Intactivism News
January - March 2005

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Another amputation

WTNH.com
March 23, 2005

Lawsuit claims circumcision botched

(Stamford-AP, Mar. 23, 2005 1:35 PM) A lawsuit has been filed against a Bridgeport doctor, claiming he botched a circumcision and partially amputated a nine-month-old boy's penis.

The suit seeks unspecified damages from Dr. Daniel Gottschall, who performed the surgery last June at Saint Vincent's Hospital. The lawsuit against names his medical and surgical group, Alliance for Women's Health.

Immediately after his injury, the boy was transferred to Yale-New Haven Hospital for surgical repair of his condition.

Telephone messages have been left for Gottschall and hospital officials.

The suit alleges the boy's injuries were caused by Gottschall's failure to exercise the proper care and skill employed by physicians specializing in the procedure.


AP Connecticut Monday, March 28, 2005

Lawsuit claims circumcision botched

By JOHN CHRISTOFFERSEN Associated Press Writer

March 23, 2005, 5:31 PM EST

STAMFORD, Conn. -- An Oxford couple on Wednesday sued a doctor who they say partially amputated their son's penis during a circumcision at St. Vincent's Hospital in Bridgeport.

...

"We are bringing this case because we already know this baby has suffered a horrible, life-altering physical injury, but we are still learning about the long term ramifications of the injury," said Ernest Teitell, one of the boy's attorneys. "What happened will profoundly affect him as he grows older."

...

Robin Biondo, the boy's mother, said Dr. Daniel S. Gottschall cut off 40 percent of the tip of her son's penis.

...

Gottschall said he has performed more than 1,000 circumcisions without a problem.

"There was a slight tip that was removed, recognized and repaired," Gottschall said. "We believe there was a congenital deformity of the penis that made the injury more likely. Because of my diligence, the boy had the repair that was necessary."

...

 

With friends like this...

IRIN.org
Fri, 18 Mar 2005

Female circumcision is a vote winner

FREETOWN [Sierra Leone], 17 Mar 2005 (IRIN) - When the president's wife sponsors the circumcision of 1,500 young girls to win votes for her husband, you know you've got a problem persuading ordinary people and the government that female genital mutilation (FGM) is a bad idea.

And when the woman who is now Minister of Social Welfare, Gender and Women's Affairs, threatens to "sew up the mouths" of those who preach against FGM, you realise that you are facing a really big uphill struggle.

But that has not dissuaded Olayinka Koso-Thomas, a gynaecologist in Sierra Leone, from campaigning against the practice for 30 years, ignoring death threats and angry protestors storming her clinic. ...

More (When this link fails, email me.)

 

Close to The Tipping Point...

UPI
date

US Circumcision Rate Falls

text

The U.S. circumcision rate declined 11.4 percent over two years, says the National Center for Health Statistics. It dropped from 63.1 percent in 2001 to 55.9 percent in 2003. There has been a slow, steady decline in the procedure, which involves the surgical removal of the foreskin of the penis, over the past 25 years.

"Medicalized, mass circumcision of infants is a uniquely English-speaking phenomenon," says Dan Bollinger of the International Coalition for Genital Integrity, an anti-circumcision advocacy group based in West Lafayette, Ind. He says Canada, Australia, New Zealand and the United Kingdom formerly circumcised the majority of infant boys, but have either abandoned the practice or reduced the rate."

Data files

Documentation

 

When they say it's not the money....

The Windsor Star (Ontario)
March 19, 2005

Circumcisions spark debate

Local rate four times national average; MD says doctors may be in it for the money

Doug Williamson
Windsor Star

Call it a money grab by doctors or a sign of the cultural times.

For new parents Michael and Susan Levesque, Windsor's fixation with circumcising its newborns is simply a matter of doing what their ancestors did.

"We just decided to go with it, based on tradition," said Michael, whose son Owen was born Feb. 1. "I was, 'So why not?'"

Just over 50 per cent of the boys born at Windsor Regional Hospital last year were circumcised, well above the national average of 13.9 per cent. The average in Ontario was 16 per cent.

Dr. Tony Hammer, a Windsor family doctor, said his colleagues may be performing the medically unnecessary procedure simply to make a buck. Hammer is critical of a procedure which is also not recommended by the Canadian Paediatric Society .

