The Lesser Circumcision Rant: Religion, Parenthood, and Urinary Tract Infections
By: Joe
Since Ross's Great Circumcision Rant, I been finding myself in more conversations with friends and family about circumcision. Below are some of the issues that have come up.
"That all sounds good, but what about if circumcision is part of your religion?"
Many cultures and religions include ritual infant circumcision. Some people suffer under the misconception that, in these instances, infant circumcision is not a violation of the infant's rights. Some even go so far as to say that restriction of religious circumcision would be a violation of religious freedom, as did critics of the recently proposed and defeated circumcision ban in San Francisco [1]. Neither of these assertions is correct.
First of all, there are hundreds, if not thousands, of religions, and the idea of freedom of religion requires freedom of choice. In other words, adult people are free to choose or not choose a religion. Infants, as you probably know, are not adult people. They do not possess the faculties to make an informed decision about religion. It is not a parent's right to make the decision in the meantime, and mutilate the infant's body, just in case when he grows up he happens to choose the same religion that the parent practices.
Second, it is true that people have the right to choose, invent, or eschew religion, but this is restricted to religious worship, not religious practice. There can be no freedom of religious practice. Because people can choose or invent any religion for themselves, freedom of religious practice would equal freedom to do anything, even if it violated the rights of others. If restricting infant circumcision is a violation of religious freedom, then by the same logic, preventing an Islamic jihadist from killing an infidel is also a heinous violation of the jihadist's rights.
If you belong to a religion that believes your child will suffer some supernatural consequences if you do not circumcise him, all I can say is that it is unfortunate you chose to believe in a god that is obviously an asshole. This, of course, assumes that your motivation really is the best interests of your child. Recently, I have begun to doubt that this is the true motivation for ritual circumcision. The other day I was waiting to get a hair cut and I picked up a Newsweek that had an article on the rise of forced marriages and honor killings in the U.S. and in the U.K [2]. Honor killings are committed, as the name suggests, because the perpetrator believes the victim has brought dishonor to himself or his family. This is the same reason that women are ostracized for not cooperating with planned marriages. It is not for the best interests of the female family member in question. In the case of killing, this is obviously the case; how could killing someone ever be in her interests? In the case of forced marriages, this is made crystal clear by the fact that women are forced to remain in these marriages despite horrifying physical and sexual abuse.
People commit these honor killings and forced marriages out of fear of what others in their tribe or community will think of them. My experience with the reactions of religious people when I tell them my children will not be circumcised (my fiance is Jewish) suggests that this is also the true motivation for religious circumcision. I have yet to hear a person say "You aren't going to circumcise your sons? But then they will not have a covenant with God. How sad for them!" The constant objection I hear is "What will people think?!" or "But then he won't be accepted in the Jewish community."
The Proper Role of a Parent
I think the unifying idea behind all of these crimes, honor killings, forced marriages, and infant circumcision is a flawed conception of the parent-child relationship. The perpetrators consider their children to be their property to differing extents, tools to be used in whatever way reflects best on them. They misconceive this relationship as pseudo-contractual. I think this position was described quite well by the now famous Tiger mom:
Chinese parents believe that their kids owe them everything (emphasis mine) [due to] the fact that the parents have sacrificed and done so much for their children. Anyway, the understanding is that Chinese children must spend their lives repaying their parents by obeying them and making them proud [3].
The correct way to conceive of the parent-child relationship is that parents voluntarily take on the responsibility of raising their children, not for any financial or social repayment the child might make in return, but for the satisfaction of watching them become an independent, rational, productive adult. The child is not a pawn to be physically altered or brainwashed for the parents' benefit. The child is the temporary ward of his parents who have committed to act in his rational and long-range best interests, until he is old enough to do so for himself.
Just to be clear, violating another person's rights to improve your social standing, whether it be standard school-yard bullying, date rape, infant circumcision, or an honor killing, makes you a very bad person.
"Well we make lot's of decisions for our kids that permanently affect their future. Why not this one?"
Some people misinterpret the above statement of a proper conception of parenthood to mean that any decision that they can possibly construe in their minds as in the child's interest is fair game. By this logic, the decision to circumcise an infant is trivial and on the same level as what school to choose, or what sports to try, where to live, etc. As I see it, there are two major flaws with this thinking.
First, it depends on a deterministic metaphysics such that a person's school, sports, or even what he ate on September 19, 1992 permanently sealed his fate in ways we cannot fully perceive. The truth, far from this, is that people have free will (a fuller discussion of determinism v. free will would be off topic, but a great source on this issue is Objectivism: The Philosophy of Ayn Rand, by Leonard Peikoff). It is true that parents' actions can influence their child's future. For example, if a parent does not put his child in Little League, then the likelihood he will become a professional baseball player is lower, but not zero. The job of a parent is not to maintain an infinite number of career possibilities including the most skilled positions of every imaginable field. It is to raise a rational, independent adult who has the ability to undertake any goal, including learning to play baseball, to whatever extent his mind and body will allow him. He might not ever be a professional, but depending on his level of commitment and physical ability, he could be pretty good and have fun. On the other hand, being a rational, independent adult would never allow him to completely restore his penis to an intact state.
