering risks and costs,
to compare the practice of infant circumcision in sterile conditions
by trained professionals, with circumcision of youths by inadequately
trained tribal figures in non-sterile conditions.
Who says they are "inadequately trained"? Who says the professionals are fully trained, when circumcision is commonly used for training? The difference between the risks of traditional Xhosa circumcision and US non-therapeutic circumcision are differences of degree, not of kind.
It is thus he, not
we, who is doing the mathematics incorrectly. Moreover, he ignores
our argument that a cost-benefit calculus is not simply a matter of
weighing medical evidence. Personal values affect the equation. Thus,
for example, it is not unreasonable for somebody to rank the death
and morbidity (from penile cancer) of an adult
At a very old age, as is usually the case?
as worse than the death (from circumcision) of an infant who may be
less invested in his life.
Tell that to the grieving parents, who were very much "invested in his life".
The point here is not that we must rank the costs in this way, but
that a ranking (one way or the other) involves not only medical but
also value judgments.
George Hill claims that we say more about the benefits than the costs
of circumcision (Hill 2003). This makes it seem as though we devote
disproportionate space to outlining the benefits. However, discussing
the alleged benefits is not the same as defending the view that these
really are (significant) benefits. Much of our discussion of the
benefits was directed to the limitations of the evidence of benefit.
Similarly, our discussion of the costs included an assessment of
whether the alleged costs were real, how great they were and whether
they could be avoided.
Pain
George Hill (Hill 2003, W-1) complains that we ignore post-operative
pain. But we did discuss this. We indicated that we "are not aware of
any studies on such pain and its control in neonates" but that there
"seems to be no reason … why simple topical or systemic analgesics
should not suffice".
Well, one is that unnecessary doping up of neonates - especially at the time they should be establishing the breast-feeding bond with their mothers - should be avoided.
Michelle Mullen acknowledges that we discuss
post-operative pain, but dismisses our arguments by saying that
although there may be no studies, "there is a prima facie case to
suggest that scalpel wounds to the genitals which are then exposed to
regular coatings of urine and feces (a diaper) would be painful"
(Mullen 2003, 49).
And create a new risk of infection.
This response misses the point. We agree that
there will be postoperative pain. In fact, there is more than a prima
facie case for thinking that there will be such pain. The relevant
question, though, is whether that pain can be controlled. Given that
postoperative pain can be well controlled for much more radical
surgical procedures,
In neonates?
it is reasonable to assume that it can be adequately controlled
after circumcision.
Can be, perhaps, but is it?
Both George Hill (Hill 2003) and Michelle Mullen (Mullen 2003) also
criticize our failure to discuss those papers that suggest that
inadequately controlled pain in infancy leads to greater pain
perception later in life. In offering this criticism they ignore how
its force rests on the inadequate control of pain. We indicated that
circumcision should not be performed without adequate pain control,
both intra-operatively and post-operatively. If the analgesic
condition is met, then the concern about after-effects of
inadequately controlled pain from circumcision simply does not arise.
The Benetars seem to live in an ideal world when it suits them, a world which is ideally suited to the practice of infant circumcision. The Taddios' study of the delayed effect of pain did not find any pain control that was adequate.
Michelle Mullen seeks to elicit her readers' disapproval of employing
(the most effective forms of) analgesia - penile nerve blocks - by
graphically describing this as "sticking needles into small neonatal
penises" (Mullen 2003, 49). This rhetorical trick obscures the
evidence (Kirya 1978; Stang 1988, and Williamson 1983) we cited that
"the administration of the injections themselves have not been found
to elicit a pain response" (Benatar and Benatar 2003, 38).
Which doesn't mean that it doesn't. There is certainly a prima facie case that it would.
Frances Batzer and Josh Hurwitz seem more confused. They state that
the "seminal issue of inflicting pain in a newborn is important" and
reassure their readers that the "technique of dorsal penile nerve
block … appears to be effective" (Batzer and Hurwitz 2003, W-1).
