Sunday, December 04, 2005

Just a little off the top, thanks

A few thoughts today on circumcision . . . I'm plunging into the topic of male circumcision with more than a little bias. I like my pupik* the way it is, and I'm not about to change it by "foreskin restoration techniques," non-surgical or otherwise. My defensive hackles are raised whenever I hear this sort of inflammatory rhetoric from the anti-circumcision faction: The medical community has long based this protocol for obtaining consent on the assumption that a parent may legitimately give consent to the non-therapeutic circumcision of a child. There is, however, no basis in law to support this assumption. A male neonatal circumcision is neither a diagnostic procedure nor a treatment of a disease. Thus non-therapeutic circumcision is, in effect, an act of battery. No parent can grant consent for an act of battery. Such language makes me want to rant about the health benefits of circumcision, but Wikipedia has done that for me. Groups that oppose circumcision ('male genital mutilation,' in their parlance) counter that circumcision is tantamount to amputation: healthy erogenous tissue is removed for no immediate medical benefit, and arguments to the contrary are based on post-pubertal sexual practices. If the kid wants those health benefits, let him decide it for himself when he's older. I'm not so fanatical that I want all baby boys circumcised. I'm in favor of the British Medical Association's recommendations, which requires doctors to act in the child's best interests**, obtain consent from both parents, involve children in the discussion (for older boys, naturally), and 'act in accordance with good clinical practice and provide adequate pain control and aftercare.' This is in line with the recommendations of the American Medical Association and the American Academy of Pediatrics, who state: Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In circumstances in which there are potential benefits and risks, yet the procedure is not essential to the child's current well-being, parents should determine what is in the best interest of the child. To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision. If a decision for circumcision is made, procedural analgesia should be provided. While it's nice that my opinion sits squarely in the mainstream, I still find myself squeezing my thighs together when the Intactivists get rolling -- especially folks like Penn and Teller, whom I otherwise idolize. (In case you're not familiar with them, Penn and Teller are a something of a phenomenon: part magic act, Vegas show, force of nature, and Crusaders for Truth in their Showtime series, Bullshit!) Why do they care so much about what other people are doing to their kids' pupiks? Note: I'm trying to avoid using that other p word in the same sentence as 'babies' or 'kids.' You wouldn't believe the sickos who come out of the woodwork, searching for the sick crap. And yet, I can understand where the Intactivists*** are coming from. No, it's not fair that parents alter (mutilate, if you prefer) their children without the kids' consent. But, to quote David Bowie's character from Labyrinth, "Whoever told you life was fair?" Parents do lots of things to their kids without their kids' consent. Giving birth to them in the first place -- that's the real capper. Everything else is small potatoes. According to UNICEF's website, over half the kids in the world come into the world saddled with poverty, war, or HIV. That's more than one billion children. My question to the Inactivists: why get exercised over a snippet of foreskin when there are far worse crimes perpetrated against infants and children every day?
The controversy derives in part from the fact that male circumcision is (1) usually complication-free, and (2) also free of serious long-term adverse consequences. It's like ear piercing, another common body modification imposed on infants. The risks and benefits are equally slight. It's hard not to wonder what all the fuss is about. Not so female circumcision, but for me, that's a far easier ethical question. When parents doom their daughters to a lifetime of pain and impaired function, the word 'battery' seems not only apt but inadequate. Religious freedom does not mean a parent is free to harm those under his protection. This goes for those folks who deny their kids proper medical care, too -- not just the "healing prayer" folks, but those who refuse to vaccinate their children. As for male circumcision, I'm aware that I'm falling into a well worn pattern. Folks who oppose circumcision tend to exaggerate the risks and longterm ill effects, while those who favor circumcision downplay the very same, or emphasize the (admittedly minimal) health benefits of the practice. And so I'm left in my usual quandary when it comes to ethics questions. (Hmm. How about a blog entitled, Ethics, Shmethics?) I can see the merits of both sides of the debate. I have an opinion, but I have a hard time backing it up with anything more than wimpy protestations ("The AMA and the BMA think like I do -- nyaah, nyaah, nyaah!") I'm forced, ultimately, to justify my bias on the basis of a personal aesthetic argument: Uncut penises? Funky. D. *Pupik = bellybutton everywhere else in the Yiddish-speaking world; but in my family, it meant . . . well, you know. **Thus, if the child's health were too precarious to undergo the procedure, the doctor would refuse to perform it, even if both parents insisted. ***Thanks to Stephen for picking up on my misspelling.


Blogger Stephen said...

My question to the Inactivists: why get exercised over a snippet of foreskin when there are far worse crimes perpetrated against infants and children every day?

This is a type of argument that I really hate to see being used by anybody about anything. Unless you are arguing that circumcision would prevent these crimes, the question above is simply a rhetorical device aimed at distracting people. Why are you blogging about circumcision when there are so many more important topics to blog about? See - it doesn't add anything to your argument.

I have noticed the change of name, btw. Does this amount to a test drive for it?

