6 10 240 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h1>Father’s anguish at circumcision of son</h1> <h3>"Consent procedures for circumcision must be tightened"</h3> A New South Wales father was so distressed at the unauthorised circumcision of his baby boy, and by the bland indifference of the authorities to whom he appealed for justice, that he has set up a <a href="http://www.mycircumcisiondisgrace.org/index.html">website to explain his case</a>. The man, Peter – who wishes to remain anonymous to protect the identity of his son – told Circinfo.org that his 6-week old son was circumcised at his partner’s request while he was overseas on a business trip. But he does not blame his partner nearly as much as the doctor who performed the surgery. “She was a victim of the blatant untruths that are spread to justify circumcision – well-meaning but ignorant. She thought that because I was circumcised I would want the boy to be done, or that all boys were circumcised as a matter of routine. I blame the doctor for three unforgivable omissions: failing to tell my partner that circumcision is very much a minority practice these days; failing to give her a copy of the Royal Australasian College of Physicians policy, which states clearly that circumcision is not widely practiced here, and is certainly not recommended; and, most importantly, for failing to obtain my explicit, written, informed consent as the other parent.” The doctor should also have been aware that the Australasian Association of Paediatric Surgeons recommends that if parents insist of circumcision, it should not be done until the boy is at least 6 months old. The doctor’s failure to seek the consent of the other parent is the nub of Peter’s anger. The <a href="http://www.bma.org.uk/ethics/consent_and_capacity/malecircumcision2006.jsp">British Medical Association</a> insists as a matter of policy that doctors who perform circumcision operations on minors must obtain written authorisation from both parents. In Australia there is no such obligation, but an open slather situation that can easily give rise to tragic situations like Peter’s case, or the <a href="https://www.circinfo.org/bundaberg.html">scandalous affair in Bundaberg</a> in 2004. In that incident, an estranged father who did not even have legal custody of the children, then under the care of the mother, took advantage of a permitted access visit to race the boys (aged 5 and 9) off to a compliant surgeon, who circumcised them on the spot, no questions asked. There was a half-hearted attempt to prosecute the man for assault, but the case was dismissed when his barrister (generously provided by Legal Aid) assured the magistrate that he had acted out of sincere religious conviction. (He was of Turkish origin, and claimed to be a practising Muslim.) There was no attempt to prosecute or even discipline the surgeon for performing an unnecessary operation without valid consent. The case attracted some publicity at the time, but apparently not enough to persuade the medical regulatory authorities that this rule-free situation was placing boys at risk of harm. Disappointingly, there was nothing about the need for a defined consent procedure in the RACP policies issued in 2004 and 2010. If there had been, both Peter and his son might have been spared their respective agonies. “You can imagine my shock and despair when I got home and found what had happened: my beautiful boy with a mangled penis. I had been circumcised – as was the fashion back then – but I had always resented that it was done without MY consent. I hated it, and was determined that my son would not be deprived in the same way. I was looking forward to watching him grow up whole and unblemished. To put it mildly, I was pretty upset when these dreams were shattered.” Peter’s mood was not improved by the indifference and hostility of the authorities to whom he appealed for help. Politicians thought it was none of their business; the Human Rights Commission did not feel that there had been any infringement of the boy’s human rights, nor of Peter’s rights as a parent; bureaucrats advised him that there was nothing they could do; legal authorities informed him – as though they were imparting great wisdom, known only to the select few – that while any form of female circumcision was illegal in most Australian states, circumcision of male minors was perfectly legal, commonly performed and, really, what was all the fuss about? Peter sent three letters to Senator Bob Brown, that doughty champion of the rights of rivers, whales, trees, refugees etc etc, who of all people might have been expected to have some sort of conscience on this issue. He eventually received a reply from a staffer, informing him that the Greens did not have policies on specific medical procedures. Moral vacuity and intellectual inanity “I was dismayed by the intellectually infantile level of the responses, and their moral vacuity. There was not a hint of sympathy, except perhaps from the NSW Commissioner for Children, who said that she did not agree with medically unnecessary circumcision of male minors. Elsewhere there was no suggestion that there were difficult ethical, moral and legal issues here, that required careful thought, not mere catchphrases.” Considering that fewer than 15% of Australian boys are circumcised these days, Peter thought there might have been a constituency that regarded uncircumcised as normal and circumcision as a misfortune, or at least an aberration. “It seems I was wrong”, he admitted. “All I got was apathy, indifference and a sort of mocking incredulity that I should be so concerned with such a trivial issue. The whole experience left me deeply shaken, with a complete loss of faith in the moral fibre of our guardians (politicians, bureaucrats and medical regulators), and even doubts as to their basic competence.” Peter hopes that <a href="http://www.mycircumcisiondisgrace.org/index.html">his website</a> will alert other parents to the appalling loophole in the child protection safety net