"There is a financial incentive for physicians, and I wonder if they are fully informing their patients of a lack of medical need," said Hammer.

Obstetricians and the hospital split a $200 fee for each procedure, which is not covered by OHIP.

The head of obstetrics at Windsor Regional couldn't be reached, but a hospital spokesman said all circumcisions are done at parents' request, and rejected Hammer's statement.

"That comment is appalling. In no way do we promote it," said David Musyj, vice-president of corporate services and medical affairs. "In no way do they do it for the money."

He also said the rate charged in Windsor is equal to and in some cases lower than those charged in other hospitals. Circumcision is the surgical removal of the foreskin of the penis.

Last year, there were 4,400 births at Windsor Regional and nearly 50 per cent were boys. Of those, 1,080 circumcisions were performed, representing 51 per cent, hospital officials said.

Jewish and Muslim rites dictate it is done on the eighth day after birth.

According to the Montreal-based Association for Genital Integrity, the Canadian average in 2003 was 13.9 per cent, and 16 per cent in Ontario. Leading the charge was Prince Edward Island at 29.5 per cent, the association said, citing figures from Statistics Canada.

Musyj said the hospital's share of the more than $200,000 charged for circumcisions last year was for supplies, attending nurses and other hospital costs.

Hammer said he regularly advises his pregnant patients not to have the procedure done, but acknowledged some do anyway.

He and Musyj agreed that Jews and Muslims, for example, require the procedure as a matter of religion, and others are doing it just because their parents did. Muslims represent one of Windsor's fastest growing ethnic populations.

In the case of the Levesques, "We didn't really look into the pros and cons," said Michael, although the couple feel that personal sanitation is improved with circumcised males.

"I just felt that guys are lazy, so I wouldn't have him go through that."

Kim and Stavros Kourtsidis of Windsor also decided to circumcise their son Joshua, who was born March 7, because his older brother had undergone the procedure.

"It's cleanliness," Kim said Friday.

But opponents argue there are more medical complications associated with circumcision, than not doing it.

"I don't think physicians are educating patients about the lack of medical need for it. In the majority of cases it is cosmetic," Hammer said.

Dr. Danielle Grenier, of the Canadian Paediatric Society, said the number of procedures is declining in Canada.

"There is no medical indication to have newborn boys circumcised," she said. "There are no advantages to doing it. And with any procedure, there's always a risk.

"It's a painful procedure," she added.

In most cases a local anesthetic is used, and there can also be reaction to medications. "You never know how much you are cutting or how much you are leaving," she added.

"Parent pressure, most of the time," is the reason it is still being done, she said.

The risks may be small but they are there, Hammer said. "They do exist. When they occur, one can argue they were avoidable.

"Any ethical physician refers to the recommendations of the Canadian Paediatric Society," he said.

Musyj said Windsor's "multicultural" population partly accounts for the high local rate, as well as local tradition.

"Windsor being the community it is, I think that has a lot to do with it," he said of the tradition of circumcising boys. Musyj said most parents know the sex of their child well before delivery, and usually have enough time to decide on the procedure. It is done before the baby goes home.

Grenier of the pediatric society said a lot of information is available on the subject.

"Heaven knows what has been published over a little piece of skin," she said.

------

TO CUT OR NOT TO CUT

According to the Canadian Paediatric Society, of every 1,000 boys who are circumcised:

- 20 to 30 will have a surgical complication, such as too much bleeding or infection in the area.

- Two to three will have a more serious complication that needs more treatment. Examples include having too much skin removed or more serious bleeding.

- Two will be admitted to hospital for a urinary tract infection before they are one year old.

- 10 babies may need to have the circumcision done again because of a poor result.

Of every 1,000 boys who are not circumcised, seven will be admitted to hospital for a urinary tract infection before they are one year old. [That's fewer than one in 100]

 

"Only women are subjected to genital mutilation." Yeah, right.

L. A. Times
March 11, 2005

Court Eases Asylum Rule for Genital Mutilation

Expanding an earlier decision, an appellate panel says the procedure constitutes persecution and makes a woman automatically eligible.

By Henry Weinstein Times Staff Writer

A woman who has been subjected to genital mutilation is automatically eligible for asylum in the United States, the federal appeals court in San Francisco ruled Thursday. ...