12/04/2005 04:15:00 PM  
Blogger Douglas Hoffman said...

I have noticed the change of name, btw. Does this amount to a test drive for it?

Perhaps. But if that were the case, the blog should be named "Odds and Ends" ;o)

Stephen, this is why I wade into ethics discussions with great trepidation. I tend to get my head handed back to me. I do it because it helps me to think about the tougher issues when people like you come along and bring up points I don't know how to counter.

My problem is that I can understand the Intactivists' point of view, and I'm having a difficult time countering it. The argument I used may be inadequate, but so is the health benefit argument (the benefits exist, but they're arguably too slim to justify circumcision), or the argument that the AMA and BMA both condone the practice, given it's the parents' informed choice, etc.

I've always liked the argument that if the son doesn't look like the father, the son will get some sort of psychological problem. Trouble is, I don't think there's a microgram of data to back that up.

I wonder . . . is it any better to argue that ear piercings set a precedent for involuntary body modification? That seems weak, too.


12/04/2005 05:15:00 PM  
Anonymous PBW said...

There are medical and pyschological issues that sometimes require (or prevent) circumcision. A couple of babies I've helped deliver had foreskin so tight it could not be retracted for proper hygiene. Stretching the foreskin is possible, but it requires the kind of daily manipulation that most new mothers are simply not comfortable with.

On the flip side, I've never known an OB to perform a circumcision on an infant whose health condition made it in any way a risk. SOP in the hospitals I've worked is that if baby is not healthy, baby doesn't get snipped until the health problem is solved.

Religious preference and personal hygiene aren't the only reasons to consider circumcision. Studies have shown that women whose partner(s) is/are uncircumsized run a much higher risk of cervical cancer than women with circumsized partner(s).

As for the idea that circumcision is battery on a baby, I'd have to say vaginal delivery is just as stressful, if not as painful, as circumcision. Should we ban natural childbirth so the baby isn't battered by uterine contractions, or squeezed while passing through the birth canal?

12/04/2005 09:38:00 PM  
Blogger Dean said...

My reasoning on this is simple: I wouldn't let anyone chop bits off my daughters, so I won't let anyone chop bits off my son.

Lynn: are you sure it's 'much' higher? I thought studies had shown a weak link? I further thought that studies had shown a strong link between cervical cancer and human papillo-whatever virus (genital warts to the layperson).

12/05/2005 04:48:00 AM  
Blogger Darla said...

The only time I get terribly incensed about the subject is when people start saying everyone either should or should not circumcise their baby boys.

I used to get angry when I'd hear young women say a guy being uncut would be a sexual deal-breaker, but then I realized I wouldn't want my sons sleeping with those women anyway. :-)

12/05/2005 06:48:00 AM  
Anonymous PBW said...

Before I start linking to things I should mention that I'm not for or against circumcision, as I think it's a decision parents should make privately according to their concerns, preferences and religious beliefs.

Dean, there's a good article here that explains the HPV connection between uncircumsized men and women who develop cervical cancer. I was diagnosed with cervical cancer fourteen years ago so I've read a lot of studies about it.

Web MD has a good article here about other health issues involved with circumcision.

12/05/2005 07:50:00 AM  
Blogger Douglas Hoffman said...

I'm getting hammered in the office, clinic, and ER this morning, so I'll comment later on today. Thanks for your comments, everyone.

12/05/2005 10:30:00 AM  
Blogger Shelbi said...

I thought the tight foreskin was normal in a newborn. The research I did before my son was born said that the foreskin loosens up with time, and at about five years old, can be fully retracted for washing purposes.

I also read that the UTI thing was true, but the cases of UTIs in circ'd and uncirc'd babies under one year old was so rare that even to be 10 times more likely was still negligible.

The thing about STDs looks like a cleanliness issue, and while I can't be sure [when he gets older] that my son will wash every day, washing after sex just seems a given, because, eww, you know?

I can see how encouraging circumcision in areas where water isn't readily available for washing purposes makes perfect sense, [who knows, maybe that's part of the reason God wanted the Hebrews to be circ'd?] but for those of us with running water, it seems like an issue that is personal choice.

It does seem kind of unfair, however, to choose to circumcise without letting the kid in on the decision, especially if it's only on the grounds of aesthetics.

12/05/2005 11:46:00 AM  
Blogger Dean said...

Lynn: thanks for the link. I did not know that there was such a strong correlation.

12/05/2005 01:12:00 PM  
Blogger Douglas Hoffman said...

Great links, Sheila. I had a mid-afternoon hiatus (a few cancellations) and managed to read both articles. Over lunch, I confused myself all over again by reading this article, which is anti-circumcision, but lacks the usual emotional anti-circ rhetoric.


12/05/2005 02:56:00 PM  
Blogger Bernita said...

Considering that, except for those for whom it has religious component, the pros and cons seem about equally balanced - it strikes me as a "busybody" issue.

12/06/2005 12:52:00 PM  
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