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indi wrote

The rhetoric from both sides of this debate is often downright histrionic. On the "for" side people roll out either incredibly stupid arguments ("I want him to look like his father") or way oversell the medical benefits. On the "against" side, you get people who mindlessly call it "child abuse" because they can't really be arsed to give it any serious thought.

I've had to research this quite recently because there is someone trying to start a court case in Canada to get it banned. I've never been a fan of circumcision, and I'm not circumcised myself so I have no skin in the game (pun intended). But after doing the research the conclusion I came to is that while it's not something that should be done routinely, outright banning it is too far.

The reason why is that unlike with female circumcision (aka, female genital mutilation) there are actually quite a few medical benefits from circumcising penises. Most of the benefits are fairly slight - like a minor reduction in the likelihood of getting HIV when condoms are much more effective - but they're not completely zero. I don't have the list of benefits in front of me right now, so don't trust my memory, but recent research has shown that it reduces risk for: HIV, HPV, penile cancer, phimosis (obviously), and more. Furthermore, the evidence so far is that most of the benefit comes from early circumcision... so if you say "just wait till they're old enough", that won't work.

That all has to be balanced against the risks of the procedure. The one most of the frantic "against" people freak out about is decreased sensation, but that's actually something that hasn't been proven scientifically, so it's not a real risk under consideration. There are risks of complication during the procedure, as with all surgery. And of course, there is the issue of permanently altering the person's body without their consent.

So never mind all the people freaking out on the "for" and "against" sides. This is really a question of balancing risks. A caretaker and a medical professional have to balance the pros (reduced risk of all those ailments) against the cons (risk of the procedure, the fact that you're permanently altering the child's body). Right now, according to all the best science we have, it's too close to call. You could reasonably go either way, especially considering other factors. (For example, certain conditions may make it far too dangerous to do the procedure... on the other hand, taking into account the conditions the child will likely be raised in, the small benefits of circumcision may become very important.)

That's about where every medical organization in the world is at right now. In fact, there are several that said the procedure shouldn't be done at all a few years ago... but have changed their tune with the new data. The current recommendation from most medical organizations is that it shouldn't be done routinely... but it shouldn't be banned. Obviously a lot more quality research is needed, and maybe when more evidence comes in, the pendulum will swing firmly one way or the other. But for now, the science says: it's not usually recommended, but could be considered in some cases.

And because I base my own position on science and evidence, that's where I stand on the issue too.

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selver wrote (edited )

Hmm. So you believe that there's no ethical dilemma about performing painful body modifications on those who are not able to consent, as long as it can be proven that it has more health benefits than risks? There's no concerns about bodily autonomy there? And what about psychological effects, have those been studied?

I'm not saying I disagree, just curious. The only actual counterpoints I can come up with are really just an appeal to nature, or makes an unjustified(?) assumption that not doing something without consent will always be more ethical than doing something without consent, regardless of the outcome. But accepting your position would also open the door to other possible child body mods.

How much of a benefit does there have to be before consent is not needed?

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indi wrote

So you believe that there's no ethical dilemma about performing painful body modifications on those who are not able to consent, as long as it can be proven that it has more health benefits than risks?

It's not that I believe there's no ethical dilemma, it's more that I think the dilemma is both wildly overstated and simplified to the point of stupidity by opponents.

Concerns about consent and bodily autonomy, while very real, are usually taken to hysterical extremes. Parents and guardians are already expected to be the ones to provide consent in the name of children. We don't call parents "abusive" when they give their child a haircut the child doesn't like. Now, here opponents of circumcision would waffle by saying "oh, but it's just a haircut, it's not permanent"... but that's not the point. If you ran up to an adult and cut their hair without consent, that's straight-up assault. So, why isn't it assault to cut the hair of a child without consent?

(I can come up with examples of permanently "damaging" the child. But to do that, I have to point to "damage" done to an organ that most rabid anti-circumcision types never even give a thought to: the brain. Right from birth, parents are making choices "without the child's consent" that make permanent, irreversible changes to the child's brain. Everything a parent chooses to teach a child... and everything a parent chooses not to teach a child... permanently changes that child's brain, and those changes have monumental impact on their adult life.)

The point of that example is to illustrate that a lot of the opposition to circumcision is by people who really haven't thought it through, and carelessly apply adult rules to children.

The ethical dilemma isn't: "it's never right to permanently alter the body of a person without that person's consent". Parents/guardians do have the right to make permanent decisions for a child... they must have that right, because a child can't consent to a medical procedure in any case. The dilemma is: "what are the powers and limits a parent has in making permanent decisions for a child?".

And generally our answer to that in most modern societies is something to the tune of imagining what the child would choose if they had adult reasoning capacities and were making the "best" choice in their own interests. The tricky part is that "best" is a pretty subjective measure, and most adults don't exactly make the most rational choices even when they have the power of self-determination. It's not exactly crazy to suggest that an adult male might look around, see most of their friends circumcised and feel the judgment of partners who are used to circumcised men and think uncircumcised penises are "weird" (I once dated an American girl who told me that), and actually choose to be circumcised. Add in cultural/social/religious norms and the likelihood even increases. And I haven't even mentioned the medical benefits yet, but think about it: if the choice is between possible penile cancer versus an hour or two of pain as an infant when you're not even going to remember it... the choice isn't as obvious as circumcision opponents think.

