Circumcision

July 18, 2020

Do No Harm - the circumcision debate


In medicine, the most important rule for physicians to follow is that of nonmaleficence.  Nonmaleficence is a fancy way of saying “do no harm.”  And perhaps the greatest breach of “doing no harm” would be performing an unnecessary surgical procedure.  


Not only is circumcision an unnecessary surgical procedure, but performing it on a newborn violates one of the other hallmark ethical pillars of medicine: autonomy, that is, that a patient should be involved in the decision making of their own care.   


The Bris and Beyond


The Old Testament mandates that every Jewish boy is to be circumcised on the eighth day of life.  For millennia, Jewish males have thus been circumcised as infants, a tradition that has carried through to modern times.  Beyond this, it has also become routine for many non-Jews to also have their children circumcised in infancy.  In some areas of the United States, over 50% of males are circumcised.  


But isn’t circumcision a good thing? 


Many will argue that circumcision is not an unnecessary surgical procedure.  Various medical bodies provide different recommendations in regards to whether the benefits of circumcision outweigh the risks.  


It is true that uncircumcised males might have a higher risk of urinary tract infections and more cases of balanitis, an inflammation of the head of the penis.  But any honest medical professional would tell you that the low prevalence of these conditions and their lack of serious morbidity nullifies the argument that circumcision should be deemed medically necessary.  For the most part, these conditions are quite rare and easily treatable.  


There are also those who cite an increased risk of HIV in the uncircumcised population as a justification for the procedure.  But the studies that have sought to demonstrate an increased risk in the uncircumcised have been fraught with bias and error and have mostly been conducted in Africa.  These results should not be considered transferable to the populations of Western countries.  


One could theoretically make an argument in favour of any surgical procedure.  The appendix has no known physiological function of significance, yet we don’t cut out people’s appendices because they pose the risk of appendicitis.  Yes, an appendectomy is a more invasive procedure than circumcision, but this merely illustrates the point that we do not simply perform surgeries in medicine for prophylactic measure.  


If we are honest with ourselves as a society, the primary motivator for people to circumcise their children has always stemmed from religious and cultural traditions.  Jews and Muslims do not circumcise their children in order to prevent urinary tract infections.  They do so because it is a longstanding tradition in their heritage.  And the more widespread practice of circumcision that has developed outside of religion has been normalized by this religious precedent and was largely fuelled by a whole other set of societal contexts beyond the scope of this article.  


Is it really a big deal though to circumcise your child?  


So let’s agree for a moment that circumcision isn’t medically necessary.  Let’s accept that it is an unnecessary surgical procedure that defies a child’s autonomy.  Still, is it really a big deal to circumcise your child?  Is this just philosophical pontification, or are there people who actually grow up to resent the fact that they were circumcised as babies?  


First of all, it should be noted that circumcision, like any surgical procedure, is not completely benign.  The foreskin is not a distinct anatomical region, so it is tough to know where exactly the foreskin should be cut.  Excising too little tissue could necessitate a second surgery, while excising too much foreskin tissue could lead to tight and painful erections later on in life.  It is impossible to quantify the number of men who might experience this latter issue, as most men would just accept their anatomy as normal and not investigate further.  Similarly, it is impossible to properly contrast the sexual pleasure experienced by men who have been circumcised with those have not.  We do know that the foreskin is the most sensitive part of the penis and can assume that having a foreskin might contribute to increased sexual pleasure.  But given the subjectivity of pleasure and sexual experience, it is impossible to reliably study.  


But perhaps more important is that there are men who grow up to be resentful over having been circumcised.  Brian Earp, an ethicist at Yale University and a leading expert in the ethics of circumcision, joined Preconceived to share his views.  He described how his and others’ research has demonstrated that the more one knows about circumcision, the more likely that person is to be upset about the fact that they were circumcised.  In contrast, the less one knows, the less one cares.  Some men resent what the circumcision represents – a religious branding on the most personal part of their body.  In an increasingly more liberal society, it is not uncommon that a man might disavow his religion and wish that his parents’ faith had not been marked onto his body.  


“Genital mutilation” 


While male circumcision is a fairly routine ritual in Western societies, any form of female circumcision is widely viewed as archaic and referred to as “genital mutilation”.  While some forms of female circumcision do entail more invasive surgical procedures than male circumcision, the idea that one is mutilation and that the other is not, is something to which we have been conditioned to believe.  In fact, there is one form of female circumcision performed in some cultures known as a “ritual nick”.  This is far less invasive than male circumcision, yet performing this procedure is considered criminal and could land the “perpetrator” in prison.   


Circumcised and uncircumcised - A complicated issue


This article is not meant to diminish the importance of cultural traditions or circumcised men.  Circumcision is a sacred ritual in the eyes of many, and to simply dismiss centuries of tradition would be insensitive.  But we do need to ask ourselves what is more important – adhering to a longstanding tradition, or respecting a male’s right to autonomy over his own body?  

Let’s at least be honest with ourselves and call a spade a spade.  For the most part, people are not circumcising their children because it is medically necessary.  Let’s do away with the rationalization of an unnecessary surgical procedure on a non-consenting baby in the name of health and medicine.  And let’s stop pretending that male circumcision is civilized, while all forms of female circumcision are archaic and should be criminalized.  Let us acknowledge that on some level, we have simply been indoctrinated to believe that males  getting circumcised is a normal practice and that perhaps we need to reconsider whether it truly aligns with our values at large.   


Listen to the preconceived podcast as we continue to challenge the paradigms by which we have been conditioned to live our lives.

 


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