Male Infant Circumcision? YES or NO

intimate participation with those of the opposite sex always involves practicing ephemerality of emotion, and evanescence of position!
[in order to secure the safety of one's 'nether regions'. Shocked

]

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smt: Unfortunately, I gave the impression that my checklist was targeted at statements that you had made. That wasn't my intention or my purpose. Indeed, I made the checklist to determine exactly what you were trying to say. I believe that these kinds of issues can be discussed much more profitably if these fundamental assumptions are made explicit. In that vein, if there is any other basis for your assertion that infant circumcision is unethical, I encourage you to reveal it before we proceed (in particular, you might want to take the opportunity to address fresco's point about the analogy between male and female circumcision).

smt wrote:

1. Infant circumcision is unethical because it involves an unnecessary medical procedure.
Agree [X] Disagree [ ] "unnecessary" because the benefits do not outweigh the risks.

Would you then apply this general rule to all medical procedures performed on infants?

smt wrote:

3. Infant circumcision is unethical because the infant cannot consent.
Agree [X] Disagree [ ] Sure, I would argue that the parent's legal right of consent is unethical in the approval of a medical procedure that has no medical indication.

If the issue of consent is irrelevant except in those instances where the procedure is medically unnecessary, then there really is no issue at all. This point would simply be subsumed under your general objection expressed in Point 1 above.

smt wrote:

7. Infant circumcision is unethical because it alters the basic function of a body part.
Agree [X] Disagree [ ] In this case, yes. When taken in the context of the lack of medical benefits and the severity of the change in function.

"In this case?" Sorry, but that's just a bit too slippery for me. Either you're proposing a general rule or you're simply advocating a string of ad hocs. If altering the basic function of a body part is unethical only in the case of circumcision, then what you're really saying is that there is something unique about circumcision; otherwise there'd be no need to add that it is unethical "in this case."

Either operating on infants to alter basic body functions is unethical in all circumstances, or else there's some other general rule that covers the case of circumcisions. In fact, isn't this simply a variation on your argument about "medically unnecessary" operations?

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Miller wrote:

How could it be made illegal, when it's part of a religious ceremony?

FWIW, I'm not arguing the legality of circumcision, but cutting the genitals of an infant girl for religious/ritualistic purposes is illegal. That's any form of cutting, even if minor with no long term consequences.

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Setanta wrote:

smt wrote:
7. Infant circumcision is unethical because it alters the basic function of a body part.
Agree [X] Disagree [ ] In this case, yes. When taken in the context of the lack of medical benefits and the severity of the change in function.

Nonsense, you have neither demonstrated that this is case, nor do i believe for a moment that you are either qualified to make a judgment anectdotally, nor likely to produce verifiable and verified research results to support such a contention.

Whatever... If you feel I have not back up a statement just say so without accusing me of being "obsessed", on a crusade, blah, blah, blah.

I do need to clarify what I said earlier "You are changing the way the male sex organ was designed to function." I did not say that circumcision changes the basic function of the penis. I should have clarified that when answering question 7 since there was a potential ambiguity there. Joefromchicago did change the wording around so that it was not specifying what "body part" was being discussed. Without a doubt, circumcision changes the basic function of the foreskin.

If you still disagree that circumcision changes the way the penis is designed to function then I will continue the discussion.

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fresco wrote:

9. Infant circumcision is unethical because it is in exactly the same category as forced female circumcision at puberty.

Agree[ ] Disagree[ ]

I never stated a relationship between male and female circumcision. Obviously, there are similarities in the sense of "cutting the genitals" but specifically there are differences between the genitalia. Personally, I think female circumcision may set a precedent that will apply to male circumcision. Beyond that, I think the ethics of male circumcision can stand on their own with or without FGM.

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joefromchicago wrote:

smt wrote:
1. Infant circumcision is unethical because it involves an unnecessary medical procedure.
Agree [X] Disagree [ ] "unnecessary" because the benefits do not outweigh the risks.

Would you then apply this general rule to all medical procedures performed on infants?

Of course not. Many medical procedures are necessary and/or recommended by major medical organizations due to the fact that there are clear benefits that outweigh the risks.

joefromchicago wrote:

smt wrote:
3. Infant circumcision is unethical because the infant cannot consent.
Agree [X] Disagree [ ] Sure, I would argue that the parent's legal right of consent is unethical in the approval of a medical procedure that has no medical indication.

If the issue of consent is irrelevant except in those instances where the procedure is medically unnecessary, then there really is no issue at all. This point would simply be subsumed under your general objection expressed in Point 1 above.

Yes, that would be the case.

joefromchicago wrote:

smt wrote:
7. Infant circumcision is unethical because it alters the basic function of a body part.
Agree [X] Disagree [ ] In this case, yes. When taken in the context of the lack of medical benefits and the severity of the change in function.

"In this case?" Sorry, but that's just a bit too slippery for me. ... If altering the basic function of a body part is unethical only in the case of circumcision, then what you're really saying is that there is something unique about circumcision; otherwise there'd be no need to add that it is unethical "in this case."

Either operating on infants to alter basic body functions is unethical in all circumstances, or else there's some other general rule that covers the case of circumcisions. In fact, isn't this simply a variation on your argument about "medically unnecessary" operations?

Point taken. If the only answer is Agree/Disagree then I could simply disagree since there are instances where it is not unethical to alter the basic function of a body part.

The whole gist of my premise is that routine infant circumcision is unethical because it is not a medically indicated procedure. There are benefits and risks. The benefits have not been proven to outweigh the risks. Issues like consent and altering the way the body functions all relate to the benefits and risks of infant circumcision.

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smt wrote:

joefromchicago wrote:

smt wrote:
1. Infant circumcision is unethical because it involves an unnecessary medical procedure.
Agree [X] Disagree [ ] "unnecessary" because the benefits do not outweigh the risks.

Would you then apply this general rule to all medical procedures performed on infants?

Of course not. Many medical procedures are necessary and/or recommended by major medical organizations due to the fact that there are clear benefits that outweigh the risks.

Once again, my question may have been phrased poorly. I'm not asking if all medical procedures on infants should be considered unethical, but rather, following through on the preceding point, if it is only those that are "medically unnecessary."

From what you've said, I gather that your answer should be "yes," but I can't quite be sure. It is evident that you consider circumcision to be medically unnecessary, but if your rule against medically unnecessary procedures only covers circumcisions, then what you're saying, in effect, is that circumcisions are unethical because they're circumcisions, and that is most assuredly a logically indefensible position.

So, either circumcision falls under a general rule ("all medically unnecessary procedures on infants are unethical, and circumcision is medically unnecessary") or it doesn't. And if it doesn't, then you either have to spell out what rule it does fall under or else concede that you oppose circumcision simply because it is circumcision.