that would allow any stranger to kidnap a boy in the street, take him to one of the medical practitioners who perform circumcision operations without medical need, and have him done on the spot. “I think that boys ought to have the same level of legal protection against circumcision as girls currently enjoy against mutilation of their genitals. I don’t expect this to happen any time soon, but while we are waiting for the law to catch up with medical ethics I don’t see why boys should have no protection at all. Even dogs have greater protection these days. At the very least, the rules and procedures for circumcision should be tightened up so that outrages like the one that I and my boy experienced cannot happen again.” <a href="http://www.mycircumcisiondisgrace.org/index.html" rel="noopener" target="_blank">Peter's website, My circumcision disgrace, can be reached here</a> <h2>Comment: Open slather on circumcision of boys must end</h2> At a bare minimum, the rules covering non-therapeutic circumcision of male minors ought to include written consent of both parents; proof of identity and of responsibility for the child; where parents disagree, circumcision not to be performed unless ordered by Family Court; signed declaration by parents that they have read and understood the RACP policy statement and a full statement of all the risks and possible adverse consequences (both physical and psychological) of the operation; requirement to watch a video of (a) the circumcision procedure (b) instructions on after-care and handling of complications and (c) appearance and care of the normal (uncircumcised) penis; a cooling-off period of at least 48 hours; operation performed by a fully trained and competent surgeon, with full anaesthesia and post-operative pain control; no rebate from Medicare unless the operation is clinically necessary <h3>Family Court case of K and H: Circumcision may require consent from both parents</h3> Although the authorities to whom Peter appealed for help seemed confident that a single parent’s consent was sufficient to procure the legal circumcision of a child, there is actually some doubt on this question; their certainty may arise from ignorance of the law rather than knowledge of it. A relevant court decision is a judgement of the Family Court in Adelaide in 2003, in the matter of K and H. The case involved the child of a Tanzanian (Muslim) father and an Australian (Anglican) mother; the father wanted the boy circumcised, the mother did not. Their dispute came before the court because the paediatric surgeon consulted by the parents declined to proceed unless both parents agreed to the operation; the father then applied to the Family Court for an order that the circumcision go ahead, while the mother sought an injunction restraining the father from having the boy circumcised. In its judgement the court came down firmly on the mother’s side, and ruled that the child’s best interests required that he not be circumcised, and it issued orders accordingly. An important aspect of the judgement is that it referred to the well-known High Court decision in “Marion’s case”, in which parents sought permission to have their handicapped daughter sterilised. The court held that if parents wanted to perform what it termed a “special medical procedure” on a child, they required permission from the Family Court. The judge in the Adelaide case did not go into the question of whether non-therapeutic circumcision of a minor was also a special medical procedure (some legal authorities <a href="http://www.cirp.org/library/legal/boyle1/">have argued that it is</a>), but he did observe in passing to make another point that “circumcision is a procedure which parents are able to consent to as an aspect of their responsibility.” Note that the reference is to parents (plural). Whether non-therapeutic circumcision of a minor is in fact a procedure to which parents may validly give surrogate consent was not the point being decided here, and the judge’s remark on this is more in the nature of a passing comment than a substantive legal ruling – or in legal terminology, an obiter dictum (thing said by the way) rather than <a href="http://www.alpn.edu.au/node/60">a ratio decidendi </a>(the reason for deciding). What is of permanent legal significance, however, and relevant to Peter’s situation, is that the court went on to make this statement: “The child, of course, is too young to consent to the procedure and it involves an exercise of parental responsibility about which the parents cannot agree. The court must then make the decision.” These words establish a clear legal precedent that the (informed) consent of both parents is required for circumcision of a child for which they are responsible, and that if they disagree the matter must come before the Family Court for a decision. That being the case, any parent who acts unilaterally is potentially in contempt of court, and any doctor who fails to obtain the consent of both parents may be acting unlawfully. Source: Family Court of Australia, Adelaide, 19 December 2003; in the matter of K (father) and H (mother), under Justice Strickland; 2003 FamCa 1364 </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Family Court case of K & H: Legality of circumcision may require consent of both parents darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h3>Legal reforms needed to protect boys from assault</h3> A shameful incident in Bundaberg, Queensland, in 2002 highlights the need for better protection of boys against unwanted interference with their genitals. In this case a Moslem father forced circumcision on his two sons, aged five and nine, against their own wishes, against the wishes of their mother, and in breach of a specific order by the Family Court. The father was separated from his former partner (an Australian woman of indigenous origin), who had sole custody of the boys, but who allowed them to visit him on the understanding that the man's sister would ensure that they were not harmed. He took advantage of this