The second and more important flaw is that it characterizes the argument that infant circumcision is immoral by a non-essential criterion, that it is permanent. The permanence is part of the reason infant circumcision is wrong, but not the essential reason. The essential reason why infant circumcision is wrong is that it is an unnecessary procedure that robs the future adult of a decision that should be his. An analogy can be drawn here between the parent making decisions for a child and a husband with temporary medical decision making power for his incapacitated wife. The husband in this case is restricted to making decisions directly relevant to his wife's well being--time sensitive decisions that could not simply be made by her later. He would be justified in choosing surgery for an acute appendicitis. He would not be justified (and no honest doctor would comply) if he said "while you're in the OR, why not do a quick boob job too." Likewise, parents must choose methods of education, exercise, nutrition, etc. but have no place deciding on a cosmetic procedure for an anatomically normal penis. The husband is not omniscient, there are risks of complication that accompany surgery, but he must make the decision with the best of his available knowledge and without evading any important factors. Likewise, the school, exercise, or nutrition of a child might end up having some negative impact, but the parents do the best they can with the information available to them. Parents have to make decisions for their children, some more trivial than others, but infant circumcision is not a decision that, under normal circumstances, need ever be made by them.
"What if the decision to circumcise is vital to the health of the child and is time-sensitive?"
No one posed this question to me, I invented it myself to test the validity of my thinking. This is a new line of thinking, and I welcome criticism of my reasoning. It is hypothetically possible that there exists some devastating disease or condition which infantile circumcision is very effective in preventing and for which there is no safer, less invasive alternative preventative measure. For example, if it was discovered in 1944 (arbitrary date previous to the invention of Salk's polio vaccine) that circumcision protected against polio then I would agree that a parent would be justified in pursuing child circumcision for this reason. The essential features of this situation are that polio is a devastating infection that was of high incidence in the United States in 1944 (over 26%) and for which, at the time, there was no safe, effective prevention [4]. In this case, waiting for the child to mature to make the decision himself poses a very real risk.
This however is not the case.
The closest clinical reality to this scenario is the risk of infantile urinary tract infection. Almost every other claimed health benefit of infant circumcision has been refuted, and the effect on urinary tract infection remains almost the sole topic of controversy among medical professionals (there is still some discussion of squamous cell carcinoma of the penis, but the rate of this disease is so incredibly low that even the least rational physicians admit that circumcising for this purpose would be ridiculous). There is a statistically significant difference in incidence of urinary tract infection between circumcised and intact infants. But, after careful consideration, UTI does not fit the criteria I have set up for a justifiable reason to circumcise an infant. First, even in intact infants the incidence of UTI is less than 1% [5]. Second, the number of infants that would need to be circumcised to prevent one hospital admission for UTI is 195, a pretty absurd figure considering UTI is easily treated with antibiotics even after hospital admission [6]. Lastly, circumcision comes with its own risks and complications [7]. UTI is simply not a devastating disease of high incidence for which circumcision is the best and safest available prevention.
The following scenario illustrates why concern over UTI could not be a realistic reason for a parent to choose circumcision. In such a case, the parents are showing very high concern over a rare condition. One could assume their goal is to protect their child from any possible cause of death. To be entirely consistent in that goal, the parents would have to show concern and willingness to take drastic action (I consider circumcision, in lieu of other methods of preventing UTI, to be a drastic action for the prevention of morbidity/mortality, especially considering that it is in itself a form of morbidity) to protect their child from other forms of preventable death. In fact, to be fully consistent, their concern and willingness to take actions toward prevention should be proportionate to the risk of each possible cause of death. Since the most common preventable causes of childhood death are motor vehicle accidents, drowning, burns, falls, and toxins, this would mean the avoidance of all roads or motor vehicles, the avoidance of large bodies of water, hot things, high places, and anything poisonous. Clearly no parent could or would pursue this level of protection, which perfectly illustrates why circumcision for UTI prevention is a real stretch as far as valid parenting decisions go. Anyone who chooses infant circumcision for his child with prevention of UTI as the ostensible reason but is unwilling to be as drastic in the prevention of far more likely causes of death is clearly using the illusion of a rational concern for his child's health to hide his irrational or self-serving purposes for circumcising his son.
References
1. Circumcision Ban to be Stricken from San Francisco Ballot. USA Today (2011).at <http://www.usatoday.com/news/nation/2011-07-27-san-francisco-circumcision-ban_n.htm>
2. Marry - Or Else. Newsweek (2011).at <http://www.thedailybeast.com/newsweek/2011/09/18/forced-marriage-and-honor-killings-happen-in-britain-u-s-too.html>
3. Why Chinese Mothers are Superior. The Wallstreet Journal (2011).at <http://online.wsj.com/article/SB10001424052748704111504576059713528698754.html>
4. Medicine: Polio Report. Time (1945).at <http://www.time.com/time/magazine/article/0,9171,801677,00.html>
5. Wiswell, T.E. & Geschke, D.W. Risks from circumcision during the first month of life compared with those for uncircumcised boys. Pediatrics 83, 1011-1015 (1989).
6. To, T., Agha, M., Dick, P.T. & Feldman, W. Cohort study on circumcision of newborn boys and subsequent risk of urinary-tract infection. Lancet 352, 1813-1816 (1998).
7. Perera, C.L., Bridgewater, F.H.G., Thavaneswaran, P. & Maddern, G.J. Safety and efficacy of nontherapeutic male circumcision: a systematic review. Ann Fam Med 8, 64-72 (2010).