The appeals court rejected the argument by government attorneys that female genital mutilation on its own cannot be a basis for a claim of past persecution because it is "widely accepted and widely practiced."

"The fact that persecution is widespread" does not make "a particular asylum claim less compelling," the court said in a 3-0 ruling, adding that a woman who has been forced to undergo the procedure has suffered a "continuing harm."

The 9th Circuit acted in a case filed by Khadija Mohamed, a young woman from Somalia. According to a State Department report, "virtually all" women in that country are subjected to one of several forms of genital mutilation. Court records indicated that Mohamed's clitoris had been surgically removed.

Forms of genital mutilation are common as coming-of-age rituals [but often on very young girls] in more than two dozen nations in Africa and some in Asia, the Middle East and Latin America.

Since 1996, the U.S. government has recognized female genital mutilation as a form of "persecution" that could entitle a woman to political asylum in at least some cases. For example, women have been able to win asylum by proving that refusing to have the procedure would open them to retaliation.

The current ruling, however, breaks ground in saying genital mutilation is enough to allow an asylum claim to go forward because the procedure, itself, is a form of continuing persecution.

"Like forced sterilization, genital mutilation permanently disfigures a woman, causes long-term health problems and deprives her of a normal and fulfilling sexual life," Judge Stephen Reinhardt wrote for the court. ...

Stephen Knight, coordinating attorney at the Center for Gender and Refugee Studies at UC Hastings College of the Law in San Francisco, said the ruling broke new ground. "No circuit court has held until now that genital cutting represented 'continuing harm,' " he said.

The ruling could aid hundreds of women, but would not "open the floodgates," Knight said. Though genital mutilation is widespread, few of the women involved "have the wherewithal to get to the U.S.," he said.

His center has records of about 380 asylum cases involving female genital mutilation in the last six years, but no definitive figures exist, he said.

The court also said a woman would not need to prove that she was part of a particular ethnic or tribal group that was persecuted.

Because only women are subjected to genital mutilation [ ! ], Mohamed could base her asylum claim on being part of a broader group of persecuted people - the "social group comprised of Somalian females" - the decision said. That ruling could apply to other situations, Knight noted. Mohamed's family fled Somalia after her father and brother disappeared during its continuing civil war. She lived in Ethiopia until four years ago when a woman there helped her get to the United States. At that point she was 17.

Mohamed previously was denied asylum by a federal immigration judge and the Board of Immigration Appeals.

In overturning that decision, the judges described female genital mutilation in detail, noting that it involved "the cutting and removal of all or some of a woman's external genitalia." The decision noted that the procedure is "extremely painful," and "often performed under unsanitary conditions with rudimentary instruments."

Under the court's decision, Mohamed will now be able to go back for a new asylum hearing ...

 

To lose one son is a tragedy, to lose two ...

New Kerala online news
February 11, 2005

Nepal child dies after ritual circumcision

[World News]: KATHMANDU, Nepal, Feb. 11 : A 5-year-old boy has died in Nepal, and his 7-year-old brother is in serious condition, after both were circumcised as part of a religious tradition.

Muyoddin Khan died from loss of blood Thursday after undergoing a ritual circumcision in the town of Indrapur, the Nepali Web site Kantipur Online reported Friday.

His brother Santalat was hospitalized due to excess bleeding after the operation was performed. Doctors said he was in serious condition.

"We carried out circumcision on the boys as part of our religion, but the bleeding did not stop," said Rahamadtulla, the boys' father. His eldest son died under similar circumstances five years ago, and the father said his 7-month-old son will also have to undergo the procedure.

"I can't go against our religion, although I've lost two of my sons," the report quoted Rahamadtulla as saying.

Copyright 2005 by United Press International

 

Baby's death prompts questioning of custom

PR Web press releases
February 9, 2005

Jewish Groups Say it's Time to Stop Circumcising Boys

The recent death of a baby boy in New York City has prompted some Jewish groups to call for an end to the practice of male circumcision. City investigators believe the boy died after contracting herpes from an infected mohel who sucked the blood from the baby's circumcision wound. Two other boys circumcised by the mohel have also contracted herpes, including the dead boy's twin brother.

San Diego, CA (PRWEB) February 9, 2005 -- The recent death of a baby boy in New York City has prompted some Jewish groups to call for an end to the practice of male circumcision. City investigators believe the boy died after contracting herpes from an infected mohel who sucked the blood from the baby's circumcision wound. Two other boys circumcised by the mohel have also contracted herpes, including the dead boy's twin brother.