generosity during one stay to race the boys off to a doctor and have their foreskins amputated. Although the case was investigated by the Queensland Police child abuse unit, which sought to prosecute the man for assault, the case was dismissed in the Bundaberg magistrate's court on legal technicalities. The case shows up the shameful state of medical ethics in Queensland. How was it possible to find a doctor to perform this unnecessary and harmful surgery on two normal boys merely because an adult preferred them to be like him? And not an adult with any legal rights over the boys: had the surgeon done his homework, he would have discovered that the father did not have custody of he boys, and that the Family Court had specifically ordered that they were not to be circumcised. That it was possible is partly a tribute to the destructive influence of circumcision advocates like Professor Brian Morris at Sydney University and the maverick Queensland GP Dr Terry Russell. They are forever popping up in the media to urge parents to have their sons circumcised. Russell's own medical practice consists almost entirely of severing the foreskins from baby boys by means of the plastibell device. No medical organization in the world recommends circumcision, and in Australia both the Australian College of Paediatrics and the Australian Medical Association have issued strong statements against the practice How effective is Queensland and Australia law in protecting the bodily integrity of children? In several European countries, including Sweden and Norway, the written permission of both parents is necessary before a doctor can legally perform a circumcision on boys. A simple rule like that in Australia that could have prevented this tragedy. The case also shows up the sexist and discriminatory double standard by which female circumcision is condemned with horror as female genital mutilation while male circumcision is tolerated as a trivial or even beneficial adjustment. Yet Amnesty International defines genital mutilation as the removal of any part of the genital organs. By this definition, these boys are victims of genital mutilation. If these boys had been girls there would be universal outrage and demands for education programs and legal reform to prevent such cases in the future. Why the sexist double standard? Do boys not have the same right to a complete set of genitals as girls? The father's right to practise his religion and culture does not extend to the right to inflict injury or disfiguring bodily alterations on other people, especially if they are defenceless children. In this special report we print a number of items relating to this tragic and disturbing case. Because new charges may still be laid against the man, it is not possible to reveal his name or that of his ex-partner and the boys. <h3> <a id="media" name="media"></a>Report in News-Mail, Bundaberg, Friday 9 August 2002</h3> Dad escapes charges By Tanya Moore A MAN who had his two young sons circumcised without their mother's permission had charges of grievous bodily harm against him dismissed yesterday. The Bundaberg father, who cannot be identified for legal reasons, had his case dismissed when the prosecution revealed they were not ready to proceed. Bundaberg Magistrates Court was told the man had taken the boys to a Bundaberg hospital while their mother was on holidays to have the operation performed on the six- and nine-year-old boys. Defence barrister Tim Ryan said the doctor had no problems with the "routine operation" because both the boys and the father had given their consent. The court was told the father was "sincere in his religious beliefs" that the boys should be circumcised. But the court was also told the mother, who is separated from the man, disagreed with the procedure and had been involved in a Family Law Court matter, which was the centre of the prosecution's case. Prosecutor Senior Constable Wayne Puxty explained to the court that the prosecution was unable to go ahead without the certified Family Law Court documents that were supposed to be supplied by the mother, and requested an adjournment to receive them. But Mr Ryan said the request was "simply outrageous" given the case had been set down for a hearing since May and the documents wanted by the prosecution had been in existence since August 2000. He added his client had not seen his two sons since the charges were laid on October 3 last year as part of his bail conditions and said any further delaying of the case would be a "misuse of the criminal justice system". Acting Magistrate Neil Lavaring rejected the application for an adjournment, which forced Snr Const Puxty to offer no evidence against the father. Outside court, arresting officer Detective Senior Constable Peter Cormack, from the Gold Coast child abuse investigation unit, said police would still be pursuing the case, on which charges could still be laid. <h3>Report in News-Mail, Bundaberg, Saturday 10 August 2002</h3> Cutting anger By Tanya Moore DOUBLE standards allowed two boys to be circumcised without their mother's permission, an outraged Australian health group said yesterday. Circumcision Information Australia spokesman Shane Peterson said the case in which a six- and nine-year-old boy were circumcised by their Bundaberg father, despite their mother's opposition, was "a tragedy". "In European countries the written permission of both parents is necessary before a doctor can legally perform a circumcision on boys", Mr Peterson said. "This rule should be implemented in Australia to prevent such tragedies." Mr Peterson said the case illustrated a double standard whereby female circumcision was condemned as mutilation while male circumcision was viewed as trivial or even a beneficial adjustment. He said the case also highlighted the lack of implementation of the UN Convention on the Rights of the Child by Australian law. The mother of the boys is also angry at what she sees as a double standard on circumcision. "If I had been in this current situation with two