Circumcision Ethics and Economics

Infant circumcision is an ethical issue that has lifelong effects on the child and societal costs.

NOTE: Primary author is Lillian Dell'Aquila Cannon (see her blog), with assistance from Dan Bollinger

No medical association in the world recommends routine infant circumcision. None.

The American Academy of Pediatrics Policy Statement on Circumcision says:

"Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision." (AAP 1999)

The British Medical Association says:

"[P]arental preference alone is not sufficient justification for performing a surgical procedure on a child." (BMA 2006)

The Royal Australasian College of Physicians says:

"After reviewing the currently available evidence, the RACP believes that the frequency of diseases modifiable by circumcision, the level of protection offered by circumcision and the complication rates of circumcision do not warrant routine infant circumcision in Australia and New Zealand." (RACP 2010)

The Canadian Paediatric Society says:

"Circumcision of newborns should not be routinely performed." (CPS 1996)

The Royal Dutch Medical Association (KNMG - Netherlands) policy statement is wonderfully clear:

"There is no convincing evidence that circumcision is useful or necessary in terms of prevention or hygiene... circumcision entails the risk of medical and psychological complications... Non-therapeutic circumcision of male minors conflicts with the child's right to autonomy and physical integrity." (KNMG 2010)

Circumcision wastes money.

Medicaid spends $198 million each year on routine infant circumcision in the 33 states that still pay for it, a procedure its own guidelines consider to be medically unnecessary. Private insurance programs are reimbursing an additional $677 million, raising prices for us all (Craig 2006.) In addition to the cost of circumcision itself, correcting its complications are said to double the cost, bringing the total bill to $1.75 billion each year. Is this what we should be spending money on during a recession and at a time when healthcare costs are skyrocketing?

Circumcision violates the Hippocratic Oath to "First, do no harm."

Doctors have an ethical duty to treat the patient by the most conservative means possible, but removing healthy tissue in the absence of any medical need absolutely harms the patient. In the case of routine infant circumcision, nothing was diseased, and thus nothing justifies its removal. Medical personnel who support infant circumcision in any way should reexamine their ethical duties to the child.

Everyone has a right to bodily autonomy and self-determination.

This is a fundamental tenet of international human rights law (UNESCO 2005). As babies cannot speak for themselves, they need special protection. Balancing the potential benefits of circumcision with the definite risks can be difficult decision, but the only person qualified to make this decision is the owner of the penis, as he is the one who is going to have to live with the results, not his parents.

Parents' aesthetic preferences are not valid reasons for circumcision.

If a mother thinks her daughter's nose is too big, should she force her to get a nose job? If a father prefers large breasts, can he force his daughter to get breast implants? If a woman prefers circumcised men, can she force her son to be circumcised?

Even if you are fine with being circumcised, your son may not be.

If you have never had a foreskin, you cannot possibly know what having one would feel like. You only know what it feels like to not have a foreskin. You cannot know now how your son will feel in 20 or 30 years. If you have your son circumcised, he may grow up to regret the decision you made for him, but circumcision is irreversible. (Yes, men can partially restore their foreskins, but it is difficult and the sensitive nerve endings are gone forever.) Leave the decision to your son. It is his penis. He deserves to decide for himself.

Parents have a duty to educate themselves on circumcision rather than do it just because it was done to them.

As parents, we are entrusted by God or the universe or by nature with the care of our babies. They truly are a gift, but one that we do not get to keep. We have a responsibility to care for them as best as we can, because they cannot speak nor care for themselves. Though they are babies now, and we have to make decisions for them, they will be adults, with minds and feelings of their own. We need to make decisions for them that we will be proud to stand behind now and in the future. If your son asks you why you had him circumcised, how will you answer? "Because I am circumcised and I needed your penis to match mine?" "Because I didn't trust you to be able to make your own decisions?" When making this decision for your son, be brutally honest with yourself. What does your decision serve: the child's rights, or your ego?

For clear, easy and plain-language help making the circumcision decision, try the Circumcision Decision Maker at http://circumcisiondecisionmaker.com/.

Just because it has been a "tradition" does not make it right.

Slavery and child labor were traditions sanctioned by religions and other authorities. But we abandoned those practices because they were unjust and harmful. Infant circumcision, similarly supported by authorities, should be abandoned by the people who care for children because it is unjust and harmful.

It's time to face our discomfort and admit that circumcision was a mistake.

Routine infant circumcision is a 90-year aberration in the more than 150,000 years that Homo sapiens has existed on this planet. It's a remnant of times when people thought it was okay to beat your wife and children, that babies couldn't feel pain and so could be operated on without any anesthesia, and that it was bad to enjoy your sexuality. We've discarded all these other ideas, and now we're discarding circumcision, too.

It is time to face reality.

If you are a circumcised man, or a parent who circumcised his child because you thought it was good for him, you have a painful task in front of you. It's time to face reality:

You were circumcised because your dad was circumcised because everyone else was circumcised because 140 years ago, some perverted doctors wanted to stop boys from masturbating. Being circumcised isn't better, and it isn't popular anymore. The 70% of the world's men who have foreskins almost never choose to have them cut off and consider them to be the best part of the penis. You don't have this part of your penis, and that's really terrible, but it would be even more terrible to make the same mistake with your own child.

The future

Circumcision is ending with the generation being born now - only 32% of babies born in 2009 in the USA were circumcised. Boys born today who keep their foreskins are not going to be mocked, because they're in the majority, and because people now are more informed. Uncircumcised boys are not going to be scarred because their penises do not match their fathers'. The myths are dying - more and more people are realizing that leaving children's penises intact is better.

Read about how early trauma influences brain development and morality in Neurobiology and the Development of Human Morality:Evolution, Culture and Wisdom (Norton book; discount code: NARVAEZ)

POSTS ON CIRCUMCISION

Myths about Infant Circumcision you Likely believe

More Circumcision Myths You May Believe: Hygiene and STDs

Circumcision: Social, Sexual, Psychological Realities

Circumcision Ethics and Economics

What Is the Greatest Danger for an Uncircumcised Boy?

Why Continue to Harm Boys from Ignorance of Male Anatomy?

Pro-Circumcision Culturally Biased, Not Scientific: Experts

Protect (All) Your Boys from Early Trauma

Circumcision’s Psychological Damage

References:

American Academy of Pediatrics. Circumcision Policy Statement (1999) Pediatrics 1999;103(3):686-93.

Circumcision of Male Infants. Sydney: Royal Australasian College of Physicians, 2010.

Craig A, Bollinger D. Of waste and want: A nationwide survey of Medicaid funding for medically unnecessary, non-therapeutic circumcision. In: Denniston GC, Gallo PG, Hodges FM, Milos MF, eds. Bodily Integrity and the Politics of Circumcision: Culture, Controversy, and Change. New York: Springer; 2006:233-46.

Fetus and Newborn Committee, Canadian Paediatric Society. Neonatal circumcision revisited. (CPS) Canadian Medical Association Journal 1996;154(6):769-80.

Intergovernmental Bioethics Committee. Universal Declaration on Bioethics and Human Rights. Adopted by the General Conference of the United Nations Educational, Scientific and Cultural Organization on 19 October 2005.

Medical Ethics Committee. The law & ethics of male circumcision - guidance for doctors. London: British Medical Association, 2003, 2006.

Non-therapeutic circumcision of male minors. Utrecht, Royal Dutch Medical Association (KNMG), 2010.