Also known as Brit Milah, circumcision is the surgical removal of the foreskin from the penis. Although circumcision deaths in the U.S. are rare, the ritual is facing heavy criticism as it becomes synonymous with genital mutilation.

"What happened to this innocent Jewish baby in New York is especially tragic," said Gillian Flato, Director of Jews Against Circumcision, an international organization of Jews who have re-examined the practice and have found it to be immoral. "I think this is a wake up call for the Jewish community. Are they willing to blindly follow tradition and jeopardize their sons' lives? Circumcision does not make one Jewish. Being born to a Jewish mother makes you Jewish, or a Jewish father in the Reform tradition. Being Jewish is in your heart, not in your penis."

Dr. Ronald Goldman, Executive Director of the Jewish Circumcision Resource Center in Boston and author of Questioning Circumcision: A Jewish Perspective, said that many Jewish parents feel pressured to circumcise their newborn sons by family members or others within the Jewish community.

"For a growing number of Jews, circumcision raises serious intellectual, emotional, and ethical conflicts. A lot of parents end up regretting their decision to have their baby boys circumcised, especially if they witness the ceremony," said Goldman. "Those Jews that forgo circumcision are at peace with their decision. Jewish parents who are questioning circumcision have options."

One of those options is a Brit Shalom, a naming ceremony that some Jewish families practice as an alternative to traditional circumcision. Growing in popularity, it shares many of the same ceremonial aspects of the Brit Milah, but without cutting the genitals. It is similar to the naming ceremony used to celebrate the birth of Jewish girls.
   
Attempts to protect boys from circumcision have now crossed into the legal realm as well. While girls have been legally protected from circumcision in the U.S. since 1996, a federal bill proposal written by a San Diego group called MGMbill.org would extend that protection to boys. Matthew Hess, the group's president, said that Jewish support for the proposed bill will be critical to its success.

"Efforts to legally protect boys from MGM ("male genital mutilation") will be much harder without the support of Jewish leaders," said Hess. "Many politicians fear that supporting a ban on infant male circumcision will upset their Jewish constituencies and cost them votes in the next election. But those attitudes can be changed if more Jews speak out against the practice - just as Muslim women have changed opinions on female circumcision in Africa."

Hess himself is not Jewish, but he said that feedback and advice received from Jewish members of Congress and their staff have made him more aware of the need to encourage activism in the Jewish community at large. "Concerns about the ethics of circumcision are pervasive," said Hess. "But transforming those concerns into action requires people to speak up."

# # #


Contact Information
Matthew Hess
MGMbill.org
http://www.mgmbill.org
(208) 330-8435


New York Daily News - http://www.nydailynews.com/
Fear rabbi gave tots herpes
By MAGGIE HABERMAN
DAILY NEWS STAFF WRITER
Wednesday, February 2nd, 2005

City health officials are investigating whether a baby boy died after contracting herpes from the rabbi who circumcised him, the Daily News has learned.

The probe was launched after city officials realized that three infants in the city who tested positive for herpes last year all were circumcised by Rabbi Yitzchok Fischer. The Rockland County-based Fischer is a prominent mohel - someone who performs religious circumcisions.

Under Jewish law, a mohel is supposed to draw blood from the circumcision wound to remove impurities. While many mohels do it by hand, Fischer uses a practice little known outside ultra-Orthodox communities called metzizah bi peh, in which the mohel uses his mouth.

On Oct. 16, 2004, Fischer performed a bris, or religious circumcision, on twins. Ten days later, one infant died of herpes, and the other tested positive for the virus, according to papers filed in Manhattan Supreme Court by city lawyers.

A few weeks later, city Health Department officials found a third baby, on Staten Island, who also tested positive for herpes after being circumcised by Fischer in late 2003, the papers say.

Herpes is far more dangerous to infants than adults because of babies' fragile immune systems. The health status of the two surviving boys was not clear yesterday.

The city "is concerned that the possible transmission of herpes simplex virus type 1 in infants may be continuing as a result of defendant's practice of metzizah bi peh," city lawyers wrote in the complaint, dated Dec. 22. "Defendant's conduct to date constitutes a threat to the public health."