Once we have definitively narrowed down your fundamental basis for opposing circumcision, you will need to define your operative terms. If circumcision is unethical because it is medically unnecessary, what, according to you, exactly constitutes "medically unnecessary?" Is a medical procedure that primarily, or even exclusively, improves appearance "medically unnecessary?" Is there a risk-benefit calculus involved in determining medical necessity, or is there some other method for ascertaining it?

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Joe - don't you think you are being too narrow?

For instance, for me, it is medically unnecessary PLUS informed consent being unobtainable PLUS there being some evidence it may alter function/sensation (unclear) PLUS apparently painful and traumatic to infant.

So - cosmetic surgery on informed consenting folk, no problem for example. Circumcision that is, for some reason, MEDICALLY necessary on an infant, no problem. Circumcision on a consenting adult, no problem.

Insisting on bringing it down to ONE criterion, which you seem to be trying to do, is, to me, very constipating and violates the essence of the case.

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dlowan wrote:

Joe - don't you think you are being too narrow?

No, certainly not. I'm merely attempting to refine the terms of the discussion by eliminating irrelevant issues.

dlowan wrote:

For instance, for me, it is medically unnecessary PLUS informed consent being unobtainable PLUS there being some evidence it may alter function/sensation (unclear) PLUS apparently painful and traumatic to infant.

So - cosmetic surgery on informed consenting folk, no problem for example. Circumcision that is, for some reason, MEDICALLY necessary on an infant, no problem. Circumcision on a consenting adult, no problem.

Insisting on bringing it down to ONE criterion, which you seem to be trying to do, is, to me, very constipating and violates the essence of the case.

If I'm misrepresenting smt's position in any respect then I will gladly revisit my remarks. But, as even smt recognizes, the consent issue is largely irrelevant to the issue of infant circumcision, since even smt would agree that necessary medical procedures could be performed on an infant without its consent.

Now, if you think that consent remains an issue, dlowan, then I encourage you to lay out your position in the same fashion as smt has done. Perhaps you could respond point-by-point to the checklist that I posted?

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Dlowan,

I agree.

Logical cheeseparing misses the essence of the question. Except where specifically indicated the "medical argument" seems to be an obvious rationalization of a cultural practice (of primitive origin). Similar "medical arguments" are made for religious dietary laws with the bonus of being "wisdom of divine origin prior to modern science",

I am tempted to say that a recent cartoon where Eve is tempting Adam with fruit from "The Tree of Gullibility" seems to be appropriate.

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smt wrote:

Whatever... If you feel I have not back up a statement just say so without accusing me of being "obsessed", on a crusade, blah, blah, blah.

Blah, blah, yourself . . . inasmuch as you arrive here, begin this thread, and hammer the theme, a course of action which is sadly familiar to the "netizens" at this site, and from other sites; and, that among the 15 posts you have made since being here only one is in another thread, while the other fourteen are in this speaks volumes. Those who arrive and remain for significant periods of time usually have shown up in other threads within a few days of arrival, indicating an interest in a variety of subjects. You seem only to have posted here for this subject. Experience may prove that you will stick around for the sideshows, but this seems to be the main event from your point of view. We see that same thing in people who arrive astride a variety of different stalking horses.

quote wrote:

I do need to clarify what I said earlier "You are changing the way the male sex organ was designed to function." I did not say that circumcision changes the basic function of the penis. I should have clarified that when answering question 7 since there was a potential ambiguity there.

Allow me to nominate you for some sort of award for understatement, as opposed to employing a less charitable term, such as say . . . poppycock. This portion of your response to WidyCityJoseph's question--"When taken in the context of the lack of medical benefits and the severity of the change in function."--seems entirely devoid of ambiguity to me, which is why i had commented that you had "upped the ante." There was no ambiguity embodied in the question, nor in this portion of your response.

Quote:

Joefromchicago did change the wording around so that it was not specifying what "body part" was being discussed. Without a doubt, circumcision changes the basic function of the foreskin.

Once again, your talent for understatement is breathtaking. I would never argue that excision of any tissue does not alter its function, inasmuch as the absence thereof is a positive assurance of the absence of function. In reference to your contention to the effect that Joe has "changed the wording around," with regard to what he has done so, completely mystifies me. The wording is exactly that of his checklist.

Quote:

If you still disagree that circumcision changes the way the penis is designed to function then I will continue the discussion.

Designed? An odd choice of descriptor . . . design infers a designer. Have you an specific point of view with regard to who or what has "designed" the penis? If so, it would greatly inform your interlocutors about your motivations in this debate to enlighten us as to your opinion about the source of the "design" to which you refer. Once again, tediously, i will point out that you can offer no first hand evidence on function. I would also point out that evolutionary factors constantly change "designs" in organisms, and survival and reproductive viability are the only valid measures of the relative "value" of the morphologic process. Unless you contend that there is a positive and demonstrable penalty to the chance of survival, and/or the opportunity to produce viable offspring in males who have been circumsized, i contend this little part of your argument has no legs, and therefore won't be going anywhere.

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joefromchicago wrote:

From what you've said, I gather that your answer should be "yes," but I can't quite be sure.

I would say that medical procedures that are unnecessary are unethical to perform on an infant. Routine infant circumcision would fall into that category.

joefromchicago wrote:

...you will need to define your operative terms. If circumcision is unethical because it is medically unnecessary, what, according to you, exactly constitutes "medically unnecessary?" ... Is there a risk-benefit calculus involved in determining medical necessity, or is there some other method for ascertaining it?

Just about any procedure can have benefits and risks. The criteria for performing a procedure is based on assessing the benefits and risks. The medical community has various organizations that assess medical studies on the benefits and risks of procedures and makes recommendations accordingly. Obviously, there is some grey area and not every study is black and white. This is where a body of evidence is used to make a recommendation. The medical community may or may not address all areas that would affect the ethics of circumcision.

I think it's fair to consider a number of factors when assessing risks and benefits. For example, the various items I originally listed are relevant to the discussion. This is especially important when making a decision that is not purely "black and white."

So, what actually constitutes "medically unnecessary"? The body of medical organizations worldwide that do not make a recommendation for routine infant circumcision(RIC) and the lack of medical organizations that do make a recommendation for RIC. In addition to this there are a few major medical organizations that recommend against RIC.

joefromchicago wrote:

Is a medical procedure that primarily, or even exclusively, improves appearance "medically unnecessary?"

I'm not sure where you are going with this, I never brought up the issue of "appearance". Are you asserting that circumcision approves the appearance of the penis or are you building some other foundation?

I will try to answer the question anyway. There are two types of procedures performed by the medical community that would "improve appereance". The first would be cosmetic surgery (tummy tucks, face lifts, breast agumentation, etc, and sometimes circumcision falls into this category when parents choose if for only cosmetic reasons). These I would consider unethical to perform on an infant. In this case I would use the term "approve appearance" loosely since it is very subjective.

