- BIOETHICS FORUM ESSAY
Circumcision Deserves Circumspection
Why the change of heart? Nothing traumatic happened to my own son; in fact, he’s sick and tired of my apologies regarding his circumcision and wishes I would never mention it again. I began to change my mind when I actually saw the procedure done, and as I’ve researched the reasons for genital surgery and the ethics of informed consent over the years, I’ve become more and more convinced that neonatal infant surgery is ethically wrong.
I signed the petition because I do not want the supreme authority on children’s health, the American Academy of Pediatrics, to issue a statement that will affect thousands of pediatricians’ judgments around the country and potentially sway the decisions of the parents of baby boys.
Circumcision has a long and disturbing history in this country. In the nineteenth century doctors touted it as a cure for masturbation primarily, but also paralysis, syphilis, eczema, gangrene, tuberculosis, impotence, general nervousness, and convulsions, among other ills. By the 1920s, some 50 percent of the urban male population was circumcised; by World War II, it was pretty clear that circumcision didn’t prevent masturbation, but the threat of sexually transmitted diseases loomed large. Doctors convinced the public that circumcision prevented STDs, and so by the 1970s, 85 percent of men were circumcised. As it happens, these assertions were misguided; today the United States has the highest rate of STDs of any developed nation, the highest rate of heterosexually transmitted HIV infection, and also the highest rate of circumcision. Go figure.
Circumcision rates rise and fall, based on prevailing social, rather than strictly medical, trends. In 1999 the American Academy of Pediatrics ruled that, in fact, there was no compelling reason to circumcise boys, other than religious and/or cultural ones. Absent any clear medical reason for the surgery, parents could make their own informed decisions, the AAP advised. Now, with recent evidence about circumcision preventing HIV infection in Africa, we’re back to the disease justification again, and the AAP might determine next week that baby boys should be circumcised for this public health reason.
I would hope parents would actually heed the “informed” part of their consent, but if they’re like me, they will likely make the decision based on other factors: some want the baby to look like the dad (who probably will be circumcised based on the rates in recent history); some choose the surgery because “it looks right.” But think about it: why should surgical alteration of a baby’s penis make it “look right?” There’s something wrong with this rationalization.
Others, like me, do it for religious reasons, without evaluating the necessity of the procedure. I’m not even religious. I don’t observe any of the other Jewish laws; why this one? If anyone had told me that my son could still be Jewish (just because his mother is Jewish), even if he wasn’t circumcised, I would not have gone through with it. But no one mentioned that possibility to me because circumcision is an enduring and undebated ritual in Judaism. And in American culture more broadly, it is sadly a choice that gets made without a whole lot of thought.
Even in the world of medical ethics, circumcision is a subject that is largely ignored. Several of the major medical ethics textbooks don’t even include it in their indexes. And this is what I object to. I think that circumcision needs to be recognized as most parents’ first ethical decision that they make about and for their child. Parents should be informed of what the procedure actually entails. Remember that video of the birth process that many of us had to watch in prenatal classes? Why not see a video of a circumcision? I am convinced that most people do not know what they are consenting to, and if they did they would avoid the procedure like the plague.
Not to get too personal, but I had never even seen an uncircumcised penis until my son was born. So when people assured me that it was not a big deal — “just a snip of skin” — I naively believed them. I didn’t know how sensitive the foreskin is, what its purpose is, how protective it is, how many nerves it contains and are cut off. A 2007 study of circumcised and uncircumcised men suggests that penile sensitivity of circumcised men is lessened, and why not? The most responsive part of the penis has been excised.
Even if all the studies on the spread of HIV in Africa are valid and we all agree that circumcision prevents HIV, I think there are solutions other than surgery that would work to decrease the spread of the disease. Condoms also prevent HIV, and in fact they’re still necessary to avoid the virus even if men are circumcised. Fewer sexual partners would also help. Babies circumcised now won’t be having sex for several years, when we hope to have new and more effective strategies for preventing HIV. Avoiding HIV in adults simply isn’t a good enough reason to recommend cutting off a perfectly healthy, useful, and pleasurable part of infants’ bodies.
If men want to make this decision for themselves, for public health or personal reasons, then let them. The American Academy of Pediatrics should elevate the principle of autonomy and encourage parents to let their male children make the choice about circumcision when they’re all grown up.
Elizabeth Reis is an associate professor of women’s and gender studies at the University of Oregon and the author of Bodies in Doubt: An American History of Intersex. (Johns Hopkins University Press, 2009).
Published on: January 28, 2010
Published in: Bioethics