Today, a German judge effectively outlawed the circumcision of german minors, ruling that the procedure amounted to "bodily harm" and "contravenes the right to choose religion later in life". The judge and his ruling are wrong on both accounts.
There are a variety of possible positions that a state might assume on this issue: ban the procedure outright, require parents to opt-in, require parents to opt-out, or to mandate the procedure. As A. M. Viens argues, generally but not always, it is appropriate to defer to parents on the issue of the well-being of their children. One notable exception is the issue of vaccination; the choice by a few parents to forgo their children's vaccination endagers the surrounding population while there is no significant risk involved in vaccination. For a ban on such a medical procedure to be justified, there would need to be compelling evidence that there is no medical benefit or that the medical risks outweighed the medical benefits. In the case where the medical outcome is unclear, the only moral policy is to defer to the wisdom of a child's parents.
I'm going to leave the medical details at the bottom in case you want to take my word for it or don't feel like reading about circumcision in detail. The conclusion about medical risks/benefits is pretty clear, though. There are cases in which male circumcision provides substantial medical benefits, most significantly where there is a high risk of HIV among the heterosexual male population. There are also cases where male circumcision involves significant risks, such as the circumcision of premature infants and older boys, and extreme risks, such as when the procedure is performed by someone other than a trained medical professional.
As far as religious choice goes, I am aware of no situations where someone has been denied admittance to a religion on the basis of that person's circumcision. So, unless I've overlooked something, it seems bizarre to suggest that circumcision contravenes ones right to choose religion later in life. However, due to the increased risk of undergoing the procedure later in life, in cases where the state forbids infant circumcision, the state actually creates a barrier to particular choices of religion, though I'm not sure this should effect legal consideration.
So, on balance, the only moral and just policies seem to be those policies that (A) carefully regulate the practice and ensure that it is performed safely by trained medical professionals with minimal risk; (B) encourage or make standard the procedure in situations where it is safe and there is a significant public health benefit; and (C) allow or require the wisdom of parents and medical professionals to intervene in cases where the procedure does not meet criteria (B).
The fact that this is a judicial precedent and that it regards the circumcision of a 4-year old boy means that it could very likely not result in a de facto ban on infant male circumcision, despite what we are hearing from the talking heads. But, to the extent to which the decision of this judge affects the circumcision of infant boys, it ignores strong medical and scientific results and contravenes, not the ability for adults to freely choose religion, but the moral duty of parents and doctors to decide in favor of the well-being of their children and patients.
Let's start with the evidence of medical benefits:
The World Health Organization has concluded (based on, I believe, this study) that male circumcision "reduces the risk of heterosexually acquired HIV infection in men by approximately 60%". The conclusions from studies of the effect of male circumcision on other STIs vary between a significant reduction of risk of HPV to a non-significant reduction of genital warts. Notably, to the best of my knowledge there is no evidence suggesting that circumcision increases the risk of any sexually transmitted diseases.
Additionally, circumcision significantly reduces the risk of general infection including urinary tract infections, though, as these studies note, the risk of non-STI infection is unlikely to justify the procedure alone.
There is also a significant reduction of the risk of invasive penile cancer, mixed evidence of the reduction of prostate cancer, and no significant reduction of the risk of cervical cancer in female partners.
And for the evidence of medical risks (I'm limiting this to infant and minor but not adult circumcision since that is the issue at hand):
There is very strong evidence that infants experience pain during a procedure when analgesic is not used but there is also evidence that this can and should be mitigated by one of a variety of methods. The psychological effects attributed to circumcision are most often suggested to be a result of the pain during the procedure and thus may be reduced by a reduction of pain during the procedure.
It has been suggested that circumcision, one way or another, reduces the ability of the adult to experience sexual pleasure. The literature is mixed but large survey studies have concluded that there is no significant effect.
There is a huge amount of literature on the complications resulting from the procedure. Those interested can look here, or to the wikipedia article. It's clear though, that the risk of any complication is very low (below 1%) when the procedure is performed on healthy infants. The risk increases with premature infants or young boys, in some cases to 10%. The risk of death or genital loss are very low (at most 1 in 500,000 and 1 in 1,000,000 respectively) when the procedure is performed by a medical professional.
No comments:
Post a Comment