The second would be plastic surgery which would be performed to reconstruct tissue which was lost, defective, etc. I would consider that an ethical medical procedure.

I would like to touch on the consent issue again. It is relevant to the discussion when you are weighing the risks and benefits. A doctor can perform a procedure without consent if it is a medical emergency (obvious medical benefits). The same does not apply to elective medical procedures (minimal, if any, medical benefits).

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smt wrote:

I would say that medical procedures that are unnecessary are unethical to perform on an infant. Routine infant circumcision would fall into that category.

That's very clear. Thank you for the clarification.

smt wrote:

Just about any procedure can have benefits and risks. The criteria for performing a procedure is based on assessing the benefits and risks. The medical community has various organizations that assess medical studies on the benefits and risks of procedures and makes recommendations accordingly. Obviously, there is some grey area and not every study is black and white. This is where a body of evidence is used to make a recommendation. The medical community may or may not address all areas that would affect the ethics of circumcision.

Well, this is a problem, isn't it? If the medical profession doesn't address the ethical issues, then on what criteria do you base your ethical conclusions?

smt wrote:

I think it's fair to consider a number of factors when assessing risks and benefits. For example, the various items I originally listed are relevant to the discussion. This is especially important when making a decision that is not purely "black and white."

I'm not sure I know what you're referring to. What are those "various items" you alluded to earlier?

smt wrote:

So, what actually constitutes "medically unnecessary"? The body of medical organizations worldwide that do not make a recommendation for routine infant circumcision(RIC) and the lack of medical organizations that do make a recommendation for RIC. In addition to this there are a few major medical organizations that recommend against RIC.

And this is another problem. Quite a few medical associations do not recommend routine neonatal circumcision, but then many of them do not discourage it either. For instance, the American Medical Ass'n states:

The AMA supports the general principles of the 1999 Circumcision Policy Statement of the American Academy of Pediatrics, which reads as follows: 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.That's hardly a ringing condemnation of the procedure.

Furthermore, since the medical organizations are not in the "ethics business," you cannot simply declare that their reports are ethically conclusive. The AMA, for instance, leaves the decision largely in the hands of the parents. The American Academy of Family Physicians and the British Medical Ass'n are similarly deferential to the parents' decision. If you, therefore, are to argue that parents who circumcise their sons act unethically because no medical organization recommends the procedure, then you are clearly going beyond the parameters of at least some of those organizations' recommendations. And it is at the point that you depart from their recommendations that you are asserting a different ethical standard. That standard, it turns out, is your standard, not the medical organizations' standard. As such, you must, at the very least, articulate some standard by which parents act unethically when they authorize a procedure that is neither recommended nor discouraged by the medical profession.

smt wrote:

joefromchicago wrote:
Is a medical procedure that primarily, or even exclusively, improves appearance "medically unnecessary?"

I'm not sure where you are going with this, I never brought up the issue of "appearance". Are you asserting that circumcision approves the appearance of the penis or are you building some other foundation?

I'm simply attempting to ascertain the limits of your position.

smt wrote:

I will try to answer the question anyway. There are two types of procedures performed by the medical community that would "improve appereance". The first would be cosmetic surgery (tummy tucks, face lifts, breast agumentation, etc, and sometimes circumcision falls into this category when parents choose if for only cosmetic reasons). These I would consider unethical to perform on an infant. In this case I would use the term "approve appearance" loosely since it is very subjective.

And that is because those purely cosmetic procedures are not medically necessary?

smt wrote:

I would like to touch on the consent issue again. It is relevant to the discussion when you are weighing the risks and benefits. A doctor can perform a procedure without consent if it is a medical emergency (obvious medical benefits). The same does not apply to elective medical procedures (minimal, if any, medical benefits).

I cannot see how the consent issue has anything whatsoever to do with the risk-benefit analysis (unless the risks and benefits are non-medical in nature). A risky operation is no less risky because the patient does not or cannot give consent. If you are truly serious about this point, then you'll have to do a much better job of explaining it.

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Setanta wrote:

inasmuch as you arrive here, begin this thread, and hammer the theme... and, that among the 15 posts you have made since being here... You seem only to have posted here for this subject.

I didn't realize that there was a minimum number of posts necessary before starting a thread or that I had to be here a certain amount of time or that they do not allow "one night stands" while debating a subject. I have strong feelings about RIC being unethical and I enjoy debating it. I find that on various "parenting" debate boards it is hard to get a real debate going without being attacked personally. I see that can also happen here. I have actually learned a lot from Joefromchicago and others, although, I can't say I've learned much from you. I might actually stick around because I am just getting into "debating" and have found this site challenging. BTW, no one is making you debate this subject. You are here by choice just as I am.

Setanta wrote:

Allow me to nominate you for some sort of award for understatement

Yeah!! I hope I win!

Setanta wrote:

Designed? An odd choice of descriptor . . .

Designed by nature, evolved... whatever works for you... or do you think the penis and foreskin is a random collection of cells? Either way, the penis functions a certain way with a foreskin and that is changed by circumcision.

Setanta wrote:

Once again, tediously, i will point out that you can offer no first hand evidence on function.

Do you deny that circumcision changes the way the penis functions during intercourse? Specifically, does an intact penis "glide" on the loose skin during intercourse? If you knew how the foreskin/shaft skin functions then you would understand this to be true. If you do not understand this then I will try to explain it/direct you to some pictures.

Setanta wrote:

I would also point out that evolutionary factors constantly change "designs" in organisms, and survival and reproductive viability are the only valid measures of the relative "value" of the morphologic process. Unless you contend that there is a positive and demonstrable penalty to the chance of survival, and/or the opportunity to produce viable offspring in males who have been circumsized, i contend this little part of your argument has no legs, and therefore won't be going anywhere.

I have not stated that the penis will not function without the foreskin or that there is any "survival" disadvantage. I have not even stated that a penis is more sensitive with a foreskin. What I do know is that a penis comes with a foreskin and I believe that it is that it should not be removed without medical cause any more than an infants fingertip should be removed without medical cause.

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Joe - I think it very likely that the American medical associations are swayed by factors well beyond pure objective assessment of risk vs benefit - do you not? For instance - they may well be swayed by a very large and vocal Jewish medical and patient population.

Here are summaries of the relevant Australian positions:

Australian Pediatric Association, 24 April 1971

The Australian Pediatric Association recommends that newborn male infants should not, as a routine, be circumcised.