daughters who were circumcised by their Muslim father, the Australian public would be outraged," said the woman, who cannot be identified for legal reasons. "Because it is my two sons who have been harmed, few people seem to care." She said her estranged husband had performed the operation during an access visit to the children last year. Grievous bodily harm and unlawful wounding charges were laid against the boys' father, but these were dropped on Thursday when the prosecution revealed they were not ready to proceed with their case. Detective Senior Constable Peter Cormack, from the Gold Coast child abuse investigation unit, said police would still pursue the case, on which charges could still be laid. <h3>Article in Sunday Mail (Brisbane), Sunday 11 August 2002</h3> Mother's fury as boys circumcised by Elissa Lawrence A MOTHER has spoken of her anguish at discovering her two young sons were circumcised without her knowledge. The woman, 27, who cannot be identified, said she was devastated to learn her former partner and father of her sons had arranged for the boys, then aged nine and five, to be circumcised at a Bundaberg hospital last October for religious reasons. The man appeared in Bundaberg Magistrates Court on Thursday facing charges of grievous bodily harm (for the circumcision). The court was told the Muslim man had taken his sons to hospital to have the operations performed while their mother was on holidays and was "sincere in his religious beliefs" that they should be circumcised. The court was also told the mother objected to the procedure and was involved in a Family Law Court matter central to the prosecution's case. But the charges were dropped when the prosecution revealed missing Family Law Court paperwork meant it was not ready to proceed with the case. An adjournment request was denied, forcing the police prosecutor to offer no evidence against the man. Outside court, arresting officer Detective Senior Constable Peter Cormack from the Gold Coast child abuse investigation unit said police would pursue the case and that charges could still be laid. The boys' mother, who now lives on the Gold Coast, said in a statement she believed her sons had been assaulted. "My sons have a right to grow into adult men with intact bodies and choose their own religious and other beliefs", she said. "If I had been in this situation with two daughters who were circumcised ... the Australian public would be outraged. Being of indigenous Australian descent, I understand the importance of freedom of personal beliefs in a multicultural society." Circumcision Information Australia spokesman Shane Peterson said circumcision was a form of mutilation. "For a long time Australia has had a double standard on male and female circumcision", he said. "Female circumcision is illegal yet male circumcision continues to be unregulated. It's morally wrong. An adult is surgically inflicting their religious, cosmetic or sexual preferences on a child. Surgery of any kind is one of the most invasive and high-risk forms of medical intervention possible, and it should always be the last resort. In European countries, the permission of both parents is necessary before a doctor can legally perform a circumcision on boys." <h2> <a id="release" name="release"></a>Media release by Circumcision Information Australia</h2> <h3>Dropping of charges on father who forced circumcision on sons shows double standard on genital mutilation</h3> A committal hearing for charges of grievous bodily harm and unlawful wounding was scheduled in Bundaberg yesterday against a father who forced his two sons to undergo circumcision during an access visit to his family home last year. The father, of Muslim faith, arranged for his sons aged 5 and 9 to be circumcised for non-medical reasons. This was against the expressed wishes of their mother. "Being of indigenous Australian descent I understand the importance of freedom of personal beliefs in a multicultural society", she said. "I believe my sons have a right to grow into adult men with intact bodies and choose their own religious and other beliefs; I am devastated that the father has stolen that opportunity away from my boys." The charges were dropped yesterday as documents from 1998 needed as evidence for the case could not be located. Prosecutor Senior Constable Wayne Puxty explained to the court that the prosecution could not proceed without certified Family Law Court documents that were supposed to be supplied by the mother, and requested an adjournment to receive them. But defence barrister Tim Ryan said the request was "simply outrageous" given the case had been scheduled for a hearing since May and claimed the documents wanted by the prosecution had been in existence since August 2000. He added his client had not seen his two sons since the charges were laid on October 3 last year as part of his bail conditions and said any further delaying of the case would be a "misuse of the criminal justice system". Acting Magistrate Neil Lavaring rejected the application for an adjournment, which forced Snr Const. Puxty to offer no evidence against the father. Outside court, arresting officer Detective Senior Constable Peter Cormack, from the Gold Coast child abuse investigation unit, said police would still be pursuing the case, and charges could still be laid. By arranging circumcision of the boys, the father was in breach of orders by the Family Court, Brisbane. After a long documented history of physical abuse by the father to the mother, the Family Court ruled that the boys would reside with their mother, and she would have the day to day care and control of their welfare and development. Despite the Court's rulings and the issue of protection orders, on a number of occasions the father threatened to abduct the children, force them to undergo circumcision, and accompany him to Turkey. The father tried to fulfil the first part of his threats by applying to the family court for the boys to be circumcised. The mother of the boys said that the man had a history