I explain why I think that considerations regarding the opposing rights involved in the practice of circumcision—rights of the individual to bodily integrity and rights of the community to practice its religion—would not help us decide on the desirable policy towards this controversial practice. I then suggest a few measures that are not in conflict with either religious or community rights but that can both reduce the harm that circumcision as currently practiced involves and bring about a change (...) in attitude towards the practice, thus further reducing its frequency. These measures are the compulsory administration of anaesthetics; the banning of the metzitzah b’peh; and having an upper age limit of a few months on nontherapeutic circumcision of minors. I conclude with general considerations on why the steps taken towards the reform of circumcision should be moderate. (shrink)

ABSTRACT The paper explores the ethical aspects of introducing cultural circumcision of children into the EU public health system. We reject commonplace arguments against circumcision: considerations of good medical practice, justice, bodily integrity, autonomy and the analogy from female genital mutilation. From the unique structure of patient‐medicine interaction, we argue that the incorporation of cultural circumcision into EU public health services is a kind of medicalization, which does not fit the ethos of universal healthcare. However, we support (...) a utilitarian argument that finds hospital‐based circumcision safer than non‐medicalized alternatives. The argument concerning medicalization and the utilitarian argument both rely on preliminary empirical data, which depend on future validation. (shrink)

J S Mill used the term ‘dead dogma’ to describe a belief that has gone unquestioned for so long and to such a degree that people have little idea why they accept it or why they continue to believe it. When wives and children were considered chattel, it made sense for the head of a household to have a ‘sovereignal right’ to do as he wished with his property. Now that women and children are considered to have the full complement (...) of human rights and slavery has been abolished, it is no longer acceptable for someone to have a ‘right’ to completely control the life of another human being. Revealingly, parental rights tend to be invoked only when parents want to do something that is arguably not in their child's best interest. Infant male circumcision is a case in point. Instead of parental rights, I claim that parents have an obligation to protect their children's rights as well as to preserve the future options of those children so far as possible. In this essay, it is argued that the notion that parents have a right to make decisions concerning their children's bodies and minds—irrespective of the child's best interests—is a dead dogma. The ramifications of this argument for the circumcision debate are then spelled out and discussed. (shrink)

The foreskin is a complex structure that protects and moisturizes the head of the penis, and, being the most densely innervated and sensitive portion of the penis, is essential to providing the complete sexual response. Circumcision—the removal of this structure—is non-therapeutic, painful, irreversible surgery that also risks serious physical injury, psychological sequelae, and death. Men rarely volunteer for it, and increasingly circumcised men are expressing their resentment about it.Circumcision is usually performed for religious, cultural and personal reasons. Early (...) claims about its medical benefits have been proven false. The American Academy of Pediatrics and the Centers for Disease Prevention and Control have made many scientifically untenable claims promoting circumcision that run counter to the consensus of Western medical organizations.Circumcision violates the cardinal principles of medical ethics, to respect autonomy, to do good, to do no harm, and to be just. Without a clear medical indication, circumcision must be deferred until the child can provide his own fully informed consent.In 2012, a German court held that circumcision constitutes criminal assault. Under existing United States law and international human rights declarations as well, circumcision already violates boys› absolute rights to equal protection, bodily integrity, autonomy, and freedom to choose their own religion. A physician has a legal duty to protect children from unnecessary interventions. Physicians who obtain parental permission through spurious claims or omissions, or rely on the American Academy of Pediatrics' position, also risk liability for misleading parents about circumcision. (shrink)

Every infant has a right to bodily integrity. Removing healthy tissue from an infant is only permissible if there is an immediate medical indication. In the case of infant male circumcision there is no evidence of an immediate need to perform the procedure. As a German court recently held, any benefit to circumcision can be obtained by delaying the procedure until the male is old enough to give his own fully informed consent. With the option of delaying (...) class='Hi'>circumcision providing all of the purported benefits, circumcising an infant is an unnecessary violation of his bodily integrity as well as an ethically invalid form of medical violence. Parental proxy ‘consent’ for newborn circumcision is invalid. Male circumcision also violates four core human rights documents—the Universal Declaration of Human Rights, the Convention on the Rights of the Child, the International Covenant on Civil and Political Rights, and the Convention Against Torture. Social norm theory predicts that once the circumcision rate falls below a critical value, the social norms that currently distort our perception of the practice will dissolve and rates will quickly fall. (shrink)

Ethical challenges surrounding the implementation of male circumcision as an HIV prevention strategyResearchers have been exploring the possibility of a correlation between male circumcision and lowered risk of HIV infection almost since the beginning of the HIV/AIDS epidemic.1 Results from a randomised controlled trial in South Africa in 2005 indicate that male circumcision protects men against the acquisition of HIV through heterosexual intercourse,2 confirming the findings from 20 years of observational studies.3 Circumcised men in the South African (...) trial were 60% less likely to acquire HIV than their uncircumcised counterparts. A mathematical modelling study, based on the South African trial, estimates that the practice of male circumcision could avert two million new HIV infections and 300 000 HIV-related deaths over the next 10 years in sub-Saharan Africa.4 More recently, two randomised controlled trials in Kisumu, Kenya and Rakai, Uganda showed, respectively, 53% and 48% reductions in HIV acquisition among circumcised men than uncircumcised men in the trial.5 These results strongly suggest that male circumcision could play an important role in the struggle against the continued rise in new HIV infections. However, as observers noted at the 2006 XVI International AIDS Conference in Toronto, Canada, excitement about the potential epidemiological impact has overshadowed the debate over the difficult translation of research on male circumcision, into policy and practice.6 Similar calls for caution have been raised before and elsewhere.7,8The topic of male circumcision carries an enormous amount of ethical baggage. Male infants, worldwide, are circumcised for various medical, social and/or religious reasons. Circumcision is a cultural act and a surgical procedure; medical reasons are not the only reasons to circumcise that people have found and continue to find as compelling. Benatar and Benatar9 have argued that—when …. (shrink)