Medical Journal of Australia, 22 May 1971, p. 1148

Australian College of Paediatrics
Official statement, 1983

1. The ACP should continue to discourage the practice of circumcision in the newborn male infant.

2. Educational material on the topic of circumcision should be available to parents before the birth of their baby and also in maternity hospitals. This will facilitate informed discussion with their medical attendant.

3. Some parents after considering medical, social, religious and family factors will opt for circumcision of their infant. It is then the responsibility of the medical attendant to recommend that this circumcision be performed at an age and under medical circumstances that reduce the hazards to a minimum.

This statement was reviewed and reissued by the ACP on 28 May 1991.

Australian College of Paediatrics
Position Statement, 1996

The Australian College of Paediatrics has prepared the following statement on routine circumcision of infants and boys to assist parents who are considering having this procedure undertaken in their male children and for doctors who are asked to advise on or undertake it.

Routine circumcision of normal male infants and boys

Circumcision of males has been undertaken for religious and cultural reasons for many thousands of years. It probably originated as a hygiene measure in communities living in hot and dry environments. It remains a very important ritual in some religious/cultural groups.

During the last 50-100 years, neonatal male circumcision became widespread in English-speaking countries. Until the late 1960s or early 1970s, it was generally performed without any form of anaesthesia. In Australia, the circumcision rate has fallen very considerably in recent years and it is estimated that currently only 10 percent of male infants are routinely circumcised. It is now generally performed with some form of local or general anesthesia.

There have been increasing claims of health benefits from routine male circumcision. There are, however, also risks associated with the procedure from infection, bleeding and damage to the glans penis. The College has recently reviewed evidence in relation to risks and benefits and has concluded that it is not possible to be dogmatic on the exact risk/benefit ratio. There are suggestions of reductions in the risk of urinary tract infections, of local inflammatory conditions of the penis and later cancer of the penis. It has also been claimed that there is a reduction in the risk of sexually transmitted disease (especially HIV) and of cancer of the cervix in partners of circumcised males. However, studies claiming these benefits do have methodological problems which could influence findings and these problems will be difficult to overcome. Therefore, at the present time it would be wrong either to claim that there are definite health benefits or to deny that they exist.

The possibility that routine circumcision may contravene human rights has been raised because circumcision is performed on a minor and is without proven medical benefit. Whether these legal concerns are valid will probably only be known if the matter is determined in a court of law.

The Australasian Association of Paediatric Surgeons has informed the College that it is its view that routine male circumcision should not be performed prior to the age of 6 months. It considers that "Neonatal male circumcision has no medical indication. It is a traumatic procedure performed without anaesthesia to remove a normal and healthy prepuce."

The College believes informed discussion with parents regarding the possible health benefits of routine male circumcision and the risks associated with the operation are essential. Up-to-date, unbiased written material summarising the evidence in plain English should be widely available to parents.

If the operation is to be performed, the medical attendant should ensure this is done by a competent operator, using appropriate anaesthetic techniques and under medical conditions that minimise the hazards.

In the majority of cases, parents will decide for or against a routine male circumcision on family, social, aesthetic and religious grounds rather than on medical ones. In all cases the medical attendant should avoid exaggeration of either benefits or risks of this procedure.

Issued 27 May 1996

The Australasian Association of Paediatric Surgeons
Position statement, 1996

Guidelines for circumcision

Preamble

The Australasian Association of Paediatric Surgeons does not support the routine circumcision of male neonates, infants or children in Australia. It is considered to be inappropriate and unnecessary as a routine to remove the prepuce, based on the current evidence available.

Due to religious beliefs, Jewish children are circumcised by the seventh day of life, as a mark of dedication to God. Children born into the Muslim faith will likewise be circumcised for religious reasons, although the timing for the procedure is less clearly defined. There are Christian groups in other parts of the world, who insist on ritual religious circumcision, as well as tribal or cultural customs promoting male circumcision.

We do not support the removal of a normal part of the body, unless there are definite indications to justify the complications and risks which may arise. In particular, we are opposed to male children being subjected to a procedure, which had they been old enough to consider the advantages and disadvantages, may well have opted to reject the operation and retain their prepuce.

Indications for male circumcision

Balanitis Xerotica Obliterans
Recurrent Balanoposthitis
Phimosis resistant to steroid cream

Contraindications to male circumcision

Hypospadias and other congenital anomalies of the penis, e.g. epispadias, chordee
Sick and unstable infants
Family history of a bleeding disorder or an actual bleeding disorder

Timing of surgery

Neonatal male circumcision has no medical indication. It is a traumatic procedure performed without anaesthesia to remove a normal functional and protective prepuce. At birth, the prepuce has not separated from the underlying glans and must be forcibly torn apart to deliver the glans, prior to removal of the prepuce distal to the coronal groove.

Balanitis Xerotica Obliterans, when diagnosed, should be treated by circumcision.

Timing of circumcision for recurrent balanoposthitis is difficult to define. Many infants and children will have an episode of preputial inflammation. If successive occurrences of dysuria with associated redness and purulent discharge from beneath the prepuce have been treated and the previously fully or partially retractable prepuce is less readily retractable after the subsidence of the inflammation, circumcision should be considered.

The physiological phimosis will normally resolve by the age of 3-4 years. If it fails to respond to steroid cream/ointment applied several times daily for 4-6 weeks, there is a reasonable probability that these boys will have problems in the future.

Infants and children who have a proven urinary tract infection and, on investigation, are found to have a significant urinary tract anomaly, e.g. posterior urethral valves or significant vesico-ureteric reflux, may benefit from circumcision. This will reduce the normal bacterial flora resident under the prepuce, which in the presence of a urinary tract anomaly may be associated with an increased risk of further upper tract infections with possible local and systemic damage.

The risk of carcinoma of the penis developing in the uncircumcised is very low. Lifetime penile hygiene is the key to penile health and a reduction in the incidence of carcinoma of the penis.

Personal sexual behaviour patterns will determine whether sexually transmitted infections with human papilloma virus, herpes simplex virus and the human immune deficiency virus are contracted. Routine or infant male circumcision is not justified in Australia to protect males from contracting diseases that some may acquire through their ignoring the recognized precautions to be taken during their sexually active life.

Consent for surgery

Parents requesting circumcision of their male children should have the complications both general and local, explained to them. These complications are usually minor but can be severe and may result in the death of the child. Time should also be spent discussing the advantages and disadvantages of the operation, both in the short and long term, as is currently applicable in Australia. There are many adults in the community who hold a very strong opinion as to the place of circumcision. This may be for religious reasons or for family "custom" or a claim of "cleanliness" or other reasons. In this event the procedure should be performed electively after six months of age.

When performed, it should be carried out by a surgeon performing circumcisions on children on a regular basis with an anaesthetist using appropriate techniques. This would imply that the anaesthetist is fully trained in the art of paediatric anaesthesia, including the ability to perform caudal and penile regional or local anaesthesia. The operation should be carried out in a paediatrically orientated environment, designed to reduce the risk to the child and providing support to the parents or caregivers.

