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Editorials
The ethics of infant male circumcision
  1. Brian D Earp
  1. Correspondence to Oxford Uehiro Centre for Practical Ethics, Suite 8, Littlegate House, St Ebbes Street, Oxford OX1 1PT, UK; brian.earp{at}gmail.com

https://doi.org/10.1136/medethics-2013-101517

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    INTRODUCTION

    Is the non-therapeutic circumcision of infant males morally permissible? The most recent major development in this long-simmering debate was the 2012 release of a policy statement and technical report on circumcision by the American Academy of Pediatrics (AAP). In these documents, the US paediatricians’ organisation claimed that the potential health benefits of infant circumcision now outweigh the risks and costs. They went on to suggest that their analysis could be taken to justify the decision of parents to choose circumcision for their incompetent children.1

    Circumcision and ‘health benefits’

    The AAP's pronouncement unleashed a firestorm of commentary, much of it censorious. In this issue, human rights attorney J Steven Svoboda and Professor of Clinical Paediatrics Robert Van Howe take the AAP to taski for committing numerous significant errors, both in their analysis of relevant evidence and in basic medical-ethical reasoning.3 In addition, an independent international panel—composed of 38 leading paediatricians, paediatric surgeons, urologists, medical ethicists and heads of hospital boards and children's health societies—has likewise condemned the findings of the AAP. Writing in the journal Pediatrics, these authors state: Only one of the arguments put forward by the American Academy of Pediatrics has some theoretical relevance in relation to infant male circumcision; namely, the possible protection against urinary tract infections in infant boys, which can easily be treated with antibiotics without tissue loss. The other claimed health benefits, including protection against HIV/AIDS, genital herpes, genital warts, and penile cancer, are questionable, weak, and likely to have little public health relevance in a Western context, and they do not represent compelling reasons for surgery before boys are old enough to decide for themselves.4

    My own analysis of the AAP documents—and of ‘health benefits’ defences of circumcision generally—can be found elsewhere.5 Let me turn my attention in this editorial, then, to …

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    Footnotes

    • Competing interests None.

    • Provenance and peer review Commissioned; internally peer reviewed.

    • ↵i A formal response by the AAP has been published alongside the critique by Svoboda and Van Howe.2

    • ↵ii The Cologne court ruling is discussed in detail by Reinhard Merkel and Holme Putzke,6 as well as by Joseph Mazor7 and Matthew Johnson.8

    • ↵iii See related arguments by Van Howe.11

    • ↵iv Or at least: non-ecclesiocratic.

    • ↵v See Svoboda.14

    • ↵vi For an in-depth discussion of the child's right to an open future, see Darby.15

    • ↵vii See also Earp and Darby.16

    • ↵viii These laws do not literally have asterisks. In the typical case, there is one statute banning assault, or sexual assault, or invasive rites, or child abuse, and then a second law saying that no criminal violation shall result from ritual (male) circumcision—even though it formally fits the definition of assault/abuse in the first law. For examples, see Geisheker.17

    • ↵ix Following the 1986 UN Convention on the Rights of the Child.

    • ↵x See Davis.18 In contrast with the outright prohibition of female genital cutting in Western democracies, male genital cutting is not only legally permitted, but is not even regulated. In other words, in most parts of the world, including in developed nations, any person, for any reason, using any implement, in any environment, with any degree of pain control (or none), any amount of training (or none), any assurance of a sanitary environment (or none), and any level of medical knowledge (or none), can attempt to perform genital surgery on a newborn boy if it is claimed that the procedure is a circumcision. It is only when such lay attempts lead to emergency hospitalisation of the infant because his life is in danger that public concern becomes aroused. See Geisheker17 for further discussion.

    • ↵xi Metzitzah b'peh is a form of circumcision practiced by some Orthodox Jews in which the ritual circumciser takes the baby's penis into his mouth to suck away the blood after the wound has been inflicted, sometimes transmitting the herpes virus. See the discussions by Ben Yami10 and Davis.18

    • ↵xii Mazor concedes, however, that circumcision probably should not be performed in the ‘secular’ case when considering the child's best interests—one of which is an interest in self-determination. He simply leaves the ultimate decision up to the parents.

    • ↵xiii Of course, religious fundamentalists within Islam and Judaism will not find these sorts of arguments compelling, but they do not have—and are not entitled to—a monopoly on matters of theology, faith or ritual practice.

    • ↵xiv In Judaism, female babies are unapologetically excluded from participation in the sealing of the divine covenant; hence, the practice is inherently sexist. Islam is more ‘egalitarian’ in permitting circumcision of girls as well as boys.

    • ↵xv Brit shalom means ‘covenant of peace.’ Contrast with brit milah, the name for the traditional Jewish genital cutting ceremony, which means (loosely) ‘covenant of circumcision’ (milah means ‘to cut’). More information on this alternative, peaceful brit can be found by visiting the website at ref. 25

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