Male circumcision—partial or total removal of the penile prepuce—has been proposed as a public health measure in Sub-Saharan Africa, based on the results of three randomized control trials showing a relative risk reduction of approximately 60 per cent for voluntary, adult male circumcision against female-to-male human immunodeficiency virus transmission in that context. More recently, long-time advocates of infant male circumcision have argued that these findings justify involuntary circumcision of babies and children in dissimilar public health environments, (...) such as the USA, Australasia and Europe. In this article, we take a close look at the necessary ethical and empirical steps that would be needed to bridge the gap between the African RCTs and responsible public health policy in developed countries. In the course of doing so, we discuss some of the main disagreements about the moral permissibility of performing a nontherapeutic surgery on a child to benefit potential future sexual partners of his. In this context, we raise concerns not only about weaknesses in the available evidence concerning such claims of benefit, but also about a child’s moral interest in future autonomy and the preservation of his bodily integrity. We conclude that circumcision of minors in developed countries on public health grounds is much harder to justify than proponents of the surgery suggest. (shrink)

Around a third of men worldwide are circumcised. It is probably the most commonly performed surgical procedure. Circumcision is also one of the oldest forms of attempted human enhancement. It is and has been done for religious, social, aesthetic and health reasons.Circumcision has a variety of benefits and risks, many of which are discussed in this issue. There is some dispute about the magnitude and likelihood of these benefits and risks. Some argue that the risks outweigh the benefits (...) and circumcision should not be performed on children who are not competent to make their own decisions.If the risks of circumcision clearly outweighed the benefits, great harm has been done and is being done globally through this procedure. Around a third of all men would have been harmed. This is an extraordinary public health injury. Presumably, many would be entitled to compensation.The fact that relatively few people think that the situation is as bad as this indicates that most people implicitly believe that circumcision is not generally a significant harm, if a harm at all. One might thus conclude either that: It is not clear from existing evidence whether the risks of properly performed circumcision outweigh the benefits, or vice versa.Or 2. If circumcision is against the interests of an infant or young child, it is only mildly so.In general, people should make their own decisions about body modification and human enhancement when this is possible. Such an approach speaks in favour of waiting until a child becomes an adult to make his or her own decision about circumcision. And procedures which are not clearly in a child's interests should not be performed on that child. However, religious …. (shrink)

The decision of the German regional court in Cologne on 26 June 2012 to prohibit the circumcision of minors is important insofar as it recognises the qualitative similarities between the practice and other prohibited invasive rites, such as female genital cutting. However, recognition of similarity poses serious questions with regard to liberal public policy, specifically with regard to the exceptionalist treatment demanded by certain circumcising groups. In this paper, I seek to advance egalitarian means of dealing with invasive rites (...) which take seriously cultural diversity, minimise harm and place responsibility for the burdens and consequences of beliefs upon those who promote practices. (shrink)

Circumcision of males represents a surgical “vaccine“ against a wide variety of infections, adverse medical conditions and potentially fatal diseases over their lifetime, and also protects their sexual partners. In experienced hands, this common, inexpensive procedure is very safe, can be pain‐free and can be performed at any age. The benefits vastly outweigh risks. The enormous public health benefits include protection from urinary tract infections, sexually transmitted HIV, HPV, syphilis and chancroid, penile and prostate cancer, phimosis, thrush, and inflammatory (...) dermatoses. In women circumcision of the male partner provides substantial protection from cervical cancer and chlamydia. Circumcision has socio‐sexual benefits and reduces sexual problems with age. It has no adverse effect on penile sensitivity, function, or sensation during sexual arousal. Most women prefer the circumcised penis for appearance, hygiene and sex. Given the convincing epidemiological evidence and biological support, routine circumcision should be highly recommended by all health professionals. BioEssays 29:1147–1158, 2007. © 2007 Wiley Periodicals, Inc. (shrink)

The article asserts that verses 124–130 in the second sūrah of the Qurʾān (al-Baqara/“the Cow”) alludes to the biblical precept (Genesis 17) but presents the practice as a custom that has no special virtues, and certainly not those the Jews ascribed to it. It then claims that circumcision is identified as one of Abraham’s trials, which are mentioned in the Qurʾān and thus part of early Islam, and that this idea did not arise in the Middle Ages.

The foreskin in small boys causes much anxiety in our society. It develops during the second half of gestation, and in premature infants may appear relatively deficient. By term, however, it has grown and protruded to well beyond the glans penis. The inner layer of the foreskin is densely adherent to the surface of the glans and cannot be retracted until it is fully separated, which occurs during the first few years of life. Prior to that time the distal opening (...) of the foreskin is narrow, but because of its adherence there is no significant pocket under the skin to allow accumulation of urine or debris. Later in childhood, after the foreskin is fully separated, urine and dirt can accumulate between the foreskin and the glans, leading to infection and inflammation . With recurrent balanitis, and/or tearing of the delicate foreskin, phimosis or scarring may constrict the distal foreskin.Circumcision has a long history in ancient societies of the Middle East, and is likely to have arisen as an early public health measure for preventing recurrent balanitis, caused by sand accumulating under the foreskin. Circumcision is a major part of the ritual for such religions as Judaism, Christianity, and Islam, and it is probably no accident that all of these arose in the Middle East. By contrast, in religions arising outside the arid Middle East , there is no ritual circumcision. In aboriginal society in Australia, circumcision is practised also.The importance of preventing recurrent balanitis and secondary phimosis in arid, sandy regions was confirmed by the Australian army medical corps in two world wars. During both wars, Australian soldiers were stationed in North Africa and the Middle East, and the incidence of recurrent balanitis caused by sand under the foreskin reached “epidemic” proportions, leading to large numbers …. (shrink)