However, in the same paragraph they go on to say that it "is a
misconception that amputating the foreskin causes pain" (Ibid). If
that latter claim were true, one wonders in what way penile nerve
block is "effective".
The latter claim is certainly not true. The former is highly debatable. Batzer and Herwitz seem even more determined to defend circumcision than the Benetars, to the latters' embarassment.
Sexual pleasure
A number of our respondents claim that sexual pleasure is diminished
as a result of circumcision. In doing so, they ignore our earlier
arguments against this claim. Rio Cruz and colleagues, for example,
are content to tell us how richly innervated and vascularized the
foreskin is and that removing it "deprives an individual … of the
full range and depth of sexual pleasure" (Cruz et al. 2003, W-1).
However, as we noted in our paper, it does not follow from the fact
that the prepuce is highly innervated and vascularized, that removing
it diminishes sexual pleasure. This is because more than enough
erogenous tissue may remain to facilitate the same degree of sexual
pleasure.
A very strange claim. Would they make it about the tongue and sensations of taste, or the removal of any erogenous tissue from women? Some day it might be possible to cleave humans down the middle and each half would have "enough" of everything to "facilitate the same degree" of enjoyment of life.... Would that justify doing it to neonates? Where does that "may" come from? Certainly not from any peer-reviewed research.
The Benetars seem to assume that "erogenous tissue" may be graphed against "degree of sexual pleasure" (and that the curve rises to a plateau) using the same graph for all men at all times. They seem to be confusing "degree of sexual pleasure" with "ability to reach orgasm" without reference to the quality of the journey.
It is possible that additional increments of erogenous tissue do not
increase sexual pleasure.
It is possible. Certainly men with bigger penises don't necessarily enjoy sex more. (But do they have any more nerves?) But the
amount of erogenous tissue any intact man was born with seems to be the
optimum amount for him, so what justification is there for saying that less is "enough".
Thus, it is a misrepresentation of our view to suggest, as Wayne
Hampton does, that we claim that men are only "entitled to" the
penile innervation of the circumcised penis (W. Hampton, 2003, W-1).
The language of "entitlement" is a red herring here.
On the contrary, throughout, they argue as if circumcision were not just the status quo but an ethical norm, from which any departure must be justified. (Consider a parallel universe - or Sweden - where circumcision is not the norm and see how these arguments stack up. Or consider a parallel operation that is not the norm. The Benetars' paper would have equal force if "circumcision" were globally searched-and-changed to "earlobeotomy" but the bizarre nature of their thinking would then be thrown into high relief.)
It should also be apparent that we do not, as George Hill claims,
ignore the "loss of the most heavily innervated tissue in the male
genitals" (Hill 2003, W-1) Rio Cruz and colleagues say that it
"should be self-evident that cutting off primary sexual tissue
unalterably changes the way sexual acts are perceived and performed"
(Cruz et al. 2003, W-1) and that we therefore bear burden of proof
that we fail to provide (Cruz et al. 2003, W-1). However, it is far
from obvious that circumcision reduces sexual pleasure.
Well it should be. Is it obvious that penectomy reduces sexual pleasure? Yes. Is circumcision anything but partial penectomy? No. Q.E.D.
As our original paper provided evidence of this, we did in fact meet
any burden of proof they may think we bear.
The "evidence" in toto was
"However, what little evidence there is on this matter suggests that the circumcised glans is no less sensitive (Masters and Johnson 1966). Moreover, removal of erogenous tissue does not necessarily entail diminished sexual pleasure if sufficient erogenous tissue remains. They present no evidence for this claim. As it stands it is a truism for which one correct solution is "and only a complete foreskin is sufficient".
Others have argued that sexual dysfunction is less common in circumcised men (Laumann, Masi, and Zuckerman 1997)
Sexual dysfuntion is not a simple reciprocal of sexual pleasure. Laumann, Masi and Zuckermann only found statistical significance for certain kinds of sexual dysfunction among older men, self-reporting their circumcision status, without correcting for ethnicity.
and that the circumcised status is preferred by female partners.
