Circumcision--A Victorian Relic Lacking Ethical, Medical, or Legal Justification

Michael Benatar and David Benatar (2003) are to be commended for raising the issue of male circumcision for ethical consideration. However, we cannot agree with their conclusion that "nontherapeutic circumcision of infant boys is a suitable matter for parental discretion," nor that "religious and cultural factors, though preferably subject to critical evaluation, may reasonably play a role." Doctors may not properly act as cultural brokers, and male circumcision is not a medically, ethically, or culturally neutral practice, suitable to be left to parental whim, but rather a clear violation of a number of central principles from the disciplines of medicine, ethics, law, and human rights.

In order to protect patients and doctors alike, it is ethically and legally essential that our default assumption must be against a procedure. This presumption cannot be reversed until we have substantial scientific evidence based on well-established research criteria that the procedure will provide an overall medical benefit to the patient. Despite the authors' candid admission that "the evidence for beneficial effects of circumcision is controversial," somehow they nevertheless come out in favor of the procedure. Either the evidence suffices to justify this invasive, painful, unconsented-to procedure, or it does not.

In fact, according to the unanimous opinion of the world's national and international medical organizations, routine circumcision is not justified, and it is the Benatars who are severely out of step with current medical knowledge. Of the at least 16 national and international medical organizations that have spoken on routine neonatal circumcision, not a single group has recommended it. This includes five leading American organizations such as the American Medical Association and the American Academy of Pediatrics.

A further serious difficulty with the Benatars' analysis is their inclusion of only complications and pain as possible disadvantages of the procedure while ignoring the elephant in the room—the inherent value of the intact penis. The authors entirely omit any discussion of the functions of the foreskin, which fall into three main categories: protective, immunological, and erogenous (Fleiss, Hodges, and Van Howe 1998). Moreover, the Benatars go on at length about the alleged benefit of helping prevent the vanishingly rare condition of penile cancer while entirely omitting any discussion of the most serious complication of all: death. Although precise estimates are difficult to give due to, among other factors, concealment of the event when it occurs (NewsNet5 1998), responsible commentators nevertheless place the number of circumcision-caused deaths in the United States annually at well over 200 (Baker 1979).

The Benatars attempt to sanitize circumcision by comparing it with various forms of plastic and cosmetic surgery that presumably are familiar to us—breast reduction, liposuction, and rhinoplasty. The critical distinctions are that these other practices are performed on adults who themselves give informed consent to the procedure prior to its performance, whereas routine circumcision is performed on nonconsenting infants. For this reason, routine male circumcision violates human-rights principles contained in documents such as the Universal Declaration of Human Rights, The Covenant on Civil and Political Rights, and the Convention on the Rights of the Child, while the other practices considered by the Benatars do not. The United Nations has acknowledged that at least in certain circumstances, male circumcision does constitute a human-rights violation.

Benatar and Benatar point out that prophylactic immunizations of children are acceptable, despite the lack of clear and immediate medical necessity for the child, suggesting a possible parallel that might support circumcision. However, the case of circumcision sharply differs from that of immunization in that the public-health "benefits" of the former are incomparably miniscule compared to the latter, and also in that circumcision constitutes a much more serious invasion of the individual's body (Hodges et al. 2002). Although prophylactic double mastectomy of girls whose family histories place them at high risk of breast cancer might result in substantial health...