Circumcision originated from ancient religious and cultural societies. Study has shown that in both the biblical context and among the Karanga people in Zimbabwe circumcision emerged as a rite of passage for a boy child’s entry into manhood. Modern societies promulgate circumcision as a preventive method against HIV and AIDS. The present study argues that circumcision tends to promote irresponsible sexual behaviour and trivialises the sacredness of sex. To safeguard societies against the belief that circumcision (...) prevents HIV and AIDS. To sensitise societies that abstinence and condom usage will serve as preventive methods against HIV and AIDS. The study utilises two complimentary methods: comparative literary method which examines both biblical and cultural initiation procedures and qualitative research method in which an interview forms part of the data pool. The potential of a scientific contribution towards transforming both the mind and lifestyle can be guaranteed. The number of individuals opting to be circumcised will decline, and abstinence and condom usage should be promoted towards the prevention of HIV and AIDS. In both ancient Israel and among the Karanga people of Zimbabwe, circumcision was performed as a religious and cultural procedure. In both contexts circumcision was regarded as a rite of passage to prepare a boy child for entry into manhood. The article argued that circumcision does not prevent HIV and AIDS. To the contrary, circumcision tends to endorse promiscuity and unprotected sex, with a potential of increasing HIV and AIDS prevalence. (shrink)

Circumcision of males represents a surgical “vaccine“ against a wide variety of infections, adverse medical conditions and potentially fatal diseases over their lifetime, and also protects their sexual partners. In experienced hands, this common, inexpensive procedure is very safe, can be pain‐free and can be performed at any age. The benefits vastly outweigh risks. The enormous public health benefits include protection from urinary tract infections, sexually transmitted HIV, HPV, syphilis and chancroid, penile and prostate cancer, phimosis, thrush, and inflammatory (...) dermatoses. In women circumcision of the male partner provides substantial protection from cervical cancer and chlamydia. Circumcision has socio‐sexual benefits and reduces sexual problems with age. It has no adverse effect on penile sensitivity, function, or sensation during sexual arousal. Most women prefer the circumcised penis for appearance, hygiene and sex. Given the convincing epidemiological evidence and biological support, routine circumcision should be highly recommended by all health professionals. BioEssays 29:1147–1158, 2007. © 2007 Wiley Periodicals, Inc. (shrink)

This paper examines the attitudes of circumcised women towards female circumcision in a community where the practice is in vogue. Also described are the type of circumcision performed, who usually performs the circumcision and complications. One hundred volunteers across the social strata were interviewed by means of a structured questionnaire. Data were analysed using frequency tables. The study revealed that 62% of respondents favoured the practice as an instrument for the control of female sexuality and maintenance of (...) cultural pride. Circumcision is mainly by excision of the clitoris and the labia minora performed mainly by traditional birth attendants. Complications include severe pain, difficulty with urination and excessive bleeding. Based on the findings, it is suggested that communities where femal genital mutilation is practised as a social norm should be involved in any eradication campaign, with the support of national and international organisations. Research is also essential to understand FGM in order to design effective reforms. (shrink)

The health benefits of male circumcision are wide rangingIn this issue, John Hutson has reiterated the conventional Western medical view that “the surgical argument for circumcision of all neonatal males at present is very weak” and he criticises many of the circumcisions performed in later childhood, without anaesthesia, as “physically cruel and potentially dangerous” [see page 238].1 He is also of the opinion that “the diseases which circumcision is able to prevent are uncommon or even rare”. But (...) therein he errs, and greatly errs.He cites only two publications dealing with the protective effect of male circumcision against HIV infection, and makes no mention of the important recent meta-analysis of Weiss, Quigley, and Hayes2 which shows conclusively from a large number of studies that …. (shrink)

The forced circumcision of men is a widespread human rights abuse that often accompanies other human rights violations. It occurs in clashes between circumcising and non-circumcising cultures, or when individuals in circumcising cultures reject circumcision. This article documents the forced circumcision of men against their will, shows how evidence of forced circumcision has been downplayed and discounted, and outlines and discusses some measures that could help to reduce its prevalence.