It is a fairly fundamental error to confuse the direct effect of circumcision on erogenous functioning with the preference of partners.
Sexual preferences for the circumcised or uncircumcised state will depend on
many variables, including culture. It thus seems ill-advised to draw general conclusions from the few studies there have been."
Yet draw strong general conclusions they do. A more conservative approach would have been to accept the prima facie case that cutting off an integral - and will the Benetars quibble at "integral"? - part of the penis impairs its sexual functioning.
Petrina Fadel says that circumcision "is documented to cause erectile
problems, a serious impairment of function" (Fadel 2003, W-1) One of
the papers she cites, by John Coursey and colleagues, does not
support this conclusion. In this study, erectile function was
evaluated following anterior urethroplasty and therapeutic
circumcision and compared with recollected function prior to surgery
(Coursey 2001). While a minority of patients in each group reported
dissatisfaction with erection, the substantial majority of men (about
70%) reported either no change or an improvement in erectile
function. The second study she cites, performed by Kenneth Fink and
colleagues (Fink et al, 2002), investigated the effect of
circumcision on erectile function, penile sensitivity, sexual
activity and overall sexual satisfaction. The low response rate
introduced a potential selection bias and reduced the sample size
sufficiently to compromise the reliability of the results. Compared
to before therapeutic circumcision, men reported decreased erectile
function and decreased penile sensitivity but overall improved sexual
satisfaction. Given these apparently conflicting results, and the
fact that sexual activity before circumcision was undertaken while
suffering from the medical problem that was the indication for
circumcision, it is difficult to know how to interpret these
findings. What does one make of reduced erectile function in the face
of increased overall sexual satisfaction?
Nothing relevant to non-therapeutic circumcision.
Penile cancer
George Hill, in what he obviously takes to be a response to our
discussion of penile carcinoma, alludes to a number of countries
where circumcision is uncommon and the incidence of this disease is
low. He evidently takes this to be a decisive objection to the claim
that circumcision offers some protection against penile cancer.
However, as we indicated in our paper, this sort of evidence is
indirect. Proponents of routine circumcision employ a similar method
in reference to a different set of countries in order to prove their
point. For this reason, we recommended a more direct and therefore
more reliable approach to the question of whether circumcision
protects against penile cancer. Mr. Hill ignores this more rigorous
approach to the question.
The Benetars don't seem to address the fact that penile cancer is 1) extremely rare and 2) of very late onset - both factors militating against circumcision of neonates as prophylaxis.
Death
Steven Svoboda says we ignore those cases of death resulting from
circumcision (2003). However, we do not. We explicitly mentioned the
risk of death but indicated that the risk was very low - less than 1
per 500 000 circumcisions. In support of this widely accepted
statistic, we cited an article, containing relevant data, in a peer-
reviewed journal.
This assumes that all deaths from haemorrage or infection are all properly sheeted home to their ultimate cause in circumcision. And even if the figure is accurate, that's pretty cold comfort to at least two US families per year who lose a son to non-therapeutic circumcision.
Mr. Svoboda sees fit to ignore this, citing instead an opinion piece
that makes a claim of 16 deaths per 90 000 circumcisions - a claim
that is neither based on presented data nor referenced. Even if we
have underestimated the actual incidence of death from circumcision,
Mr. Svoboda's claim of over 200 circumcision related deaths per year
in the United States is about a 100-fold greater risk than the best
evidence suggests. Mr. Svoboda says that we should focus on the
deaths from circumcision rather than on the prevention of penile
cancer, which he calls a "vanishing[ly] rare condition" (Svoboda 2003,
53). Death from circumcision, however, is rarer still.
But one deprives a person of a lot more of his life than the other.