Points of interest

Marshall in 1960, reporting to the Society of Pediatric Urologists in Philadelphia and quoted by John Duckett, a distinguished pediatric urologist in Philadelphia, calculated that 140 boys a week for 24 weeks would need to be circumcised to prevent one case of carcinoma of the penis.

The Jewish Talmud stated that "the third child was excused from circumcision if the first two had died as a result of the circumcision".

Dr. Derek Llewellyn Jones in his book Everywoman (1971), stated: "Mothers
demand it, doctors profit by it and babies cannot complain about it".

The 1989 United Nations Convention on the Rights of the Child states:

"State parties should take all effective and appropriate measures with a view to abolishing traditional practices prejudical to the health of children."

Circumcision of male infants was addressed in a research paper published by the Queensland Law Reform Commission in December 1993. The preface addresses the problem when it states:

"From the Commission's research to date, it is apparent that there are two quite vocal sides of the debate on routine male circumcision. One side advocates the practice, primarily on a preventative health basis or on religious grounds. The other side opposes the practice, primarily on human rights and preservation of bodily integrity grounds. Both sides rely on medical evidence and opinion to support their respective views".

Having considered all the information the paper concludes with "The Commission has yet to decide what, if any reform of the law should be recommended in relation to infant male circumcision."

Australian Medical Association, 1997

The AMA will discourage circumcision of baby boys in line with the Australian College of Paediatrics "Position Statement on Routine Circumcision of Normal Male Infants and Boys".

The statement, released in June and supported by the AMA's November Federal Council meeting, includes:

The Australian College of Paediatrics should continue to discourage the practice of circumcision in newborns.
Educational material should be available to parents before the birth of their baby and in maternity hospitals.
Some parents after considering medical, social, religious and family factors will opt for circumcision. It is then the responsibility of the doctor to recommend this is performed at an age and under circumstances which reduce hazards to a minimum.
Australian Medicine, 6-20 January 1997, p. 5

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British Medical Association position paper:

http://www.bma.org.uk/ap.nsf/Content/malecircumcision2003?OpenDocument&Highlight=2,circumcision

Interesting highlights:

"Summary: the law
Male circumcision is generally assumed to be lawful provided that:
- it is performed competently;
- it is believed to be in the child's best interests; and
- there is valid consent.

The Human Rights Act may affect the way non-therapeutic circumcision is viewed by the courts. There has been no reported legal case involving circumcision since the Act came into force. If doctors are in any doubt about the legality of their actions, they should seek legal advice."

Best discussion of conflicting factors in weighing best interests of the child that I have seen on this topic:

"Best interests
In the past, circumcision of boys has been considered to be either medically or socially beneficial or, at least, neutral. The general perception has been that no significant harm was caused to the child and therefore with appropriate consent it could be carried out. The medical benefits previously claimed, however, have not been convincingly proven, and it is now widely accepted, including by the BMA, that this surgical procedure has medical and psychological risks. It is essential that doctors perform male circumcision only where this is demonstrably in the best interests of the child. The responsibility to demonstrate that non-therapeutic circumcision is in a particular child's best interests falls to his parents.

It is important that doctors consider the child's social and cultural circumstances. Where a child is living in a culture in which circumcision is required for all males, the increased acceptance into a family or society that circumcision can confer is considered to be a strong social or cultural benefit. Exclusion may cause harm by, for example, complicating the individual's search for identity and sense of belonging. Clearly, assessment of such intangible risks and benefits is complex. On a more practical level, some people also argue that it is necessary to consider the effects of a decision not to circumcise. If there is a risk that a child will be circumcised in unhygienic or otherwise unsafe conditions, doctors may consider it better that they carry out the procedure, or refer to another practitioner, rather than allow the child to be put at risk.

On the other hand, very similar arguments are also used to try and justify very harmful cultural procedures, such as female genital mutilation or ritual scarification. Furthermore, the harm of denying a person the opportunity to choose not to be circumcised must also be taken into account, together with the damage that can be done to the individual's relationship with his parents and the medical profession if he feels harmed by the procedure.

The BMA identifies the following as relevant to an assessment of best interests in relation to non-therapeutic circumcision:
- the patient's own ascertainable wishes, feelings and values;
- the patient's ability to understand what is proposed and weigh up the alternatives;
- the patient's potential to participate in the decision, if provided with additional support or explanations;
- the patient's physical and emotional needs;
- the risk of harm or suffering for the patient;
- the views of parents and family;
- the implications for the family of performing, and not performing, the procedure;
- relevant information about the patient's religious or cultural background; and
- the prioritising of options which maximise the patient's future opportunities and choices.[13]

The BMA is generally very supportive of allowing parents to make choices on behalf of their children, and believes that neither society nor doctors should interfere unjustifiably in the relationship between parents and their children. It is clear from the list of factors that are relevant to a child's best interests, however, that parental preference alone is not sufficient justification for performing a surgical procedure on a child.

The courts have also identified some factors that are important in a decision about circumcision. J was a 5 year old boy who lived with his mother, a non-practising Christian. His father, a non-practising Muslim, wanted him to be circumcised. Asked to decide whether J should be circumcised, the Court considered all the factors relevant to J's upbringing and concluded that J should not be circumcised because of three key facts:
- he was not, and was not likely to be, brought up in the Muslim religion;
- he was not likely to have such a degree of involvement with Muslims as to justify circumcising him for social reasons; and as a result of these factors,
- the "small but definite medical and psychological risks" of circumcision outweighed the benefits of the procedure.[14]

Summary: best interests
- Doctors must act in the best interests of the patient.
- Even where they do not decide for themselves, the views that children express are important in determining what is in their best interests.
- The BMA does not believe that parental preference alone constitutes sufficient grounds for performing a surgical procedure on a child unable to express his own view. Parental preference must be weighed in terms of the child's interests.
- The courts have confirmed that the child's lifestyle and likely upbringing are relevant factors to take into account. The particular situation of the case needs to be considered.
- Parents must explain and justify requests for circumcision, in terms of the child's interests.

Health issues
There is significant disagreement about whether circumcision is overall a beneficial, neutral or harmful procedure. At present, the medical literature on the health, including sexual health, implications of circumcision is contradictory, and often subject to claims of bias in research. Doctors performing circumcisions must ensure that those giving consent are aware of the issues, including the risks associated with any surgical procedure: pain, bleeding, surgical mishap and complications of anaesthesia. All appropriate steps must be taken to minimise these risks. It may be appropriate to screen patients for conditions that would substantially increase the risks of circumcision, for example haemophilia.