In lieu of an abstract, here is a brief excerpt of the content:Circumcision:Ordinary and Universal in My CommunityAllan J. JacobsMy1 circumcision experiences are remarkable mostly for their ordinariness. My wife Danaë gave birth to our son Perseus2 while I was a resident in obstetrics and gynecology in a city where we had no family. Perseus was circumcised in a Jewish brit milah3 ceremony on the eighth day of his life, as were my wife's and my male ancestors back (...) into ancient times. We were relieved because Perseus had just recovered from a potentially serious condition. After a difficult forceps delivery, his blood bilirubin rose almost to the point where he might have developed the dreaded kernicterus syndrome. Kernicterus can cause permanent severe motor, intellectual and visual impairment. It was unclear whether he would be discharged from the hospital in time. He had to spend a week in restraints under a bright light whose frequency degraded bilirubin. Happily, he came home the day before the scheduled brit.Our four parents attended the brit. Danaë's father was the sandek,4 being granted the honor of holding our son on his lap during the circumcision ceremony. The mohel, or circumciser, was the local Conservative rabbi. We were mildly anxious because he didn't do many circumcisions in this city with few Jews. Perseus cried briefly after he was circumcised. The circumcision undoubtedly was far less stressful than treatment of elevated bilirubin. The circumcision certainly was less painful than the prodding and sticks for the many blood tests he had to undergo in the hospital, not to mention the pain of his difficult forceps delivery. Perseus did not seem to have much discomfort in his penis afterward, and had no circumcision complications.After the brit, our parents and my resident colleagues ate refreshments and chatted for an hour or so. A brit milah is a happy occasion, but not an elaborate one. It marks the end of the joy, anxiety, and excitement of the child's birth and its aftermath and is followed by the less exalted rhythm of feedings, diaper changes, and sleep deprivation.At the brit, our boys are assigned Hebrew names and confirmed in the Biblical covenant between God and the Hebrew people established between God and Abraham, and reaffirmed between God and Moses. Regardless of the historical truth of the formation of the covenant, it is accepted as a myth tantamount to [End Page 71] truth. In other words, regardless of its literal truth, such a myth is to be regarded as true because it concretizes God's demands or a moral truth. The covenant is real for me whether or not there was a historical Abraham. As with other religious commitments, the obligation to circumcise our sons is unprovable, but binding. On this basis, Perseus's ancestors on both sides were circumcised in brit milah ceremonies for many centuries into the past.My two grandsons were circumcised as well. Achilles was circumcised among friends and relatives. The mohel was an experienced obstetrician who was certified to officiate at a brit milah following the practices of Conservative Judaism. He administered adequate analgesia with topical local anesthetic cream followed by an injected regional block. Achilles slept through his circumcision, suffered no complications, and had little discomfort afterward. My other grandson had a circumcision performed as an infant outside the context of Judaism and is not being raised as a Jew.The two brit milah in my family were beautiful, dignified ceremonies, welcoming the infants into the Jewish fold, and bestowing their Hebrew names.5 Some of my relatives, including Perseus's son, had circumcisions performed in a medical setting without a ceremony. None of the many boys in my family had obvious short- or long-term problems with their circumcisions. My social circle has many Reform and Conservative Jews. I have never heard any Jewish man in my circle of acquaintances complain about his circumcision. Circumcision is a given. Problems are rare, and an exposed glans is the norm. Our men typically enjoy sex and have no difficulty in fathering children. Circumcision is part of the comforting cocoon of custom and tribe that helps to protect us as a group. It also reinforces Jewish endogamy... (shrink)

Despite global and local attempts to end genital mutilation, in their various forms, whether of males or females, the practice has persisted throughout human history in most parts of the world. Various medical, scientific, hygienic, aesthetic, religious, and cultural reasons have been used to justify it. In this symposium on circumcision, against the background of the other articles by Hutson, Short, and Viens, the practice is set by the author within a wider, global context by discussing a range of (...) rationalisations used to support different types of genital mutilation throughout time and across the globe. It is argued that in most cases the rationalisations invented to provide support for continuing the practice of genital mutilation—whether male or female—within various cultural and religious settings have very little to do with finding a critical and reflective moral justification for these practices. In order to question the ethical acceptability of the practice in its non-therapeutic forms, we need to focus on child rights protection. (shrink)

J S Mill used the term ‘dead dogma’ to describe a belief that has gone unquestioned for so long and to such a degree that people have little idea why they accept it or why they continue to believe it. When wives and children were considered chattel, it made sense for the head of a household to have a ‘sovereignal right’ to do as he wished with his property. Now that women and children are considered to have the full complement (...) of human rights and slavery has been abolished, it is no longer acceptable for someone to have a ‘right’ to completely control the life of another human being. Revealingly, parental rights tend to be invoked only when parents want to do something that is arguably not in their child9s best interest. Infant male circumcision is a case in point. Instead of parental _rights_, I claim that parents have an _obligation_ to protect their children9s rights as well as to preserve the future options of those children so far as possible. In this essay, it is argued that the notion that parents have a right to make decisions concerning their children9s bodies and minds—_irrespective of the child9s best interests_—is a dead dogma. The ramifications of this argument for the circumcision debate are then spelled out and discussed. (shrink)

Khalafzai, Rida Usman There is currently much debate about the medical and ethical issues related to male circumcision. This article explores this controversial subject in the light of current research.