of substance abuse and psychiatric illness, and that the Family Court "justly dismissed his application for my boys to be forcibly circumcised." The mother feared for her family's safety and moved from Bundaberg to an anonymous address in the Gold Coast to escape the father's continued threats and harassment. For her boys' well-being, she preferred that they have no contact with their father. "I only allowed my boys to stay with their father during the recent access visit as his sister agreed she would be responsible for their care and well-being", she said. It seems the mother's trust was misplaced, as the boys' aunt did not prevent the circumcision that went ahead. The mother believes this was due to the family's Muslim faith. "The father always used his Muslim religion as an excuse for his violence", she said. "He treated us as though we were less than human; he saw us as objects or property for him to do with as he pleased. And now he has assaulted and mutilated my two boys in the worst possible way, by cutting off part of their sexual organs and depriving them of future sexual pleasure". The boys are reluctant to speak of their experience, but have expressed that their father misled them to believe they were going to the doctor for an examination. They are very upset that part of their bodies was removed and do not want any contact with their father. Despite the obvious trauma and breach of court orders, the father's barrister argued that the circumcision should be treated as a moral rather than a criminal issue. This has outraged the mother, who is adamant that her sons have been assaulted. "If I had been in this current situation with two daughters who were circumcised by their Muslim father, the Australian public would be outraged. Because it is my two sons who have been harmed, few people seem to care". A spokesman for Circumcision Information Australia, Mr Shane Peterson, said that the case highlighted the lack of implementation of the United Nations Convention on the Rights of the Child by Australian law. "In several European countries the written permission of both parents is necessary before a doctor can legally perform a circumcision on boys. This rule should be implemented in Australia to prevent such tragedies." Mr Peterson also said that the case illustrated the double standard by which female circumcision is condemned as mutilation, yet male circumcision is viewed as a trivial or even beneficial adjustment. "Amnesty International defines genital mutilation as the removal of any part of the genital organs. By this definition, these boys are victims of genital mutilation." <h3>Further comments on multiculturalism</h3> Stricter rules governing consent for non-therapeutic circumcision could have prevented this sad and all too common occurrence. A high proportion of marriages in Australia are between men and women of different ethnic/cultural backgrounds, and the children of such unions cannot be said to belong strictly to one or the other group; this is all the more true in the many cases where marriages end in separation while the children are still young. Children in such situations will eventually decide which (if any) of the parental cultures they wish to identify with, or whether they wish to choose a cultural identity of their own, and we recognize their right to make a free choice. In a multicultural society, freedom of religion means that each individual must have the freedom to adopt his or her own religion and not have it imposed on them. In order to ensure that this right is real, their bodies should be protected from tell-tale and irreversible alterations. Although these children may choose to identify with the culture of one or other of their parents, they are not only members of that culture; they are also Australian citizens who are entitled to the protection of Australian law and custom. Individual determination has a physical as well as a mental dimension. Multiculturalism was intended as a policy to make people from non-English speaking backgrounds feel more at home in Australia; it was never meant as a carte blanche for the retention of customs that Australian society finds abhorrent. In the <a href="http://www.cirp.org/library/legal/Re_J/">United Kingdom</a> and <a href="http://www.circumstitions.com/Sweden.html">Sweden</a> the judicial systems have intervened in instances where Moslem fathers have sought or arranged for the circumcision of boys without maternal consent. In two cases the fathers were convicted, and in one of these cases the father was gaoled for three months. The practitioner who performed the circumcision was also charged with an offence, though acquitted, by the National Board of Health and Welfare. The United Nations Convention on the Rights of the Child and other international treaties which protect the physical and moral integrity of individuals are available at <a href="http://www.arclaw.org/">http://www.arclaw.org</a> <h2> <a id="rej" name="rej"></a>Important British case upholds child's right to physical integrity</h2> <h3>In re J (1999) confirms that child's physical integrity is more important than desires of parent</h3> J was a five-year old boy living in England, born of a mixed marriage. J's father is a Turkish Moslem, his mother is British. The father wanted him brought up as a Moslem and circumcised. The mother did not, and she took the father to court to prevent that from happening. In a landmark decision she won on both issues. Here are some significant quotes from the judgement of Wall J, delivered in England on 6 May 1999. What the judge said Where there was disagreement between those who had parental responsibility for the child, including a local authority exercising parental responsibility under a care order, circumcision was not to be carried out without the leave of the court. The question of the father taking J to Turkey on holiday is, however, linked with the question of his circumcision. If I decide that J should not be circumcised, the question arises as to whether or not the