Doctors should ensure that any parents seeking circumcision for their son in the belief that it confers health benefits are fully informed of the lack of consensus amongst the profession over such benefits, and how great any potential benefits and harms are. The BMA considers that the evidence concerning health benefit from non-therapeutic circumcision is insufficient for this alone to be a justification for doing it.

Standards
Doctors unfamiliar with circumcision who are asked about it should seek advice about the physical risks from doctors experienced in conducting circumcisions. Religious and cultural organisations may be able to give advice and suggest practitioners who perform circumcisions. It may be necessary to refer a family to a paediatric surgeon, urologist or other doctor experienced in performing the operation for advice and care.

Poorly performed circumcisions have legal implications for the doctor responsible. An action could be brought against the doctor responsible on the child's behalf if the circumcision was carried out negligently. Alternatively, the child could issue such proceedings in his own name on reaching the age of 18 and the normal time limit for starting legal proceedings would run from that birthday. However, unless the lawfulness of circumcision itself is successfully challenged, action cannot currently be taken against a doctor simply because a man is unhappy about having been circumcised at all. A valid consent from a person authorised to give it on the patient's behalf is legally sufficient in such cases. It goes without saying that a health professional who is not currently registered must never give the impression of so being even though there is no legal requirement for non-therapeutic circumcision to be undertaken by a registered health professional.

The General Medical Council does not prohibit doctors from performing non-therapeutic circumcision, although would take action if a doctor was performing such operations incompetently. The Council explicitly advises that doctors must "have the necessary skills and experience both to perform the operation and use appropriate measures, including anaesthesia, to minimise pain and discomfort".[15]"

"Health issues
There is significant disagreement about whether circumcision is overall a beneficial, neutral or harmful procedure. At present, the medical literature on the health, including sexual health, implications of circumcision is contradictory, and often subject to claims of bias in research. Doctors performing circumcisions must ensure that those giving consent are aware of the issues, including the risks associated with any surgical procedure: pain, bleeding, surgical mishap and complications of anaesthesia. All appropriate steps must be taken to minimise these risks. It may be appropriate to screen patients for conditions that would substantially increase the risks of circumcision, for example haemophilia.

Doctors should ensure that any parents seeking circumcision for their son in the belief that it confers health benefits are fully informed of the lack of consensus amongst the profession over such benefits, and how great any potential benefits and harms are. The BMA considers that the evidence concerning health benefit from non-therapeutic circumcision is insufficient for this alone to be a justification for doing it. "

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To make you happy Joe!

1. Infant circumcision is unethical because it involves an unnecessary medical procedure (on a being unable to give informed consent.)
Agree [* ] Disagree [ ]

2. Infant circumcision is unethical because it is irreversible.
Agree [* ] Disagree [ ] (Effectively so, I believe, despite some attempts made recently - also - all surgical procedures carry risk - to circumcise partly in the belief that it will be reversible, if there IS an effective reversal possible one day, would be to expose any boy (should he be so distressed, for some reason, by the circumcision - like I said on the last thread about this topic - I have never met a fella bothered either way, but I hear they exist!) to one surgical risk, without the possibility for informed consent, and to the potential for another.

3. Infant circumcision is unethical because the infant cannot consent (AND because the procedure is of extremely dubious value medically, to say the least)
Agree [* ] Disagree [ ]

4. Infant circumcision is unethical because it is a painful procedure.
Agree [* ] Disagree [ ] (Note - medical standards hold that there ought to be anaesthesia - which carries its own risks - but, for Jewish religious purposes, I understand it is normally performed without anaesthesia, and at a stage where its performance requires more trauma to the penis (see the Oz guidelines) than it would if done later.

5. Infant circumcision is unethical because the risks outweigh the benefits.
Agree [* ] Disagree [ ]

6. Infant circumcision is unethical specifically because it affects the genitalia.
Agree [ ] Disagree [*]

7. Infant circumcision is unethical because it alters the basic function of a body part.
Agree [ ] Disagree [ ] I do not know enough to comment - I would think not.

8. Infant circumcision is unethical because it just grosses me out.
Agree [ ] Disagree [* ]

See, Joe - I refuse to allow you to separate out the bits of this argument - several bits ONLY make sense when taken into account together.

By the way - I have no very strong position on this. Overall, I think male infant circumcision unethical, and I have said so because the question was asked, and because I think it is an interesting ethical question, but I will not be trying to tell any parents anything, and I think a certain hysteria is developing in the anti-camp.

Because of the weight of tradition - and kids' need to belong - I can very well see the best interests of the child arguments in favour of it for kids in some cultures.

However, such an argument can be, has been, and is made for far more obviously dangerous and extremely damaging procedures like most female genital mutilation - and COULD well be used in favour of the surgical procedure of taking fat from a newborn baby's bottom and creating a turnip shaped object on its head - if this was the deeply revered for many millenia and god-commanded custom in a particular group.

Where do we draw a line about the practice of religious and cultural beliefs? FMG is banned, as far as I know, in the west - and on the statute books in a number of countries where it is carried out.

Where does male infant circumcision stand in the continuum of harmless cultural/religious practices, and those we say we will ban despite their having such standing?

Proponents of FMG say, in all honesty and fervency, that little girls will not be accepted or marriageable within their cultures with that ugly clitoris, and nasty bifurcated vulva.

I do, and would, oppose the FMG and turnip procedures more vigorously than I do male circumcision, in line with the dangers they pose and, for FMG, the demonstrated ongoing pain, infection and loss of joy it causes - plus the high death toll.

I am unsure about the turnip procedure - I assume the bottom would renew itself? In modern times it is performed with an anaesthetic. Of course, this kills a number of children - but the community believes that survival of the procedure is a sign that their god has accepted the new baby. Babies who die are considered to have been devils.

I think ongoing pain and loss of sensation is not strongly demonstrated (at least yet) in male circumcision - but risking such would seem a big thing to risk for a child - and, being a gel, I consider that a decision for the males to make!

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dlowan wrote:

Joe - I think it very likely that the American medical associations are swayed by factors well beyond pure objective assessment of risk vs benefit - do you not? For instance - they may well be swayed by a very large and vocal Jewish medical and patient population.

Certainly that is a possibility, just as it is a possibility that medical associations outside the US are influenced in their anti-circumcision positions by non-medical factors. Consequently, anyone who relies upon the statements of medical associations as ethically conclusive must acknowledge these non-medical factors, regardless of how they may influence the result.

dlowan wrote:

Here are summaries of the relevant Australian positions

The Australian and British medical associations' positions do not differ in any significant degree from the AMA position: parents are to be fully informed, but the final decision is left to them. The Australians differ only in that they recommend waiting until the infant is six months old. The court case that you cite is inapposite, since it involves a situation where the parents disagreed. The AMA, BMA, and other medical association guidelines envision a situation where both parents consent to the procedure.

dlowan wrote:

To make you happy Joe!