In lieu of an abstract, here is a brief excerpt of the content:Circumcision and Regrets from the Mother of Three SonsMaría Viola SánchezI am a psychologist and a radio talk show host for 25+ years. Both of my parents spoke English as their second language. I was raised by immigrants who demanded that "we speak English because we are Americans." I have four adult children, three sons, and a daughter.I gave birth to my children in the mid-80s. They are (...) very close in age and remain dear friends to this day. While I was a professional with a career when my children were born, I took a leave to work part-time and largely, to be a stay-at-home mother for nearly ten years. I was very involved with all their academic and extracurricular activities. I became a single mother when they were 2, 4, 6, and 7 years old, which served to redouble my parenting efforts to compensate for the absence of their father.My dirty secret is that I circumcised my three sons. I did so out of sheer ignorance. I am ashamed and deeply saddened by my decision at the time of their births. This is a burden that I will live with for the rest of my life. Something that I took away from them and that I can never repair.Here's the justification for my ill-informed decision. My father was circumcised, my two brothers were circumcised, and my then-husband was circumcised. I blindly assumed all males were to be circumcised. Further complicating the circumstances surrounding their births and the decision to circumcise them is the fact that their father is Jewish. He most likely would have given me pushback on not circumcising our sons, even though we had agreed to raise our family as Roman Catholics, my religion.After delivering my sons, I was asked, "Who would you like to circumcise your son?" My reply was, "Who has performed more of these procedures? And please bring my son to me to nurse after you have finished." Not one person, not one family member, not my son's father, any healthcare providers, not my pediatrician, or my OB/GYN asked me, "What are your thoughts about circumcising your son?" Had I been asked that question, I might have pondered the concept that there was a decision to be made, not a procedure that was necessary, as is the case with cutting the umbilical cord. When my infant sons were brought to me to nurse, they were sobbing so violently that they were unable to latch on to my breast. One can only surmise that no numbing agents were applied or anesthesia given, further compounding my burden of responsibility. Imagine their trauma!Over the course of my radio career, I hosted a program for an American non-profit national media organization, and one of my guests, Steven Svoboda, was scheduled to promote his newly founded organization, Attorneys for the Rights of the Child (ARC). Steven has remained a colleague. I've interviewed him a dozen times over the decades to promote ARC's amazing work. Steven is the one that first opened my eyes to the ridiculousness of male circumcision. Subsequently, I now understand that circumcision is unnecessary, not medically mandated and that the procedure denies males their [End Page E1] right to genital integrity. What I have also learned is that the removal of the foreskin is the most important sensory component and it is comprised of thousands of Meissner's corpuscles as well as branches of the dorsal nerve and in between 10,000 and 20,000 specialized erotogenic nerve endings of several types.I have since apologized to my adult sons for the uninformed and ignorant decision I made after they were born. Two of my three sons have gracefully accepted my apology. The other son says that he's glad that he resembles both his father and most of his male peers.I have become such an "intactivist" that I earned my Ph.D. in Psychology, and my dissertation concerns itself with Female Genital Mutilation (FGM) and its eradication. To know that 200 million females who are alive today have experienced FGM is another responsibility... (shrink)

This commentary examines twelve stories in which parents recount how they (and often their co-parent) decided whether or not to circumcise their newborn sons. Several debated whether this should be their decision to make. The stories offer an intimate glimpse into people's efforts to do the best for children in a context of incomplete and changing information and intense public controversy. The commentary explores the diverse meanings and contradictory commonsense beliefs that surround foreskin removal in the United States today. Considering (...) these parents' reflections—and their silences—can help us appreciate the real-life consequences of debates about the ethics of male circumcision. (shrink)

In his contribution to the Journal of Medical Ethics, Joseph Mazor1 makes a logical case, based on the premises underlying his reasoning, for his article's primary thesis: he concludes that parents have the prerogative to determine the ‘best interests’ of their infant son in a circumcision decision. If the facts of the matter were ultimately no different from what he adduces, one could admit the soundness of his argument. But the paper is flawed by some questionable assumptions and grievous (...) incompleteness.First, the author insufficiently explores the profound implications of a serious equivocation in the term ‘circumcision’ that is common throughout the literature. He does superficially reference the article on ‘Circumcision’ in The Jewish Encyclopedia, which describes in detail the actual steps involved in brit milah versus brit periah.2 Despite this general allusion, though, he hardly discusses the matter further, as though the distinction were practically irrelevant. It does have fundamental import, however. Milah is merely a token clip of the very tip of the prepuce, which leaves most of the organ system intact. This was evidently the version practiced in biblical times under the old Abrahamic–Mosaic covenant, before the Talmudic guardians of Judaic ethnic and religious identity proposed a means to prevent Hellinising Jewish men from attempting foreskin restoration by stretching their remaining preputial tissue forward. The rabbis mandated the replacement of milah with the more drastic procedure of periah, a radical surgery that cuts and tears from the penis its entire covering, leaving the glans irreversibly denuded. Unlike traditional milah, the innovation of periah necessarily has significant adverse consequences .Second, Mazor concedes that circumcision might cause a ‘moderate’ reduction of sexual pleasure in the lad's …. (shrink)

The paper addresses arguments in the recent philosophical and bioethical literature claiming that social and cultural benefits can justify non-therapeutic male infant circumcision. It rejects these claims by referring to the open future argument, according to which infant circumcision is morally unjustifiable because it violates the child’s right to an open future. The paper also addresses an important objection to the open future argument and examines the strength of the objection to refute the application of the argument to (...) the circumcision case. (shrink)

This paper explores ethical considerations for active studies of circumcision, i.e., the amputation of the foreskin, in the form of a case study of three major trials performed in African countries in the early 2000s. The paper outlines the function of the foreskin and method and history of its amputation as well as its current use in attempting to combat the global AIDS crisis. These trials are then interrogated in accordance with the Declaration of Helsinki. In particular, the irreversible (...) nature of amputation is given great consideration. The case studies are found to have serious failures in terms of the modern iteration of the Declaration of Helsinki. This paper calls for extreme scrutiny in accordance with international norms relating to the ethical treatment of human subjects in a research context of studies of circumcision if and when they are proposed again. (shrink)