The custom of metzizah is thousands of years old. But experts said that these days, many mohels breathe in through a sterile tube to draw the blood instead of using their mouths directly on the wound, although in some ultra-Orthodox sects, the oral practice is mandatory.

The city asked Fischer to submit to a blood test in November, and ordered him to stop performing metzizah by mouth while waiting for the results, court papers show. Officials told him to use a sterile tube and gloves in the meantime.

But the Health Department got a report that Fischer wasn't following the order, so the city filed the legal complaint to compel him do so.

Fischer, 66, declined to comment yesterday.

His lawyer, Mark Kurzmann, wouldn't say whether Fischer has done the blood test, citing medical confidentiality. But he said Fischer is "cooperating with the city's investigation to resolve this matter."

"My client is known internationally as a caring, skilled and conscientious mohel," Kurzmann said.

He suggested the babies could have contracted herpes elsewhere. He also said there are concerns about the government regulating religious practices.

City lawyers declined to comment.

Health officials, aware of the sensitivity of the issue, have been talking extensively to community leaders.

"There's been a constructive dialogue between the community and the Department of Health, and we're working with [them] to ensure the safety of all our city's children," said Arie Lipnic, spokesman for City Councilman Simcha Felder (D-Brooklyn).

Other case reports also exist, but the true frequency of metzizah bi peh and associated herpes and other infections could be much higher than we suspect.

Distel, R., V. Hofer, et al. (2003). "Primary genital herpes simplex infection associated with Jewish ritual circumcision." Isr Med Assoc J 5(12): 893-4.

Gesundheit, B., G. Grisaru-Soen, et al. (2004). "Neonatal genital herpes simplex virus type 1 infection after Jewish ritual circumcision: modern medicine and religious tradition." Pediatrics 114(2): e259-63.

 

Another medical association fails to support R.I.C.

South African medical Association says no indication for Routine Infant Circumcision

THE SOUTH AFRICAN MEDICAL ASSOCIATION

4 February 2005


Mr A Fabre
Co-director
NOCIRC-SA
Dear Mr Fabre

SAMA POLICY STATEMENT ON ROUTINE INFANT CIRCUMCISION

Thank you for your email addressed to lris Maliga Pilay ol the SAMA Human Rlghts Law and Ethics Department, requestinq for a SAMA Policy Statement on Routine Infant Circumcision.

The matter was discussed at the meeting of the Education Science and TechnologyCommittee held on 23 January 2005. Below is an extract of the minutes of that meeting:

"The Committee NOTED the following: -
1. The contents of the email message, together with annexures on Routine Infant Circumcision received from the National Organisation of Circumcision lnformation Resource Centres - Soulh Africa (NOCIRC-SA);
2. That NOCIRC-SA would make a presentation to Parliament on the draft Childrens Bill in due couse on, inter alia, the relevant provision in the Bill which protected only minor girls from non-medically justified genital modification, but minor boys did not enjoy the same legal protection;
3. NOCIRC-SA indicated that they obtained Policies and Statements from several National Medical Associalions from which none advocated the practice of cncumcision or any olher genital surgeries on boys or girls, wilhout a valid medical diagnosis;
4. NOCIRC-SA requested an oflicial statement from SAMA on the subject matter.

The Committee was also INFORMED of the following extract on Cultural Circumcisions which emanated from the SAMA Human Rights, Law and Elhics Committee meeting held on 6 November 2004, namely: -

"At present there appeared to be two schools of thought to justify circumcisions. The one was for medical reasons and the well-being ot the patient whilst the other was based on religious and traditional grounds. The latter appeared to create problems since it was often conducted without anaesthetic and [under] unsafe conditions.

The Committee AGREED that even in situations where circumcisions were done for religious and traditional reasons, it should be done in medically safe conditions and in a humane manner."

After lengthy DISCUSSION on the matter the Committee RESOLVED that it be conveyed to NOCIRC-SA that, from a medical point of vlew, there was no medical justification for routine circumcision in neonates and children."

We trust the above will be of assistance to your organisation

PROF. ED COETZEE
CHAIRRPERSON SAMA EDUCATION

 

Calling them all off never seems to occur to anyone

Saturday Star (South Africa)
January 8, 2005

Initiates die in botched operations

Chris Stali finds conditions at traditional Xhosa circumcision sites in Cape Town to be 'shocking'
January 8, 2005

By Myolisi Witbooi

Shocking conditions have been found at some traditional Xhosa circumcision sites in Cape Town - including the use of car seatbelts as bandages.