My cup runneth over!

dlowan wrote:

1. Infant circumcision is unethical because it involves an unnecessary medical procedure (on a being unable to give informed consent.)
Agree [* ] Disagree [ ]

OK.

dlowan wrote:

2. Infant circumcision is unethical because it is irreversible.
Agree [* ] Disagree [ ] (Effectively so, I believe, despite some attempts made recently - also - all surgical procedures carry risk - to circumcise partly in the belief that it will be reversible, if there IS an effective reversal possible one day, would be to expose any boy (should he be so distressed, for some reason, by the circumcision - like I said on the last thread about this topic - I have never met a fella bothered either way, but I hear they exist!) to one surgical risk, without the possibility for informed consent, and to the potential for another.

Quite so. I doubt that even the committed "foreskin restorationists" think that a restored foreskin is an adequate substitute for the real thing.

But then there are all sorts of surgical procedures performed on infants that are irreversible. If irreversibility were a sufficient criterion, then you should also oppose all manner of medical procedures designed to correct birth defects, such as cleft palates. Is that your contention?

dlowan wrote:

3. Infant circumcision is unethical because the infant cannot consent (AND because the procedure is of extremely dubious value medically, to say the least)
Agree [* ] Disagree [ ]

Sorry, there is no "AND" option here. Either the procedure is objectionable because the infant does not consent, or else there is some other factor that is controlling. If a medical procedure is unethical because an infant cannot consent, then an operation to correct a cleft palate is just as objectionable as an operation to remove a foreskin.

dlowan wrote:

4. Infant circumcision is unethical because it is a painful procedure.
Agree [* ] Disagree [ ] (Note - medical standards hold that there ought to be anaesthesia - which carries its own risks - but, for Jewish religious purposes, I understand it is normally performed without anaesthesia, and at a stage where its performance requires more trauma to the penis (see the Oz guidelines) than it would if done later.

I would suppose that any operation is a painful procedure -- even with anesthetic. But if it is unethical to inflict a painful medical procedure upon an infant, then you are saying that even painful but beneficial procedures are unethical.

dlowan wrote:

5. Infant circumcision is unethical because the risks outweigh the benefits.
Agree [* ] Disagree [ ]

And what are those risks?

dlowan wrote:

See, Joe - I refuse to allow you to separate out the bits of this argument - several bits ONLY make sense when taken into account together.

See dlowan -- you don't want to separate out the bits of this argument because, taken separately, they don't make a whole lot of sense. But arguments that are without merit individually do not magically gain merit when bunched together. They simply become a bunch of meritless arguments.

dlowan wrote:

By the way - I have no very strong position on this. Overall, I think male infant circumcision unethical, and I have said so because the question was asked, and because I think it is an interesting ethical question, but I will not be trying to tell any parents anything, and I think a certain hysteria is developing in the anti-camp.

If your ethics are such that a violation of them is not worthy of reproach or condemnation, then I don't think much of your ethics.

dlowan wrote:

Where does male infant circumcision stand in the continuum of harmless cultural/religious practices, and those we say we will ban despite their having such standing?

That is a question worth asking. What is your answer?

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smt wrote:

I didn't realize that there was a minimum number of posts necessary before starting a thread or that I had to be here a certain amount of time or that they do not allow "one night stands" while debating a subject.

Nor are you justified in imputing to me such a contention, nor inferring it from what i wrote. You have gutted the context of what i wrote (how very convenient for you!), and you know well that i was responding to your snide remark about not being obsessive (which i continue to contend that you are), which you ended with a ". . . blah, blah, blah." I had made two contentions: that it appears that you may be obsessive (and you convince me more and more of this), and that it appears that you may obesssively crusading. Your use of " . . . blah, blah, blah" in the post to which i responded was unnecessary in that in that post you had denied both contentions with regard to yourself--blah, blah, blah was superfluous to the response.

Quote:

I have strong feelings about RIC . . .

Ah yes, again, your penchant for understating a case.

Quote:

(I have strong feelings about RIC) . . . being unethical and I enjoy debating it. I find that on various "parenting" debate boards it is hard to get a real debate going without being attacked personally. I see that can also happen here.

If this were the case, then i question why you have placed this thread in the "Philosphy and Debate" category, rather than in the "Parenting and Childcare" category. The principle reason for my questioning your use of "designed" (of which, more presently) results from your having placed this in "Philosphy and Debate," as opposed to the more appropriate category mentioned. Please have the kindness, when accusing me to that effect, of demonstrating in what regard what i have written constitutes a personal attack. To disagree with you, and to question whether or not you are "crusading" is not a personal attack. I do feel that you are obsessive, the evidence for which, to my mind, arises from your willingness to employ many dubious arguments as opposed to simply registering your disapproval as a starting point for debate. If you did not make wildly undemonstrable statements such as: "When taken in the context of the lack of medical benefits and the severity of the change in function."--i might be less inclined to charge that you overstate your case, and adduce unsupportable contentions to make that case. This is a primary reason that i have considered you obsessive and suggested that your position partakes of the character of crusading. As this thread is nearly the entirety of your contributions to these fora as evidence, one can only judge of your world view from the contents of this thread. Disagreeing with you and taking this scant evidence at face value, openly questioning the obsessive nature of your view and questioning whether or not it partakes of the character of a crusade does not constitute a personal attack. Placing this thread in Philosophy and Debate rather than Parenting and Childcare does appear to be questionable judgment on your part (although it may have just been carelessness resulting from not having thoroughly perused the fora) unless you are crusading. In a context of childcare, your remarks are still larded with a great deal of unnecessary and questionable contention, but less remarkable. In a context of philosophy, your motives appear suspect, it appearing (to my humble intellect at the least) that you elevate the issue to one of moral universality--as though you likened this to criminal mutilation. Circumcision might be considered an odd custom by some; in the first half of the 20th century, it was considered a medically beneficial procedure, the evidence i have for that statement admittedly being the anectdotal evidence of my mother's testimony as a former obstetrical nurse.

Arriving in this (still very silly) thread, to be found in Philosophy and Debate, my immediate reaction is that we likely were being visited by yet another obsessive crusader. Your continued performance does little to disabuse me of that surmise.

Quote:

I have actually learned a lot from Joefromchicago and others, although, I can't say I've learned much from you.

Allow me to return the compliment, and note that you have provided nothing in the way of education for me. This is especially the case in that the bulk of your argument is unsupported; i strongly suspect that you will not be able to support, from commonly recognized expert sources (without contradiction from other equally expert sources) a statement as extreme as that this procedure results in any " . . .severity of [a] change in function." If you employ such flagrantly questionable contention, you lay yourself open to charges of being obsessive, and of making statements which are not demonstrably true; at the very least, in so far as you have not demonstrated such a case.

