An ominous sign of the growing American disenchantment with circumcision is an increasing number of papers and theses by young undergraduates and graduate scholars who are taking a very critical this hitherto taken-for-granted practice. A few years ago, it was only members of the dedicated anti-circumcision movement who were carrying out research into the history, medical rationalisations and bioethical aspects of circumcision; today we find papers being given at mainstream academic conferences, and theses written by under- and post-graduate students at prestigious universities. Recent theses by Shemuel Garber and Chris Jones are summarized here.
A well-researched by an American undergraduate, Shemuel Garber, particularly considers the practice of circumcision among the Jewish people, and as justified and practised by American medical authorities today. He writes in the introduction:
Genital cutting has been around for so long that nobody knows when or why it began, though speculation abounds. Today, both male and female genital cutting are commonly practiced by various cultures in various regions of the world. Presently, all forms of genital cutting are almost universally regarded with disgust and often even moral indignation in the West. All forms, that is, but one. Male circumcision, a procedure in which the prepuce (or “foreskin”) of the penis is severed from the rest of the penis, permanently exposing the penile glans, is commonly practiced as a religious rite by Muslims and Jews and is routinely (though certainly not universally) practiced for non-religious reasons in the United States of America.
I have a bit of personal experience with circumcision that, for the purpose of full disclosure, I will presently relate. As an infant, I, like many boys born in American hospitals, was circumcised shortly after my birth as a matter of routine. For just over a decade, my penis underwent no further marking by civilization. Then, when I was eleven, I converted to Judaism. Since my prepuce was long gone, circumcision was not an option. In order to initiate pre-cut male converts like me into the covenant between the male descendants of Israel and God, Jewish law stipulates a ritual called hatafat dam brit. To execute this sacred task on the day of my conversion, the mohel (ritual circumciser) politely asked me to lower my pants sufficiently provide access and then proceeded to stab my penis with a hypodermic needle, collect a little blood on a piece of gauze, and show it to three witnesses.
Surprisingly, this was not my last encounter with a mohel. A few months later, I learned that the Cleveland orthodox community did not consider my conversion to be valid since they did not consider the rabbi who had conducted it to be sufficiently orthodox. I had to do everything including hatafat dam brit once again. Although from God’s perspective it was apparently much more kosher the second time around, everything was basically the same from my perspective, except that the mohel used a scalpel instead of a hypodermic needle. For the record, the scalpel hurt a bit more, though it was nothing a brave and consenting convert couldn’t handle.
On July 21, 2012, I thought about circumcision critically for the first time at the Freies Museum in Berlin. A German lady to whom I had just been introduced broached the subject, wanting to know my opinion on whether Jews and Muslims should be allowed to circumcise their young in Germany. When I expressed my belief that they should have this right in name of religious freedom, she promptly informed that the question was not one of religious freedom at all, but rather a question of the rights of the child, rights, which she insisted, were violated by those who circumcised unconsenting children. My view, she asserted, was prejudiced by growing up in a country which this barbaric practice is commonplace.
Troubled by these unexpected remarks, I spent the next several days reading about the debate over the legality of circumcision that was raging in Germany and trying to formulate my own opinion. Eventually, I realized that I had found a thesis topic. I went into the research with an open mind. All I knew for sure was that I was very confused. Over time, however, I developed a strongly oppositional opinion on circumcision. This opinion certainly comes through in my analyses. I sincerely attempt to argue fairly throughout the work, avoiding unnecessarily hyperbolic claims and honestly engaging with opposing views where appropriate, but I am not a disinterested observer and I make no claim to objectivity.