father's family and/or a Turkish court would accept that decision and feel themselves bound by it. The father assured me in evidence that he would respect the English court's decision, however much he might disagree with it, and would not seek to have J circumcised in Turkey. The father also recognised that if J returned from Turkey circumcised that would constitute a clear contempt of the English court. It is, therefore, clear to me that in Islamic law, J is to be regarded as a Muslim. According to Dr Hinchcliffe, circumcision is not mentioned in the text of the Koran, but in the Sunna (the practice of the Prophet Mohammed), which is the second recognised source of law, it is strongly recommended, and sayings from the Prophet himself are cited in support of the practice. J is plainly not in a position to give an informed consent to his circumcision. There is also ... a body of medical opinion which regards both male and female circumcision as invasive procedures involving unnecessary mutilation of the genitals, and which calls for male circumcision to be criminalised, except in the rare cases where it is medically called for. A case can be made for describing ritual male circumcision without any medical need for it as an assault on the bodily integrity of the child; indeed, that is the case which is made in much of the medical literature to which I was referred. If J were to be circumcised this could be carried out as a day case. J would be likely to be unconscious for about 20 to 30 minutes. It would be a painful procedure. The medical benefits arising from circumcision (apart from the three conditions identified by Dr S for which surgery is indicated) are highly contentious. There is a powerful body of medical opinion which puts strongly in issue any suggestion that male circumcision prevents or reduces the risk of urinary tract infection, penile cancer, or sexually transmitted disease. Equally contentious is the suggestion that it reduces the incidence of cervical cancer in women. There is evidence that tissue loss during circumcision removes or destroys the function of tissue which plays an important part in the overall sensory mechanism of the penis, and that there is a consequential loss of sexual sensory pleasure during sexual intercourse. Dr S's view, as a paediatrician, was that circumcision should only be carried out if medically indicated. I should add, in parenthesis, that amongst the documents shown to me was material from an organisation called Norm UK, the aims of which are to provide education about (1) the need to avoid circumcision and (inter alia) (2) about foreskin restoration. Within this material was an article on foreskin restoration which indicates that it is possible, although restoration cannot give back the erotogenic nerves amputated at circumcision. Equally, there was nothing in the medical evidence I read and heard which indicated that J could not be circumcised as an adult. The father simply could not understand the objections to circumcision. It was a means of demonstrating and reinforcing J's relationship with him: they had to be the same. The procedure for a child of J's age carries small but identifiable physical and psychological risks. It is an invasive procedure, which therefore carries with it risks shared by all surgical interventions: pain, bleeding, infection, surgical mishap and complications of anaesthesia. The father did not accept the risks, either physical or psychological, outlined in the medical evidence by Dr S; and I have to say that, despite his obvious sincerity, there was an element of exaggeration in the father's account of his own circumcision (no doubt as a result of the passage of time), and in my judgment he minimises its painful aspects and underestimates the likely effect of the procedure on J. In my judgment, the strained relationship between the parents, and the fact that as a circumcised child J would be unlike most of his peers, increases the risk that J will suffer adverse psychological effects from being circumcised. The disadvantages are that despite the father's passionate defence of the procedure, J may be traumatised by it. Thus, contrary to the father's perception, circumcision may in fact weaken rather than strengthen his relationship with J. Circumcision carries with it the small but definite risks of both physical and psychological harm to which I have referred. Furthermore J, as a circumcised child, would undoubtedly be different from the majority of his peer group. The consequential possibility that he may be picked on or teased by his peers cannot be excluded as a risk. I think that, because of his strong feelings and the passage of time, the father minimises the pain and discomfort likely to be suffered by J if the operation is performed. Circumcision is an effectively irreversible surgical intervention which has no medical basis in J's case. It is likely to be painful and carries with it small but definable physical and psychological risks. Under art 9 [of the Human Rights Act 1999], the father says that his right to manifest his religion in practice includes the right to arrange for the circumcision of his son in accordance with the tenets of his religion. That seems to me plainly correct. It follows that any limitations on that freedom imposed by a court must be (1) as are prescribed by law; and (2) as are necessary in a democratic society for the protection of the rights and freedoms of others - in this case, the rights and freedoms of both the mother and J himself. … I therefore see nothing inconsistent with the proper operation of arts 8 and 9 of the Convention in a decision of the court which, on the particular facts of this case and in the exercise of a judicial discretion, refuses to make a specific issue order permitting J's circumcision, alternatively prohibits the father from causing J to be circumcised. … Equally, given the balance which the court has to strike between the competing rights of the mother, the father, and the child, it does not seem to me that an order