Quote:

I might actually stick around because I am just getting into "debating" and have found this site challenging. BTW, no one is making you debate this subject. You are here by choice just as I am.

A needlessly snide response. As with your fondness for understatement, statments of the obvious seem to appeal to you as well. Simply because this forum's title contains the word "debate" is not reason to have (inappropriately, to my mind) placed this topic here. In that you chose to do so, i considered your motives suspect as i have already mentioned, and have found your justifications unfounded. The entertainment value of this site lies in the silliness in which we all engage (as i have done in this thread) and questioning the statements of others during debate. I am become convinced that you would very much like it if i chose not to respond in this thread--something without any possibilty of motivating me.

Quote:

Yeah!! I hope I win!

Good manners, and a due regard for the happiness of all arising from the collective happiness of individuals impels me to join you in your fond desire.

Quote:

Designed by nature, evolved... whatever works for you... or do you think the penis and foreskin is a random collection of cells? Either way, the penis functions a certain way with a foreskin and that is changed by circumcision.

I was attempting to establish whether or not you are motivated by religious fervor. Pardon me for suspecting as much when you put a childcare issue in a philosophy forum. As it appear that you refer to evolutionary morphology, i direct you again to my remarks about the survival of the individual and the question of breeding opportunity. Your case fails on those bases.

Quote:

Do you deny that circumcision changes the way the penis functions during intercourse?

I most assuredly deny that you have made any such case.

Quote:

Specifically, does an intact penis "glide" on the loose skin during intercourse? If you knew how the foreskin/shaft skin functions then you would understand this to be true. If you do not understand this then I will try to explain it/direct you to some pictures.

You use sarcasm as a cleaver when it is commonly understood to have the character of a rapier. Glide is a verb which i consider very appropriate to my humble, mutilated, circumcised penis during heterosexual intercourse (i cannot speak to the issue of homosexual intercourse, having no experience thereof), and your vague reference to "loose skin" makes little sense. I do have sufficient command of this language to understand clearly and comprehensively stated descriptions. If you find some prurient interest in such pictures as those to which you allude, by all means, i heartily endorse your use of them. I won't need them, thank you. I will only require that you express yourself more clearly. During my training at the United States Army Medical Field Service School in 1970, in those bad old days when there was not noticeably any loud opposition to infant circumcision, we were taught that men who elected circumcision did so because of painful experience of intercourse, during which the penis did not smoothly glide. Sadly, i took no measures to determine if we were so instructed as a result of a vast and hidden conspiracty of doctors with a penchant for infant mutilation. I cannot speak from experience. But then, a difference between your approach in this thread and mine, is that i don't make statements about the function of the penis with a foreskin, and the function of one lacking a foreskin without the subjective evidence. You would do well not to make such statements yourself, as they make you appear ridiculous. I will note for you, as i did for Bo, that even were you to assemble a test sample of equal numbers of men with and without foreskins, and provide means for them to engage in sexual intercourse, your results would nevertheless not be subject to any meaningful quatification, and therefore useless. I know of no good reason to accept your statement from authority about the function of a penis in either condition during sexual intercourse. I am not disposed to take your word for this, nor to believe that you or anyone else has designed a study which would yield anyting other that anectdotal and useless results.

Quote:

I have not stated that the penis will not function without the foreskin . . .

But you have, as a statement from authority, stated that it does not smoothly glide during sexual intercourse. You make such a statement without any reason for me to accept your authority to make it. I have already remarked why it is unlikely that i would accept the statment from anyone making it.

Quote:

(I have not stated that the penis will not funciton) . . . or that there is any "survival" disadvantage. I have not even stated that a penis is more sensitive with a foreskin. What I do know is that a penis comes with a foreskin and I believe that it is that it should not be removed without medical cause any more than an infants fingertip should be removed without medical cause.

I will again refer to your outrageous remark about "severity of the change in function." It is a statement you make unsupported, and which, for the reasons i have already given, i do not believe you or anyone else competent to make. The comparison of the removal of the foreskin to the removal of a fingertip is patently false and misleading. A fingertip is a crucial piece of tissue, necessary for tactile investigation, without which it is reasonably arguable that one's capacities have been diminished. You have not made, and i do not believe you can make such a case with regard to the foreskin. Once again, you employ flagrantly inapproriate rhetoric in your defense of your position, which rhetoric leaves you open to a charge of obsession.

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Joe - why will you insist on ONE criterion and one only?

I keep telling you that it is a this and - not a this or.

There are AND positions. These - especially in medical and other professional ethical decisions - are the meat of daily ethical decision making

Defend your position that there are not.

Your artificial question format does not allow this, but this is "Joe's" rule. Defend it.

Ethical decisions require the taking into account of all sorts of criteria simultaneously all the time - and weighing them up.

What is YOUR position?

Do you take a position that unnecessary medical procedures are fine without informed consent?

Or that necessary procedures are not ok without?

Or do you consider both criteria?

What is your position upon the following scenario,

A 21 year old male Jewish boy is brought in in a coma following an accident.

He requires urgent surgery to save his life. The doctors perform this surgery - his life is saved. He was unable to give informed consent.

Wrong or right to operate?

A 21 year old jewish boy is brought in in a coma from a drug overdose.

His parents somehow missed out on the circumcision earlier in his life. They consent to life-saving surgery on his behalf. Doctor, they say - we did not do the right thing by our boy - please, while you are operating, circumcise him. We will give consent.

Should the doctors do this?

A 21 year old man goes to a doctor. Doctor, he says, I have converted to Judaism - please circumcise me.

What should the doctor do?

Please use only one criterion for each ethical decision.

I think your contention that more than one criterion cannot be used at the same time to be ridiculous - once again, defend it.

Of course I am not going to say that fixing a faulty heart valve or a cleft palate is not ethical because an infant cannot consent. These are medically necessary and defensible - it is easy to do a risk/benefit analysis that comes out in favour.

Medically necessary/no informed consent possible because of infant's age = very likely ethical because possible and likely benefit outweighs likely harm.

Medically unnecessary AND no possible informed consent = probably unethical - because risk likely outweighs benefit - except that, as the BMA discusses, there is the added question of best interests of child, which can include acceptance sameness factors, to complicate the matter.

For the same reason I am NOT saying that necessary and painful procedures are unethical - although it IS ethical practice to minimize pain and trauma.

Risks include: the risks associated with any surgical procedure: pain, bleeding, infection, surgical mishap and complications of anaesthesia - including death.

Joe - as for your rudeness about my ethics - do you hold every ethical belief you have equally fervently?

For instance, were you a good christian, would you hold not coveting your neighbour's ass as highly as not killing?

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