Garber understands the essential point: that circumcision is not favoured because the medical evidence supports it, but because cultural commitment to or faith in circumcision generates the medical evidence that seems to provide a justification for it. Consequently, as one reason for circumcision loses its force (prevention of masturbation, epilepsy or hip joint disease), others take their place. He also understands that it is only because circumcision is performed on the most culturally, physically and sexually significant site of the male body – his penis – that it escapes the normal rules of surgery, evidence-based medicine and bioethical principles. As he explains with a telling thought experiment in chapter 2:
Michael Katz writes with regard to the medical justifications for male circumcision that “There is no parallel in other prophylactic measures, such as immunization. No other prophylactic measure attempts to achieve a benefit by abrogating a natural process.” The point is that even if the prophylactic claims are true, they come at too high of a price. He also points out that, over time, the medical justifications for circumcision have changed while the recommendation has remained the same. As each new set of claims is discredited, another pops up to replace them. The medical community attempts, time and time again, to retroactively provide justifications for a ritual that is already culturally sanctioned. Were it not already culturally sanctioned, the medical arguments would not be accepted or, perhaps, put forth at all. The problem is not that it is inconceivable that a prophylactic effect could arise from the amputation of a functional body part. Rather, the problem is precisely that, in the absence of prejudicial cultural influence, the possibility would never be explored for obvious ethical reasons.
A hypothetical example will help demonstrate this point. A freethinking American biologist contemplates America’s tragic obesity epidemic. After several minutes of deep reflection, he comes up with an idea. In order to prevent future generations of Americans from becoming grossly overweight,infants will be subjected to a relatively minor surgical procedure that inhibits their capacity for olfaction. Mind you, it will not eliminate their capacity for olfaction altogether. It will just reduce it enough so that the experience of flavor is moderated to a level that is more nutritionally adaptive in the context of today’s superabundance in the availability of calorically rich foods.
If one were to conduct trials, one would likely be able to demonstrate that those who had undergone the procedure are significantly less likely to develop obesity and all of the medical conditions that are associated with it. Furthermore, after a few decades, one might be able to establish rigorous procedural standards that ensure that operative complications (like accidentally eliminating olfaction altogether) are reduced to nearly negligible levels. The essential point is that, even in light of these empirical demonstrations and technical advances, the practice would be rejected as intrinsically and essentially harmful. A reasonable critic would surely say, “If you are concerned about your child’s weight, then teach him about proper nutrition and stock your kitchen with produce rather than junk food. Don’t resort to damaging his sense of smell. That’s unethical!”
If an American is truly concerned about his or her son getting HIV, the appropriate course of action would be to give him condoms and explain how using them consistently nearly eliminates the possibility of sexual transmission of HIV and to explain the dangers of intravenous drug use. Whether or not circumcision effectively reduces rates of HIV transmission or any other ailment, it should not be considered as a routine prophylactic measure because it is inherently harmful.
Shemuel Toviah Garber. The Circular Cut: Problematizing the Longevity of Civilization’s Most Aggressively Defended Amputation. Thesis submitted to the faculty of Wesleyan University in partial fulfillment of the requirements for the Degree of Bachelor of Arts with Departmental Honors from the College of Letters and with Departmental Honors in Philosophy. Middletown, Connecticut: April 2013.
In “The facade of inevitability”, an MA thesis from Iowa State University, Chris Jones takes a cool and highly critical look at the policy statement on circumcision issued by the American Academy of Pediatrics in August 2012. He presents a provocative argument that, contrary to the AAP’s claims, it is not an objective scientific assessment, but an exercise in rhetoric and persuasion. While the AAP claims it is merely providing information to assist parents to make a decision, in reality the policy is nudging them, not so subtly, in making a decision in favour of circumcision. The significance of Jones’ thesis is wider than the specifics of his argument, for he is really declaring that the emperor has no clothes. The AAP likes to regard itself as the pre-eminent world authority on all matters relating to the health of children; according to this unimpressed graduate student, it is nothing more than a professional interest group with an ideological axe to grind. Jones writes in the introduction:
The scientific issue I will focus on in this thesis is infant male circumcision (IMC) in the United States. A series of clinical trials conducted in sub-Saharan Africa (Kenya and South Africa) between 2003 and 2006 indicate that circumcision of males may prevent the transmission of HIV by as much as 60%. While the research was conducted on adult males in a region where an estimated 68% of the 34 million people living with HIV reside and where the infection rate among adults is a staggering 5% (AVERT), the American Academy of Pediatrics (AAP) has relied heavily on this research to justify their support of infant male circumcision (IMC) in the United States where less than 4% of the world’s HIV cases occur and where only an estimated .4% of the population are infected with HIV (CDC). The AAP indicates that recent research shows that the medical benefits of IMC outweigh the risks and that this justifies “access to this procedure for families who choose it” (756). What remains unclear is how this HIV research is used and applied to a vastly different context as a form of argument. The report focuses heavily on the ability of the family to make choices for their infant, but constructs a narrative of risk – primarily the risk of contracting HIV that makes the decision not to circumcise medically negligent. The report also displays an unresolved tension between the right of the family to make such a decision and the right of the child to make that decision once they reach the age of consent.