Cervical cancer
Not all our respondents thought that we overstated the benefits of
circumcision. Armand Antommaria suggests that there is more evidence
than we indicated, for the claim that the sexual partners of
circumcised men are relatively protected from cervical cancer
(Antommaria 2003). In support of this claim, he cites a recent study
(Castellsagué 2002), which was published after we had written and
submitted our paper. This study does lend some support to
circumcision's protective effect against cervical cancer.
No it doesn't. In short, it compares women in the Philippines with women in four other countries, while we know there are many regional, lifestyle and genetic factors affecting the incidence of cervical cancer.
It is worth
noting, however, that this benefit was identified only in a subgroup
analysis of the female partners of those men who themselves had had
more than six sexual partners. This study suggests that matters are
more complicated than Frances Batzer and Josh Hurwitz think, when
they claim that varying cervical cancer rates are (solely?)
attributable to "social issues such as the number of sexual partners
and … monogamy" (Batzer and Hurwitz 2003, W-1). Social issues are
clearly relevant variables, but it would seem that circumcision
status is also relevant.
Financial
Armand Antommaria notes, quite correctly, that the medical costs and
benefits are not the only relevant ones (2003). Indeed, our argument
considered a number of important non-medical benefits, including
cultural ones. The monetary cost of circumcision is relevant to
considering the allocation of public health care resources, and thus
has bearing on publicly funded (especially routine)
What do they mean by "routine" this time? Apparently this is "weak routine" - non-therapeutic circumcision at the parent's request.
neonatal
circumcision. But the question of whether circumcision may be
publicly funded was not one that occupied us in "Between Prophylaxis
and Child Abuse". We doubt that the financial costs, privately borne,
could render impermissible the choice of particular parents to
circumcise their child. (If they did, then people's moral freedom to
spend their money in a manner of their choosing would have to be
severely limited in other ways too.)
Which they are, of course.
Medical associations and medical indications
A number of our critics note that no medical associations recommend
infant circumcision. These critics (eg. Cruz et al., Fadel, Hill)
either charge us with ignoring this, or they suggest that our
conclusions are at odds with the views of these organizations. What
these critics have ignored, however, is that we do not recommend
infant circumcision. In other words, we do not think that it ought to
be performed routinely. Nor do we recommend against it, however. Our
view is that it is a morally permissible practice.
Steven Svoboda and George Hill seem to ignore the difference between
taking circumcision to be permissible and taking it to be preferable,
when they attribute to us a position that is ambiguous between these
possibilities. Steven Svoboda says that we "come out in favor of the
procedure" (Svoboda 2003, 53) and George Hill claims that we offer a
"defense" of circumcision (Hill 2003, W-1). These claims could mean
that we take circumcision to be morally preferable and that we defend
circumcision against those who deny that it is. That is not the view
we take. We are "in favour' of circumcision only in the sense that we
are not opposed to it. Similarly, we "defend" circumcision only
against those who think it is morally impermissible. We do not defend
it against those who deny that it is morally preferable.
Petrina Fadel makes the overly confident and unsubstantiated claim
that there "are no medical indications for circumcision in the
newborn period" (Fadel 2003, W-1). Our paper examined the evidence
and we concluded that there was some evidence of modest medical
benefit.
"Benefit" is not the same as "indications". Removing any part of the body will eliminate the possibility of any disorder of that body part - the same kind of benefit as is claimed for circumcision - but these are not claimed as "indications" for removing those body parts.
Ms. Fadel's claim would be more plausible if it were that
there are no decisive medical indications for circumcision in the
newborn period. Notice again, however, that one cannot infer from
this that circumcision is morally impermissible. Just as there are no
decisive medical indications for neonatal circumcision there are also
no decisive medical indications against this practice.
Armand Antommaria (2003) suggests that if routine neonatal male
circumcision is performed for cultural rather than medical reasons
then it should not be characterized as a medical procedure and that
it might therefore be better for doctors not to be involved. But
insofar as a cultural practice has medical value, its being performed
for cultural reasons is not incompatible with its being a medical
procedure.