This essay reconsiders the haphazard arrangement of Donne's first printed collection of poems in relation to an elegy written for Donne by one Thomas Browne, published for the first and only time in that same volume. The earliest recorded response we have to Donne's verse considered as a complete body of work, Browne's elegy thematizes the readerly tendency to interpret this textual body in the light of "subjective" notions of "proper" desire. Through a close reading of Browne's poem, in which (...) I contextualize his key image of the bad reader as a "circumciser" within the theological and medical discourses of the period, I argue that Browne's response to Donne's text is at once instructively prescient -- providing a useful allegory of reading for the contemporary critic -- and also helpful in situating Donne at the cusp of a historical transformation between "medieval" and "early modern" conceptions of the sexual and the spiritual.IThe structural organization of John Donne's first printed book of poetry makes no obvious sense. Published posthumously in 1633, the collection eschews even the basic generic distinctions so familiar to Donne's modern audience: "Songs and Sonnets," "Satires," "Verse Letters," and "Divine Poems" . Several readers over the years have commented upon the disorderly configuration of Donne's 1633 text; and most recently, Leah Marcus has provided a detailed analysis of the collection in Unediting The Renaissance, itself an ambitious attempt to combine the traditional skills of textual bibliography with the insights of poststructuralist theory. Among other things, Marcus asserts that the very layout and internal composition of Donne's first collection constitute graphic evidence for the ultimate impossibility of "fixing" him within any reductively binary scheme. Indeed, for Marcus, the version of Donne projected by the 1633 Poems confirms not only her deconstructivist principles but also her aesthetic taste more generally. In her words, the collection is a striking melange of sacred and secular that refuses to separate John Donne from Jack. Verse epistles . . . jostle up against scurrilous amatory verses and evocations of human decay in a rough gallimaufry of mingled passions that projects a John Donne very like the Donne most of us value, a Donne for whom the sacred and secular are so closely entwined as to be inseparable.This reading would probably not be considered controversial in most quarters, and I too am in agreement with the main points of Marcus's argument, insofar as they go. However, I want to pause for a moment over one of the more undeveloped aspects of Marcus's interpretation, encoded in her use of the phrase "most of us." As the context makes clear, by "most of us" Marcus means a rather small band of nonreligious or liberal, professionalized, twentieth-century readers. Of course, Marcus is perfectly justified in assuming that her audience will be drawn from exactly this narrow demographic , but at the same time it must also be admitted that "most of us" therefore only refers to the tiniest portion of Donne's actual historical readership. Given that Marcus is performing an analysis of Donne's 1633 Poems, then, one obvious question emerges from her account: How might readers in 1633 have responded to the collection's juxtaposition of the religious with the secular? What might its disorganization have signified for them?One possible answer to this question has been suggested by Arthur F. Marotti, perhaps the most influential of Donne's textualist critics. In Manuscript, Print, and the English Renaissance Lyric, Marotti suggests, against Marcus, that Donne's first editors deliberately delay the readerly encounter with Donne's more earthly lyrics by burying them toward the back of the book. In other words, according to Marotti, the appearance of random disorganization that Marcus values is actually an intentional blind -- the result of a conscious attempt to "protect the reputation of Dean Donne from moral taint."However, this ingenious theory is not without flaws. For example, we are required to accept Marotti's contention. (shrink)

Opponents of male circumcision have increasingly used human rights positions to articulate their viewpoint. We characterize the meaning of the term “human rights.” We discuss these human rights arguments with special attention to the claims of rights to an open future and to bodily integrity. We offer a three-part test under which a parental decision might be considered an unacceptable violation of a child's right. The test considers the impact of the practice on society, the impact of the practice (...) on the individual, and the likelihood of adverse impact. Infant circumcision is permissible under this test. We conclude that infant circumcision may be proscribed as violating local norms, even though it does not violate human rights. (shrink)