Most traditional surgeons and nurses have little knowledge of the traditional initiation ritual and some initiation nurses are tending to initiates while under the influence of drugs and alcohol.

That was the observation of Western Cape minister for sport and culture Chris Stali after visiting several male circumcision sites in Cape Town last month after the death of three initiates and the hospitalisation of at least five.

Two of the dead, Moretima Mokgosi (20) from Gugulethu and Tumelo Thabane (21) from Langa, died at an initiation school in Paarl and another died in Khayelitsha. The other five were admitted to Groote Schuur and GF Jooste hospitals with infected circumcision wounds.

Police are probing the deaths of Mokgosi and Thabane, but are not investigating the death of the Khayelitsha man, although his father's "carelessness" came under heavy criticism.

Stali said the man, in his 20s, had dehydration problems, but his father delayed responding when called to the bush area where the initiation school was and then refused to let his son go to hospital when things got worse.

Last weekend an initiation nurse was beaten to death in Port Elizabeth after he took a sick initiate to hospital without notifying the family first.

A traditional leader, Coetzee Ntotoviyane, said that in the past, initiates landing up in hospital had been rejected by their communities, but things had changed and people were becoming more tolerant in the wake of the increasing problems that beset the ancient custom.

However Stali said it was depressing to note that parents often did not care about the progress of their sons in the bush. He said the conditions were "totally shocking".

Most initiation nurses had no idea about what was going on in the bush and were doing irresponsible things such as using car seatbelts to bind circumcision wounds. Initiates spoke of the use of all kinds of drugs and alcohol by the initiation nurses at a site in Philippi "and some nurses were under the influence as I was talking to them", Stali said.

He called a meeting of parents of those undergoing initiation. There was no response but this has not deterred him.

He said committees to oversee the ritual would be formed in each area in the city and the few people who knew the custom would be identified and trained to teach others. Nurses and surgeons would also be educated and given certificates to operate.

"The trained nurses may even get paid for looking after initiates," he said.

But to do that, Stali needs to introduce legislation, similar to that in the Eastern Cape, to give him powers of intervention. He said it was impossible to have only one initiation site for Cape Town and sites needed to be identified in each area. The Western Cape government and the City of Cape Town had funded the development of a R3.2 million initiation school called Ebakhwetheni Village in Driftsands, which was approved early last year but strongly opposed by many people on traditional grounds. The project has been halted.

Published on the web by Star on January 8, 2005.


© Star 2005. All rights reserved.

 

Kids, don't try this at home.

CNN.com
January 3, 2005

Young initiates kill circumcision nurse

Monday, January 3, 2005 Posted: 11:10 AM EST (1610 GMT)

JOHANNESBURG, South Africa (Reuters) -- A group of young South African men taking part in coming of age rituals due to include circumcision turned on their male nurse and killed him, an official said on Monday.

Sizwe Kupelo of the Eastern Cape provincial health department said the men aged 18 to 25 beat the man to death with sticks at the site of their initiation ceremonies in Port Elizabeth on Friday.

"He was attacked by about 20 initiates who assaulted him, and he later died," Kupelo said.

He said the attack followed complaints by the men that they were not being properly looked after during their initiation ceremonies, but did not elaborate.

The nurse had been in charge of caring for the men ahead of their circumcision.

No arrests have been made yet, Kupelo said.

A number of South African clans including the Ndebele, Sotho and Xhosa send teenage boys and young men into the bush for up to eight weeks to learn their clan's cultural and moral values and undergo coming of age ceremonies, including circumcision.

In recent years, the practice of circumcision has come under scrutiny as dozens of boys have been accidentally killed or mutilated by amateur elders who have seized on the tradition as a way to make money.

Kupelo said in the Eastern Cape at least 10 young men had died during the current initiation period, which began in December.

Chairman of the Eastern Cape House of Traditional Leaders, Chief Ngangomhlaba Matanzima, condemned the attack, which he said showed there were "serious problems" around initiations.

Copyright 2005 Reuters. All rights reserved.This material may not be published, broadcast, rewritten, or redistributed.

For the record, this website advocates not killing circumcisors.

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