This hopelessly blurs two unrelated reasons for doing it. "Insofar as a cultural practice has medical value" is an open-ended clause, that begs the question whether circumcision has any medical or cultural value.
Thus Professor Antommaria's suggestion presupposes that
there are not medical benefits to circumcision, and this
presupposition is a point of contention. Notice also, that even if
circumcision were thought not to have any medical benefit, it would
not follow that there is no sense in which it is a medical procedure.
The term "medical procedure" is ambiguous between (a) a procedure
performed for medical purposes, and (b) a procedure employing medical
means. Even if circumcision were not a medical procedure in the
former sense, it could still be a medical procedure in the second
sense.
Paul Ford also questions the involvement of doctors in circumcision.
He says that even if parents may permissibly have their children
circumcised "it does not mean that the medical profession should be
involved in the practice" (Ford 2003, 58). Indeed, parental
preferences do not commit doctors to being involved. Nor can one
infer, however, that doctors should not be involved. Paul Ford is
correct that the involvement of doctors in a procedure that is
exclusively cultural is less easily justified than their involvement
in a procedure that also has medical benefits. However, this is not
to say that doctors may not be involved in procedures that have only
cultural and no medical goals. One possible justification is that
doctors will be more expertly equipped to employ the medical means to
the cultural end, thereby minimizing the health risks. More would
obviously need to be said about this, but we should not lose sight of
the fact that circumcision is not clearly an exclusively cultural
practice. We argued that there is some evidence for a modest medical
benefit. Accordingly it seems reasonable for those doctors willing to
perform the procedure to facilitate the preferences of those parents
who do wish to have their sons circumcised for its possible medical
benefits. Paul Ford says that "physicians should actively discourage
the practice and not simply leave it as an unproblematic decision for
parents" (Ford 2003, 58) The evidence we presented suggested that
there are no grounds for actively discouraging circumcision, just as
there are not grounds for actively encouraging it. Our respondents
would do well not to draw conclusions that are stronger than the
evidence supports.
Parental decision making
Armand Antommaria (2003) and Sarah Waldeck (2003) refer to evidence
that non-medical considerations are paramount in parents' decisions
to circumcise their children. They take this to reflect negatively on
these decisions to circumcise sons. Indeed, it is regrettable that
the decision to circumcise (as well as just about every other kind of
decision people make) is not informed by all the relevant information
and is influenced by inappropriate considerations. This shows that
decisions are not made in the right way, but it does not follow from
this that the wrong decision is made. Sometimes the right decision
can be made for the wrong reason
This is very sloppy thinking. The Benetars seem to be claiming some God-like power to know what is the "right" decision (to
circumcise) other than the reasons adduced for it.
and sometimes there may be more than one acceptable decision. We
have suggested that circumcision falls into the latter category.
How can it be both right to cut part of a baby's genitals off and right not to? This is not "crumbed versus battered" we are choosing (for someone else) here.
Notice too, that the very factors that are said to influence
parents' decisions to circumcise their sons - to resemble their
fathers and peers, for example - will influence parents not to
circumcise their sons in those societies where circumcision is
uncommon.
This implies that parents make a decision whether to circumcise everywhere, and just make a different decision in three-quarters of the world. Parents in most of the world do not decide about circumcision at all, so looking like the father is taken for granted. (In the same way, "parents' decision not to cut off their babies' hands" is not
"influenced by a wish that they look like their fathers", because
there is no such decision.)
Thus Professors Antommaria and Waldeck's comments do not entail the
wrongfulness of circumcision (any more than they would entail the
wrongfulness of not circumcising in societies where circumcision is
rare).
Again, the Benetars assume cutting part of a baby off is ethically on all fours with leaving a baby alone. It is not.