My goal in this research is not to suggest that circumcision is right or wrong, only to examine how the technical report functions as a rhetorical artifact. What is particularly interesting about this document is that on a surface level it seems to merely suggest that parents have an opportunity to choose whether or not to have their children undergo the procedure, but a closer analysis reveals that the report is really arguing that circumcision is a better option. Because the primary audience of the report is the medical community (physicians, pediatricians, nurses, etc.), it is important to note that the technical report on male circumcision is available for free on the AAP’s website and was published both online and in the September 2012 issue of their journal. Given the immediacy and intensity of news coverage the policy statement received, it is reasonable to assume that a number of people viewing the report were parents or expecting parents. For this reason, the report is treated as having a pluralistic audience.
A quick scan of articles touting the medical benefits of IMC or blasting the credibility of these claims will reveal a host of prevalent issues, and a review of commentary on such articles indicates just how intense this debate can be. The discourse that envelops the IMC issue has existed in the public sphere for a number of years, but more than ever medical research is being viewed by a public that may or may not be equipped to interpret it. In addition, this particular scientific discussion concerns both religious and cultural practice. Still, medical organizations like the AAP have a vested interest in presenting recommendations based on their evaluation of current research. The AAP is an organization “dedicated to the health of all children” (AAP History). Founded in the 1930’s by a cohort of medical professionals, the goal of the organization was to foster relationships within the medical community and between the medical community and other organizations. Their current mission is to “attain optimal physical, mental, and social health and well-being for all infants, children, adolescents and young adults” (AAP Facts). From a practical standpoint, the AAP helps to establish standards for preventative care of children such as immunization and diet.
While the percentage of circumcised infant males in the United States has been declining in recent years (Rabin), there remains a need to regularize and medicalize the procedure due to the inconsistencies with how, when, and where the procedure is performed. From a number of viewpoints – human rights, religious rights, cultural ideology, socioeconomic, medical, etc. – infant male circumcision occupies a complex discursive web.
In this paper I argue that the AAP maintains that the choice to circumcise should be left to the family of the infant, but they also inhibit this choice by both positioning the physician as the primary decision maker and by constructing a rhetoric of risk in regards to HIV infection. What looks like only a recommendation that circumcision should be an option for parents is really a suggestion that circumcision is a vastly better decision. In general, the AAP and their report (among other things) act to regulate the practice of circumcision and in doing so position those who choose not to circumcise as dissenters. By stating that it is better, from a medical standpoint, to have infant males circumcised, the AAP divides families into those who make good choices and those who do not. In chapter two I use cluster criticism to explore the discursive patterns of the technical report, and use recent theories about agency and kairos in chapter three to see how risk is constructed. In chapter four I use Latour’s model of the circulatory system of scientific facts to help to illuminate aspects of the AAPs 2012 technical report and how the report functions at a more macro level. I conclude that for a true choice to exist, we as a culture must understand and confront the social constraints that make not being circumcised unnatural.
Chris Jones. The façade of inevitability: Risk, agency, and the American Academy of Pediatrics’ technical report on male circumcision. A thesis submitted to the graduate faculty in partial fulfillment of the requirements for the degree of MASTER OF ARTS. Iowa State University, 2013. Available as PDf from Iowa State University