prohibiting circumcision in the circumstances of this case could properly be described as discriminatory under art 14. In my judgment, the argument put forward by the Official Solicitor on this point is sound. Circumcision is an irrevocable step in a child's life. Changes of surname, which require applications to the court in cases of disagreement are reversible: circumcision is not. In my judgment, therefore, where there is a dispute between parents or other persons having parental responsibility for a child over the child's circumcision, that dispute should be referred to the court. For all these reasons, there will be no order on the father's application for J to be brought up as a Muslim and there will be a prohibited steps order preventing the father from arranging or permitting J to be circumcised without the leave of the High Court. I propose to invite counsel to agree the precise terms of the order. Order accordingly. Leave to appeal granted. Re J (child's religious upbringing and circumcision) FAMILY DIVISION, Judge WALL J. 2, 3, 4 MARCH, 6 MAY 1999 Justice Wall's decision was confirmed on appeal. <a href="http://www.cirp.org/library/legal/Re_J/">The full text of the judgement</a> <h2> <a id="muslim" name="muslim"></a>The truth about Muslim circumcision practices</h2> Although the father in the Bundaberg case, and his barrister, tried to excuse his actions by reference to the Moslem religion, Islam does not impose an obligation on parents to circumcise their children. Furthermore, its recommendations about circumcision apply to women as much as men. The Koran, the Moslem bible, makes no mention of circumcision at all, but the prophet Mohammed is reported to have stated that "Circumcision is a sunnah for the men and a makrumah for the women". (Note the reference to men and women: nothing about boys and girls.) The term sunnah means customary or traditional; the term makrumah means meritorious. The most you could conclude is that circumcision was customary for men and meritorious for women, and thus desirable for both but obligatory for neither. In these respects Islam is quite different from Judaism, which requires the head of the household not only to circumcise his baby sons at eight days, but also his male servants and employees, which makes no mention of women in this context, and in which the rule of circumcision is stated prominently in the first book of the Jewish bible. Mohammed further laid down five rules for Moslem men: shaving the pubic hair; circumcision; trimming the moustache; plucking the hairs from the armpits; and clipping the nails. These constitute the fitrah, or laws of personal deportment, to which a pious man in pursuit of perfection must conform. According to Sami Aldeeb, "They are not compulsory, but simply advisable". The vital point about this list is that circumcision is a recommendation for adult men, perhaps no more important than trimming their moustache or shaving their pubic hair. It is thus less obligatory than the rule of prayer five times a day, the pilgrimage to Mecca, fasting at Ramadan or abstention from alcohol and pork. There is certainly nothing in the fitrah which requires a father to circumcise his children. Before assuring the Bundaberg magistrate's court that the man in this case was "sincere in his religious beliefs", his barrister should have established that he scrupulously observed all these requirements, not just the observance that his sons, rather than he himself, had to pay for. There is no unanimity among Islamic theologians as to whether Mohammed himself was circumcised and how it happened. Some say that he was born without a foreskin, others that he was circumcised by an angel or his grandfather. It is thus obvious that, whatever traditions may have evolved in particular cultures over the centuries, Islam does not require parents to have their boys and girls circumcised; and that parents who do have them circumcised cannot appeal to rules of their religion as a justification for this assault. Some Moslems even question whether circumcision itself is necessary and suggest it was merely a custom taken over unthinkingly from desert Arabs when Islam arose in the seventh century. The Egyptian Dr Nawal El-Saadawi writes: "If religion comes from God, how can it order man to cut off an organ created by Him as long as that organ is not diseased or deformed? God doe not create the organs of the body haphazardly without a plan. It is not possible that He should have created the clitoris in woman's body only in order that it be cut off at an early stage in life." As a woman and a victim of circumcision herself, she was referring to the female genitals, but the point is equally applicable to the male foreskin - the part of the penis removed by circumcision. References Sami A. Aldeeb Abu-Sahlieh, <a href="http://www.nocirc.org/symposia/fourth/aldeeb.html">Jehovah, his cousin Allah and sexual mutilations</a>, in George C. Denniston and Marilyn Milos (eds), Sexual mutilations: A human tragedy, New York, Plenum Press, 1997 Dr Sami Aldeeb, <a href="http://www.cirp.org/library/cultural/aldeeb1/">To mutilate in the name of Allah or Jehovah: The legitimation of male and female circumcision</a> Medicine and Law, Vol 13, No 7-8, 1994, pp. 575-622 Also available at <a href="http://www.quran.org/CIRCUMCISION.HTM">http://www.quran.org/circumcision.htm</a> <a href="http://www.fgmnetwork.org/samialdeeb/">http://www.fgmnetwork.org/samialdeeb/</a> <a href="http://go.to/samipage">Dr Aldeeb's home page</a> Sami A. Aldeeb Abu-Sahlieh, Male and female circumcision among Jews, Christians and Muslims: Religious, medical, social and legal debate, Warren PA, Shangri-La Publications (Marco Polo Monographs, No. 5), 2001 <h3>The marsh Arabs: Report by an English traveller</h3> When he was travelling through the marshy region of the lower Euphrates River in the 1930s (present-day Iraq), the British traveller Wilfred Thesiger encountered many Arab people who did not practice circumcision, and others who did and suffered nasty injuries and