And what about psychological effects, have those been studied?

I don't know if that's ever been studied, but if you think about it: almost a billion people are circumcised, including many millions of Americans... yet how often has this ever been a political issue? There are way more people in the US advocating for banning abortion or gay marriage - or even legalizing ayahuasca! - than there are advocating for banning circumcision. Even men, who should be more concerned about circumcision than about abortion because the latter is really of no impact to them, care more about those other things!

And aside from simply not caring, if there really were majorly noticeable psychological effects from circumcision, they would be pretty damn obvious. There are parts of the US where the number of circumcised men is over 80%, and some even higher... and some where it's as low as 20% or lower. Across Canada, the rates go from 5% to something like 40%. You'd think if there were measurable psychological effects, someone would have noticed them by now.

The only actual counterpoints I can come up with are really just an appeal to nature, or makes an unjustified(?) assumption that not doing something without consent will always be more ethical than doing something without consent, regardless of the outcome. But accepting your position would also open the door to other possible child body mods.

Yes, it might, which is why I'm not saying there is no dilemma.

I'd agree that "not doing something without consent will always be more ethical than doing something without consent" is probably a good rule of thumb. What bothers me is turning it into an absolute rule. A good rule of thumb is almost never a good rule when applied absolutely.

It's all about balance: going full tyrannical "the state decides what's best for a child and not the parents" is just as bad as going full libertarian "parents should be able to choose whatever they want for the child without state interference". And the balance will depend heavily on the situation in question; I don't believe it is possible to make a single, absolute rule that will cover everything.

Obviously sometimes the balance will be pretty damn clear. I don't think anyone can sanely argue that a parent should be able to say: "I think this baby will look so much cuter without all those arms and legs flailing around; honey, get me the saw!" But even that is a context-dependent choice: there may actually exist a society where most people like having no arms or legs (you can imagine some kind of science-fictional world where people truck around in exoskeletons and those who grew up limbless from infancy have an easier time of controlling them because no phantom pain and so on), so in that society, a rational adult might actually be angry their parents didn't saw off their limbs as a baby. (Or hell, even without speculating about science fictional societies, I could just be completely off base because I'm blinded by my ableist biases.)

I honestly can't think of a universal heuristic that will work in all cases. But I think this one comes close: Whatever choice is made, it has to be justified as being in the child's best interest. In other words, saying "I'm going to perform surgery on this child's face because I find it ugly" is not cool, but "I'm going to perform surgery on this child's face because they have a cleft lip and that could lead to infections, speech problems, and social ostracization for the child" is... even though we're talking about the same procedure in both cases.

Male circumcision sits in a fuzzy space straddling good reasons and bad reasons. "I'm going to circumcise my boy because God (or my religion) says so" is a stupid reason... but "I'm going to circumcise my boy because it will make him better fit in with our society/culture" is much less so. Is it enough to justify circumcision? I don't think so. But when you take that and add the potential medical benefits... it's not enough to make circumcision the right choice in all cases... but it's enough of a reason to make a blanket ban seem gratuitous.

How much of a benefit does there have to be before consent is not needed?

To reword what you're asking in another way that really highlights the problem: "How much control should we give the state over deciding what's best for children, rather than parents/guardians?"

The correct answer is - I hope obviously - not "total control", which is why a total ban on letting parents choose something that appears to do very little harm and even has some medical benefits feels like it's going too far.


For the record, because I don't think I've stated my own personal position: I am very opposed to circumcision of minors (without a medically justifiable reason, of course). I think it's stupid and barbaric. I think all the cultural, social, and religious justifications are stupid and not worth even considering. I acknowledge the medical benefits (and that's a new thing; just 5 or so years ago, there really wasn't enough evidence), but I don't think they're enough to justify the procedure. (In this, I am backed up by the Canadian Pediatric Society, which used to recommend against circumcision completely, but after the new evidence came in, now just recommends against routine circumcision.) I am not circumcised and neither is anyone in my family, and I would never even consider doing it to a child under my care.

However....

Given that there are proven medical benefits, and given that there are no medically-proven harms, and given that it's such an important custom in some cultures, I don't believe a complete ban on it is justified. In fact, I believe keeping it legal would be better, because then the procedures could all be done safely in a hospital. And doctors could warn parents of the potential risks, so at least they'd be getting both sides of the issue, and not just "everbody in my culture/region does it, so I'll do it to". (I would say banning non-hospital circumcisions is fine, though.)

My own personal opposition to it doesn't give me the right to dictate to others, and I don't really have any solid science or reason to back me up. I don't like it... but without the evidence or logic to back me up, I can't justify forcing my beliefs on others in this case.

Besides, rates of circumcision are dropping rapidly worldwide. We don't need to ban it. It's going away on its own. People are figuring out for themselves that it's a stupid and barbaric practice. At this point, banning it might even be counterproductive. Sometimes the best way to fight a regressive ideology or practice is to simply step back and let it die of its own stupidity.

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Dumai wrote (edited )

i think you're right to be skeptical, especially because western-sponsored circumcision campaigns in southern africa to combat hiv have had pretty damaging racist consequences. however the fact that these health benefits do exist (and they're one reason why west africa, with its generally higher rate of circumcision, has a much lower rate of hiv) mean we, at the very least, should not call parents who make this decision abusive.