Male Circumcision, Religious Preferences, and the Question of Harm

In "Between Prophylaxis and Child Abuse: The Ethics of Neonatal Male Circumcision," Michael and David Benatar (2003) stake out a moderate position, proposing that, first, the choice of whether to circumcise a male child is an acceptable choice and a choice appropriately left to parental prerogatives, and, second, that the participation of the physician is permissible as well. The basis upon which such a conclusion is viewed as acceptable is the empirical evidence that tips in favor of perceiving circumcision as providing a benefit and not a significant risk, and also that not all medical service has to be in response only to what is medically indicated.

An important part of the paper is the dispassionate, thoughtful, and apparently fair manner in which the empirical evidence on either side of the question is carefully analyzed. Of course, much turns on the question of whether what seems to be the case regarding the analysis of the empirical studies is in fact the case. That is, if the studies in question did find serious harms associated with male circumcision and no benefits, a very different conclusion regarding parental choice and physician involvement might be in order, or, at least, a different set of arguments would have to be developed in order to support the same conclusion.

With the latter point in mind, I want to address two issues that were touched on in the paper but need to be developed more fully. The first has to do with the religious dimension that is associated with the practice and what complications follow if one permits a consideration of this association. The second has to do with medical interventions that occur, at parental discretion, that are not actually medically indicated. My purpose is not to put forward conclusions that I want to defend (at least not at this time) but to point out issues that would seem to require further discussion.

What if it were the case that male circumcision posed a real risk and was a religious requirement? Would it still be a matter for parental choice or discretion? Probably most would argue that it should not be. The Benatars would likely argue to this conclusion, as well. But, as I pointed out elsewhere (Sheldon 1996; 2000), when religion is involved, matters become complicated. Different perspectives come into play that are simply incompatible, that pass each other as a result of operating within a different set of priorities.

Most perceive the refusal of a blood transfusion by a Jehovah's Witness parent as the gold standard for unacceptable parental choice. The reason for this is that there is no perceived ambiguity regarding harm to the child. If the child does not receive the blood transfusion, he or she will die and death is a harm. There might be significant acceptance of this parental discretion if death were only vaguely possible. But since it is just about certain that death will occur, almost all people will push for intervention that would oppose parental discretion.

The problem, however, is that as soon as one brings religion into the mix one finds that what constitutes harm becomes complicated, becomes a matter of perspective. For instance, in the case of the Jehovah's Witnesses, harm occurs when one receives a blood transfusion, not when one dies. While this might, to many, sound preposterous, the fact is that we actually do not know who is correct on this question. We might actually suffer a harm when we receive a blood transfusion—the harm of being cut off from eternal life—but not when we die physically. Furthermore, we currently have no way to settle the differing claims on this question, to determine, actually, which is right. We would have to die in order to determine an answer to the question, and, even then, our personal fate might be such that we will never be availed of a position that would enable us to...