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Male and Female Circumcision: Medical, Legal and Ethical Considerations in Pediatric Practice
  1. Dr Sirkku Kristiina Hellsten
  1. Head of Philosophy Unit University of Dar es Salaam Dar es Salaam Tanzania

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    Edited by George C Denniston, Frederick Mansfield Hodges and Marilyn Fayre Milos, New York, Kluwer Academic/Plenum Publishers, 1999, 547 pages, US$155.00.

    The book is an exploration of the medical, legal, moral and cultural aspects of the practice of circumcision. The title suggests that the book will cover both topics, male and female circumcision. This, however, is misleading. The main focus of this collection is on male circumcision. This is problematic because the fact that female circumcision is left with much less attention means the reader may get the false impression that the practice of female genital mutilation (FGM) is not very widely spread or has less serious consequences than male circumcision. In reality, however, FGM is still extensively practised in different parts of the world and due to its radical nature its physical, mental and social effects are usually even more devastating than those of male circumcision. This important fact is undermined in the very first chapter of the book, in which the trauma of male circumcision is emphasised by the claim that the differences between male and female circumcision are mainly man-made rationalisations of the issue rather than based on the persistent structural gender inequality.

    The study starts with the historical origins of the tradition of circumcision, showing how the justification for the practice has varied from religious and cultural demands to a number of medical explanations. The first article by Nahid Touba brings out the social connections of diseases by focusing on the role that the practice of circumcision has had in medical history. Removal of the male foreskin has been believed to cure insanity, masturbation, epilepsy, cancer of the penis and even cancer of the cervix of the future wives of the circumcised boys as well as sexually transmitted diseases and particularly phimosis (either as a disease or as a cause of other diseases such as cancer). Even presently the relation between circumcision and HIV/AIDS is still extensively studied and debated. This shows that while opinions on the diseases that circumcision is to be used to prevent or to cure has changed throughout the times, circumcision as such has persistently maintained its place as a medical practice.

    While the book gives lots of attention to the traditional religious and cultural justifications of circumcision, it also attempts to explain why the practice has persisted this long in modern societies such as America. Articles by Van Hower and Paul M Fleiss, for instance, note that justifications for the routine operation of circumcision in North America are usually based on alleged medical conditions. Thus, the practice has gained stronger rational justification than is generally given to the religious or traditional demands of many other cultures. The same was earlier true in the case of female circumcision in which a form of clitoridectomy was used both in Europe and in America either for hygienic reasons or as a medical cure for masturbation and for mental disorders such as hysteria. Since both male and female circumcision were practised by qualified doctors for allegedly legitimate medical indications in the Western countries, they were not considered to be the same brutal and intervening mutilations of the human body as they were seen to be elsewhere in more primitive societies. This shows that the medicalised nature of Western culture itself can give legitimisation to even violent and unnecessary physical interventions of the human body in the name of science, progress, normality and health.

    In this context particularly worthy of note is the comparison between the United States and Europe in the case of male circumcision. The study shows how in the United States, due to the widespread diffusion of the “scientific myth”, the medical data with counter-results was deliberately ignored or misinterpreted. For instance, the latest reports from European medical research on the issue were neglected in order to maintain the practice even when it was already rapidly disappearing in Europe. An additional explanation for the maintenance of the practice in modern, market-oriented American society is found in the commercial exploitation of children through circumcision. Physicians, in cooperation with transnational biotechnology corporations, look for the sales of marketable products made from harvested human foreskins, that can be used in the pharmaceutical industry.

    In this book the legal and ethical aspects of the practice of circumcision as well as its physical, mental and social consequences are, for the most part, discussed from medical and empirical points of view rather than set within a wider framework of philosophical ethics. Nevertheless, the book takes a clear ethical stand against the practice and the articles show plausibly how little factual basis the religious and cultural justifications of the practice have, even in cases based on medical rationalisation. All in all, the book is useful not only for medical professionals but also for philosophers and ethicists.