Male and Female circumcision
A number of commentators took issue with our comparison of male and
female circumcision. Frances Batzer and Josh Hurwitz suggest that "to
equate female circumcision with male circumcision under any guise is
ludicrous" because "the ultimate outcome and purpose of each is quite
different" (Batzer and Hurwitz 2003, W-1) They seek to assure us that
male circumcision "is performed with no intent to inhibit or change
sexual or psychological function" whereas female circumcision, they
say is "meant to decrease sexual enjoyment" (Batzer and Hurwitz 2003,
W-1) What these authors do not realize (but should, because it was
mentioned in our paper) is that male circumcision has not
infrequently been performed with the intention of curbing sexual
desire - the very same justification that has often been used for
female genital cutting. Now, it happens to be false that circumcision
has this effect, but it is also false that the equivalent form of
female genital cutting (as distinct from the more severe form, the
effects of which these authors describe) has this effect. Thus we
find that the analogy is immune to the criticism of these authors. We
explained this carefully in our paper. These commentators have not
sought to rebut our argument, but instead ignored it.
Sara Webber and Toby Schonfeld make a similar mistake. They note that
female circumcision, the removal of clitoral preputial tissue, has
been used for two apparently conflicting purposes - sometimes to curb
sexual activity, and sometimes to promote it (in married women).
And the same is true of male circumcision.
Although this may seem odd, they suggest that these two purposes are
explained at a deeper level by an attempt to direct a female's
sexuality toward her husband. With this aim, masturbation, premarital
and extramarital sexual activity are to be curbed, and "missionary
position heterosexual sex with the husband" is to be promoted. It is,
these authors say, the "directing [of] women's sexuality that is
objectionable" (Webber and Schonfeld 2003, 66) rather than the
curbing of sexuality, to which we had referred. This argument fails
in a number of ways. First, it is hard to see why it is only
"directing sexuality" rather than also "curbing sexuality" that is
morally troubling. Second, the explanation that circumcision has been
used in an attempt to direct sexuality, could as (im)plausibly be
employed to explain why males are circumcised as it can to explain why females are circumcised. Indeed, as we indicated, male circumcision has sometimes been employed in an attempt to curb male sexuality, while it has also been thought to enhance sexual pleasure. It could be argued, that the sexuality of
males has been directed, even if not in exactly the same way, that
the sexuality of females is alleged to be directed. The point is not
that female sexuality has not been controlled and directed, but that
the evidence does not suggest that the practice of circumcision
(understood as the removal of preputial tissue) is any more directive
of women's sexuality than it is of men's.
Huh? So the fact that it doesn't work makes it all right??
The third problem with the argument of Professors Webber and
Schonfeld is that even if circumcision had been used in a bid to
direct female but not male sexuality, it would not follow that
different moral judgments could be made about physically analogous
male and female circumcision,
This seems to mean that the Benetars have no more ethical objection to FGM than to MGM, namely, none.
particularly if two conditions were
met: (a) neither the male nor female form actually had any effect on
sexuality; and (b) neither male nor female circumcision, in the given
instances, were employed in the hope of directing sexuality. We have
suggested that condition (a) is true.
But their suggestion is probably false.
Instances of male and female
circumcision performed by people recognizing the truth of condition
(a) would satisfy condition (b). Professors Webber and Schonfeld
might respond that it is the historical purpose of circumcision,
rather than the purpose of any given circumcision that is relevant.
But on this argument, currently innocuous practices are tainted for
all eternity if they once had an odious foundation.
This is confused. The historical purpose, to limit sex, still taints the present purposes.
A Catholic debate
John Paul Slosar and Daniel O'Brien very helpfully showed how our
arguments are compatible with the best Catholic thinking about
circumcision. Petrina Fadel takes them to task for looking to non-Catholics "for guidance" instead of following (her view of) Catholic
teaching. While we do not wish to enter a debate around what the
correct Catholic view is on circumcision, there are numerous
weaknesses in Ms. Fadel's response to Drs. Slosar and O'Brien, which
require no special knowledge of Catholic teachings to recognize.
First, she employs the very rhetoric against which we cautioned and
carefully argued. For instance, she cavalierly describes circumcision
as "amputation"
And how is it not amputation? Do the Benetars demand bones?