This study set out to investigate the influence of male circumcision and other factors on sexually transmitted infections in Botswana. A syndromic approach, which diagnoses a sexually transmitted infection based on the presence of urethral discharge or genital ulcers rather than on laboratory tests, was used. The data were from the 2001 Botswana AIDS Impact Survey where a nationally representative, randomly selected sample of men and women aged 1064 years who had ever had sexual intercourse. The logistic regression technique (...) was executed to examine the association between male circumcision and self-reported urethral discharge or genital ulcers, while controlling for all other independent variables in the analysis. The main finding of this study was that among men who are circumcised, the odds for self-reported urethral discharge or genital ulcers are significantly lower than for those men who are not circumcised in both urban and rural Botswana. The analysis also showed that the odds in favour of self-reported urethral discharge or genital ulcers, for men who drink alcohol, are twice as large as those for men who do not drink alcohol, controlling for all other independent variables in the analysis. Religion and ethnicity also came through as factors exerting a protective influence against self-reported symptoms of sexually transmitted infections. The conclusion is that while male circumcision appears to be significantly associated with the risk for self-reported urethral discharge or genital ulcers, it is man’s behaviour, irrespective of ethnicity or religious dictates, that continues to play a vital role in protection against self-reported symptoms of sexually transmitted infections in Botswana. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Declining Circumcision for My Premature NewbornDionne DeschenneIn 1993, I was pregnant with my first of three sons and was busy preparing for his arrival. Unlike most parents, who focus much of their time on decorating the nursery and buying supplies, I was researching the medical decisions that I would need to make in the moments and weeks following his birth. Having worked in a hospital while a pre-medicine (...) student, I had heard the cries of babies undergoing tests and procedures shortly after birth and knew I needed to be clear on the necessity of those tests and procedures if I was going to consent to them for my baby.My husband was in the Navy and out to sea for six months, so I took a few college courses to pass the time. One was a philosophy course on ethics, and I chose the bioethics of infant male circumcision as the focal point of my coursework that quarter. This allowed me to work through my findings in a racially, religiously, and age-diverse classroom under the guidance of a skilled professor. I was shocked to learn that even the American Academy of Pediatrics (AAP) at that time acknowledged that there were no known medical benefits that resulted from circumcision. How, I wondered, could parents allow their newborns to undergo such a harrowing experience for no reason?As the months passed and the birth of our first son grew nearer, I had everything ready—all of the decisions made, the doctors prepared, and the hospital selected. All of that preparation went out the proverbial window when I contracted pneumonia at 30 weeks. I was admitted to the Naval Hospital and treated for a week before being airlifted to a nearby Army Hospital when my condition worsened. After a few days there, the doctor came in very early one morning to wake me. Our son's heart rate was slowing, and we were at risk of losing him. They needed to immediately perform an emergency Cesarean section to preserve his life. I was terrified, knowing the potential myriad adverse effects his pre-term birth could cause.We were rushed into the OR and within seconds I had an epidural in my back. Moments later, my perfect, tiny but silent baby was whisked from the room to be attended to by a highly skilled and immensely respected NICU team. My husband followed to keep a watchful eye on our son while I was taken to Recovery. A few hours later, I was allowed to join my husband and son in the NICU.Our baby was beautiful, but so tiny that my husband could hold him in one hand. He weighed four pounds and had an enormous needle in the top of his head. The nurse explained to me that the IV needle was in the best location for administering the IV fluids and medications that our baby needed. His pre-term birth had introduced the need for several tests and treatments I had not anticipated. This was immensely distressing for me as someone who wanted to research and understand so that I could make well-informed and ethical decisions. Keep in mind that this was in the days before smartphones. In fact, we didn't even have cell phones at that time! In order to do research, I needed to find a medical text within the hospital that I could read, or get to a library. I had an abdomen full of staples, couldn't drive, and refused to be away from my baby, so going to the library was not an option.Under the conditions, I relied on the hospital staff to help me understand the risks, benefits, and necessities of each procedure or test that they recommended. We formed a relationship of mutual respect. I think this was due to the in-depth [End Page 89] conversations we had during that time. That mutual respect we developed likely led to a remarkable conversation toward the end of our son's first week in the NICU. Our doctor was making his rounds when a nurse asked if we wanted to have our son circumcised that day since the doctor... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:My Circumcision Decision:A Journey of Inquiry, Courage and DiscoveryLaurie EvansBefore becoming a mother, I was teaching parents to massage their babies and offering trainings for professionals. To promote my work, in 1984, I exhibited at the Whole Life Expo in New York City. When I returned to my booth after a break, I noticed someone had left a pamphlet by Edward Wallerstein, who wrote "Circumcision: An American (...) Health Fallacy." Since I am naturally curious, I read it. Disturbed, I thought of tossing it. But, how could I be teaching a nurturing technique for newborns and avoid this topic? As a Jewish woman, how would I make the decision for my own future sons? Little did I know this one piece of paper would lead me on a path of inquiry that would change my life.One of the presenters at this conference was Dr. Robert Mendelsohn, an Orthodox pediatrician. Although Dr. Mendelsohn realized some parents would allow circumcision for religious reasons, he was honest enough to dispel every medical myth and explain the harm of removing normal functioning tissue. He also described possible complications from removing the foreskin, including infection, hemorrhage, and although rare, death.To learn more, I read whatever I could find on the topic. I attended midwifery and childbirth conferences to promote my work and prepare for when I became pregnant. I decided to ask about circumcision, but the conversations were awkward and I received little helpful information. I found that circumcision was a taboo topic; few people wanted to talk about it. Why? Doctors who perform circumcisions, nurses who recommend it, and parents who consent to it do not want to face the reality of the harm they cause. Instead of facing the pain, they avoid the topic, and the procedure continues. Most men do not want to discuss or think about their own circumcisions. I learned that we need to have compassion during these conversations.A Jewish ritual ceremony (bris) is performed on the eighth day after the boy's birth, and includes circumcision and prayers. At a bris, friends and relatives are invited to observe and celebrate. It is part of my heritage. I tried to talk to my relatives about the information I had found, but everyone refused to discuss it. This avoidance made my decision very difficult. Then, for the first time, I was invited to a bris; I didn't want to attend. However, I had been at the boy's birth, so I decided to go to offer support. During the circumcision, my reaction was intense: I wanted to take the baby and run. I felt like an accomplice. I wanted to grab people by the [End Page E2] shoulders and scream, "How dare you?" I vowed I would never attend another bris, and I made the decision to write publicly instead of anonymously.I still had doubts, because I didn't know one intact adult male. What if I were to have a son, keep him intact, and he developed a complication later in life? I have learned that doctors are not taught non-invasive solutions, so most circumcisions performed after infancy are unnecessary. A Jewish doctor recommended a circumcision for a seventynine year old man who had a persistent rash that would not respond to treatment. Our organization suggested that he apply topical acidophilus. After he followed the recommendation, the rash disappeared, so he canceled the circumcision.In 1985, I became pregnant. Like many women I spoke to, I didn't want to face the circumcision decision, so I prayed for a girl. Our childbirth educator shared about male circumcision, which led to conversations with my husband. These tense interactions ended in an impasse. I wondered how this decision would impact my marriage. I experienced immense relief that my firstborn was a girl. Time was on my side.One day while walking in New York City, I serendipitously crossed paths with my childbirth educator. She was going to the United Nations to oppose female circumcision. I was in my 30s and had a master's degree in teaching. I had studied massage and anatomy. Yet, I had never heard about this tribal ritual. I had... (shrink)

What are the effects of circumcision on sexual function and experience? And what does sex—in the sense related to gender—have to do with the ethics of circumcision? Jacobs and Arora (2015) give short shrift to the first of these questions; and they do not seem to have considered the second. In this commentary, I explore the relationship between sex (in both senses) and infant male circumcision, and draw some conclusions about the ongoing debate regarding this controversial practice.

In 2017 Ploug and Holm argued that anonymizing individuals in the Danish circumcision registry was insufficient to protect these individuals from what they regard as the potential harms of being in the registry. We argue that Ploug and Holm’s fears in each of the areas are misguided, not supported by the evidence, and could interfere with the gathering of accurate data. The extent of the risks and harms associated with ritual circumcision is not well known. The anonymized personal (...) health data supplemented with the circumcision registry will enable more precise research into the medical consequences of ritual circumcision, and allow parents to make more fully informed decisions about circumcision with minimal, if any, adverse consequences. (shrink)

This study in moral, political, and legal philosophy contends that it is morally impermissible to circumcise male minors without a medical indication (nontherapeutic circumcision). Male minors have a moral anticipatory autonomy right-in-trust not to be circumcised. This right depends on norms of autonomy and bodily integrity. These norms generate three direct non-consequentialist arguments against nontherapeutic circumcision: (1) the loss of nonrenewable functional tissue, (2) genital salience, and (3) limits on a parental right to permanently modify their sons' bodies. (...) An indirect argument holds (4) that if it is morally impermissible to remove the female prepuce (clitoral hood), then it is also morally impermissible to remove the male prepuce (foreskin). Although there is debate across medical cultures, a reasonable understanding supports the claim that nontherapeutic circumcision causes some harms and imposes unwarranted risks on male minors. The overall moral case applies to secular circumcisions and, with some qualifications, to religious circumcisions in Judaism and Islam. Arguments of political philosophy that invoke the freedom of religion, toleration, multiculturalism, and social meaning qualify somewhat, but do not eliminate, the case against circumcising male minors without a medical indication. Nevertheless, the arguments deployed in this study do not warrant legal interference at this time with secular and religious practices of nontherapeutic circumcision. (shrink)

Cyril of Alexandria was a prolific biblical commentator who underscored the meaning and relevance of the Old Testament for Christian theology by employing a typological method of interpretation. His exegetical concern was to demonstrate that everything associated with the old covenant- people, events, commandments, institutions-were types and shadows foretelling the ‘mystery of Christ’. The key to understanding the types of the Old Testament is to recognize their soteriological fulfillment in the person and work of Jesus Christ. Throughout his exegetical writings, (...) Cyril draws particular attention to the Jewish rite of circumcision, showing how the physical operation signifies the saving work of Christ through the Spirit. Cyril does not interpret circumcision in a monolithic sense, but derives multiple soteriological meanings from it. Insofar as circumcision represents a variety of saving realities for Cyril, it helps us understand his complex, multi-faceted doctrine of salvation. (shrink)

A survey of Nigerian women who have undergone female circumcision (female genital mutilation) revealed a majority in favour of the practice. Are Western feminist bioethicists entitled to condemn it?

The article aims to illuminate the recent debate in Germany about the legitimacy of circumcision for religious reasons. The aim is both to evaluate the new German law allowing religious circumcision, and to outline the resulting conflict between the surrounding ethical and legal issues. We first elucidate the diversity of legal and medical views on religious circumcision in Germany. Next we examine to what extent invasive and irreversible physical interventions on infant boys unable to given their consent (...) should be carried out for non-medical reasons. To this end, the potential benefits and harms of circumcision for non-medical reasons are compared. We argue that circumcision does not provide any benefits for the ‘child as a child’ and poses only risks to boys. We then set out to clarify and analyse political justifications of the new circumcision law. We demonstrate through this analysis how the circumcision debate in Germany has been transformed from a legal and ethical problem into a political issue, due at least in part to Germany's unique historical context. Although such a particular political sensibility is entirely comprehensible, it raises particular problems when it comes to framing and responding to medical ethical issues – as in the case of religious circumcision. (shrink)

This paper examines the attitudes of circumcised women towards female circumcision in a community where the practice is in vogue. Also described are the type of circumcision performed, who usually performs the circumcision and complications. One hundred volunteers across the social strata were interviewed by means of a structured questionnaire. Data were analysed using frequency tables. The study revealed that 62% of respondents favoured the practice as an instrument for the control of female sexuality and maintenance of (...) cultural pride. Circumcision is mainly by excision of the clitoris and the labia minora performed mainly by traditional birth attendants (TBAs). Complications include severe pain, difficulty with urination and excessive bleeding. Based on the findings, it is suggested that communities where femal genital mutilation (FGM) is practised as a social norm should be involved in any eradication campaign, with the support of national and international organisations. Research is also essential to understand FGM in order to design effective reforms. (shrink)

Ritual circumcision of infant boys is controversial in Norway, as in many other countries. The procedure became a part of Norwegian public health services in 2015. A new law opened for conscientious objection to the procedure. We have studied physicians’ refusals to perform ritual circumcision as an issue of professional ethics. Qualitative interview study with 10 urologists who refused to perform ritual circumcision from six Norwegian public hospitals. Interviews were recorded and transcribed, then analysed with systematic text (...) condensation, a qualitative analysis framework. The physicians are unanimous in grounding their opposition to the procedure in professional standards and norms, based on fundamental tenets of professional ethics. While there is homogeneity in the group when it comes to this reasoning, there are significant variations as to how deeply the matter touches the urologists on a personal level. About half of them connect their stance to their personal integrity, and state that performing the procedure would go against their conscience and lead to pangs of conscience. It is argued that professional moral norms sometimes might become more or less ‘integrated’ in the professional’s core moral values and moral identity. If this is the case, then the distinction between conscience-based and professional refusals to certain healthcare services cannot be drawn as sharply as it has been. (shrink)