(Fadel 2003, W-1) and "mutilation" (Fadel 2003, W-2).
She liberally disburses anecdotes (Fadel 2003). She appeals to those
authorities who support her view (Fadel 2003), and leaves critical
readers wondering how representative these interpretations of the
relevant teachings are in Catholicism. These readers will not be
content with her assurance that she is "certain" that she is
"interpretating the genuine sentiment of every upright conscience"
(Fadel 2003, W-2). Such talk is crude rhetoric, not the sort of
reasoned argument we expect to see in an academic journal.
Any Catholic judging circumcision to be immoral would have to explain
how God could have once commanded (some) people to circumcise their
sons, something which Catholics must surely believe given that they
accept what they call the Old Testament. Even if one believes that
the covenant of the circumcision has been superceded and that
circumcision is no longer required, Catholics opposed to circumcision
need to explain how God could have commanded what they take to be
immoral. Ms. Fadel offers us no such explanation. She does note
(correctly) that ancient Hebrew circumcision (which would have been
performed on Jesus) involved removal of less of the foreskin than
contemporary Jewish circumcision. But given Ms. Fadel's arguments
about circumcision, it is hard to see how she could think that even
this more limited form of circumcision is morally permissible. Thus
she needs to explain how God could have commanded a form of
circumcision she takes to be immoral.
A moment ago, they said, "But on this argument, currently innocuous practices are tainted for all eternity if they once had an odious foundation." But on THIS argument, currently immoral practices (such as human sacrifice) are redeemed for all eternity if they once had a sanctified foundation.
Other problems
The responses of our critics abound with other defects. We cannot
list them all, but we shall provide a few examples.
Rio Cruz and colleagues offer us a non sequitur. They say that to
reach our conclusion that circumcision is morally permissible, we
ignore the fact that, worldwide, circumcision is relatively rare
(Cruz et al. 2003). But the rarity of a practice is utterly
irrelevant to determining its moral permissiblity. Worldwide,
baseball is rare, but that does not make it immoral.
These same authors also offer appeals to authority. For example, they
say that forced "male circumcision has been recognized as a human
rights violation in at least one legal case and in two United Nations
reports" (Cruz et al. 2003, W-1). But moral arguments cannot be
settled by appealing to legal judgments and United Nations reports.
And if one could, it would be far from clear that merely one legal
case and two United Nations reports would establish the conclusion.
Wayne Hampton is prone to a crude relativism. He says that we
"neglect the fact that child abuse is not an objective
interpretation, but a subjective one" (Hampton 2003, W-1). Now,
insofar as that is true, he has no moral complaint against those who
circumcise. He might take this practice to be child abuse, but if
what constitutes "child abuse" is merely a matter of subjective
interpretation he has no grounds for criticizing those circumcisers
who deny that circumcision is child abuse.
In a non-relativist moment, he assures us that there "is a whole
website devoted to cataloging bad reasons for circumcision" (Hampton
2003, W-1).
Aw, shucks! It's actually only a page of this site.
Only the most naïve readers will be impressed by this. There are
whole websites devoted to holocaust denial,
Should I invoke Godwin's Law? Actually, it is the circumstitions, not the listing of them, that have a lot in common with holocaust denial - they are both desperate attempts to defend the indefensible.
various conspiracy theories and dozens of other crackpot views. The
mere existence of these websites and the "evidence" they list,
provides us with no reason to accept their claims. There is no
substitute for examining the actual evidence, as found in peer-
reviewed papers.
My catalogue of bad reasons (as well documented as I can make them) has an underlying point: to illustrate that something else is going on - that there is a wish to (meddle with the genitals,
specificially to) circumcise that has nothing to do with health,
religion or anything but itself. And in fact the Benetars' casuistry
is only circumstitionising writ large. If circumcision were not
already rampant, their argumentation for it would look completely
mad. As I said above, try substituting "earlobe-removal" throughout, and see how
sane it is.
George Hill does not distinguish causation from relationships such as
correlation and mere coincidence. In support of his claim that
circumcision impedes intromission and intra-vaginal penile gliding,
he notes that "the sale of sexual lubricants" in the United States
"far exceeds that in countries where routine non-therapeutic
circumcision is unknown" (Hill 2003, W-1).
That's very interesting. It's certainly
hard to think of any other reason that it might be true. Do the
Benetars think lubricant sales cause circumcision perhaps, or that
both have some other underlying cause? It'd be fascinating to know what that is.
A number of our commentators employ inflammatory rhetoric. For
example, Petrina Fadel compares the research use of circumcised
prepuces with the Nazi use of Jewish skin to make lampshades (Fadel
2003). But there is a vast moral difference between using surgical
waste
To call somebody's foreskin "surgical waste" could be called inflammatory rhetoric. The Benetars beg the question that the "surgical waste" has been obtained by ethical means. There are still ethical issues involved in the use of "surgical waste": consider the scandals involving the misuse of the hearts and brains that are "surgical waste" from autopsies.
... for research and making lampshades out of somebody one has
murdered.
It might have been better to cite commercial, rather that research, use of foreskins.
Numerous of our respondents provide tendentious formulations of their
arguments and beg the question. Wayne Hampton, for example, says that
"conformity, anatomic incorrectness, chastity enforcement, false
ideas about how men are made … conflict with real human values such
as autonomy, wholeness, human dignity, and so on" (Hampton 2003, W-
2).
Loosely formulated, perhaps, but hardly wrong for that reason.
Paul Ford describes circumcision as a "type of barbarism",
lumping it together with penile bifurcation (Ford 2003, 58). Rio Cruz
and colleagues proclaim that we "conclude that amputating normal,
natural, protective, and sexually important tissue from a non-
consenting infant does not constitute abuse" (Cruz, 2003, W-1). None
of these formulations are helpful. They assume the very conclusions
for which the authors need to argue.
Do the Benetars believe the foreskin with which almost every male is born is abnormal, unnatural, dangerous and/or sexually unimportant? Apparently so, when they compare it to a gangrenous foot, and to malignancy.
Conclusion
While we welcome the great deal of attention our paper has received,
we find it regrettable that so many of our respondents discuss the
issues as emotively as they do. What is needed when engaging this and
other topics about which people feel strongly, is a cool and
impartial examination of the evidence and a careful analysis of the
issues and arguments. There has been all too little discussion of
circumcision in the bioethics literature and we sought to alter that.
It is important, however, that the discussion meet rigorous quality
standards.
It is highly debatable whether the Benetars' discussion does this. They seem determined to defend circumcision by hook or by crook:
- Claiming the slimmest margin of benefits as justification, but failing to do the converse for deficits
- Deeming every justification to be adequate and worthy
- Denigrating every defence of the normal, whole, intact human's right to stay that way
- Comparing the individual's right to autonomy over the possession of his own body unfavourably with obscure, rare and marginal deficits of him deciding later to have part cut off
- Claiming marginal (and as yet unacheived) pain reduction to be equivalent to the complete and universal painlessness of leaving babies alone
Circumcision, we argued, is a permissible practice, suitably subject
to parental discretion.
This raises the question, if the penis's owner has no right to decide for himself what of it he may keep, why that right should be transferred only to both parents? Alternatives are: -
- The father only
- The mother only
- A grandparent or grandparents
- Siblings
- The wider family
- The local community
- The doctor
- The medical profession
- The state
- but one can imagine the howls of outrage at any serious suggestion in any of those directions. What puts both parents, and only both parents, ahead of the penis's owner in making this decision and behind all those others?
However, we suggested that the way it is
currently performed - namely without (appropriate) analgesia - is
morally unacceptable. Opponents of current circumcision practices
would be on strong ground if they restricted their opposition to this
feature of the practice.
This assumes that "(appropriate) analgesia" is harmless and does provide sufficient, if not complete, pain relief, and both assumptions are unproved and probably false.
References