infections as a result of the operation. His report makes a mockery of the ill-informed statement by the Australian College of Pediatrics (1996) that circumcision "probably originated as a hygiene measure in communities living in hot and dry environments". On the contrary: cutting flesh in primitive conditions was about the least hygienic thing anybody could do, carrying a high risk of bleeding, infection and permanent disability or death, as Thesiger found. Thesiger writes: Circumcision, although nowhere mentioned in the Koran, is generally regarded as obligatory for Moslems following the example of the prophet Mohammed himself, who was circumcised in accordance with Arab custom. No uncircumcised person may lawfully make the pilgrimage to Mecca. Among the tribes in southern Iraq … the operation was often deferred until manhood … and was seldom performed before puberty. It was done by specialists who travelled round from village to village in the summer. Their traditional fee was a cock [!], but more often they charged five shillings. The examples of their work which I saw were terrifying. They used a dirty razor, a piece of string and no antiseptics. Having finished, they sprinkled the wound with a special powder, made from the dried foreskins of their previous victims, and then bound it up with a tight rag. People living under these conditions acquire a remarkable resistance to infection, but they could not resist this, and boys sometimes took two months to recover, suffering great pain in the meanwhile. One young man came to me for treatment ten days after his circumcision, and although I am fairly inured to unpleasant sights and smells, the stench made me retch. His entire penis, his scrotum and the inside of his thighs were a suppurating mess from which the skin was sloughing away, the pus trickling down his legs. I cured him eventually with antibiotics. In spite of the social stigma of being uncircumcised, some boys not unnaturally refused. In other cases the fathers would not allow their sons to be operated on because there was no one else to look after the buffaloes. A few maintained that they had been circumcised by an angel at birth, a superstition that is also current in Egypt. Later I visited villages … where I heard that hardly anyone was circumcised. Wilfred Thesiger, The marsh Arabs, London 1964, pp. 101-2 <h3>Further information on Islamic circumcision</h3> <a href="https://www.circinfo.org/sattouf.html">Riad Sattouf's account of his circumcision as 8-year old in Syria</a> Dr Sami Aldeeb, <a href="http://www.quran.org/CIRCUMCISION.HTM">To mutilate in the name of Allah or Jehovah: The legitimation of male and female circumcision</a> Also available at <a href="http://www.cirp.org/library/cultural/aldeeb1/">http://www.cirp.org/library/cultural/aldeeb1/</a> <a href="http://www.fgmnetwork.org/samialdeeb/">http://www.fgmnetwork.org/samialdeeb/</a> <a href="http://www.quran.org/khatne.htm">A site maintained by Moslems who oppose circumcision</a> </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Abduction and forced circumcision of Queensland boys darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h3>Hypocrisy, sexism and double standards rule at the United Nations</h3> Neither the United Nations and its organizations, nor the Council of Europe, nor Western legislatures [with the partial exception of Scandinavia and South Africa] have addressed the issue of male circumcision. So long as these institutions remain quiet, one cannot expect the Organisation of African Unity or African legislatures to open their doors to address the issue. Some have tried to justify the practice of male circumcision invoking religious and cultural rights, but such a justification can also apply to female circumcision, which has been nearly unanimously rejected. In any case, both practices violate individual rights, notably the right to physical integrity and life, the right not to be submitted to inhuman treatment and torture, the right to the modesty, and the right to respect of the dead when circumcision takes place after death. <h2>The deafening silence concerning male circumcision</h2> “Circumcision of male children does not concern the United Nations”. — Mrs. Halimah Al-Warzazi, special rapporteur of the UN, appointed pursuant to the Convention on the Rights of the Child to campaign against “traditional practices prejudicial to … children.” The United Nations and its specialized organizations have always maintained a radical distinction between female circumcision, which they condemn, and male circumcision, which they are silent about, without ever making a scientific survey justifying the distinction. A distinction has already been made just at the semantic level. That is, these organizations used to use the term female circumcision, but changed to female genital mutilation in 1990, keeping the term circumcision for only male circumcision. Male circumcision has never been qualified in international documents as a mutilation. During the UN seminar in Ouagadougou (Burkina Faso) in 1991, participants asked for a way to dissociate, in the minds of people, male circumcision from female excision. Three reasons were invoked against female circumcision: it is based on superstitions, it is not mentioned in the Bible or the Koran, and it is harmful to women’s health. As for male circumcision, it was deemed to have a hygienic value. A policy paper on female circumcision published by the World Health Organisation in 1998 attempted to justify distinguishing it from male circumcision be reference to the greater physical harm, though even that admitted that as rites they had much in common: Female circumcision is no different from male circumcision, as both are cutting rituals performed on a child with no demonstrated positive impact on health. One difference between the two practices is that male circumcision is a clear requirement of some religions while female circumcision is not. The most important difference, however, is that even the most minimal form of female circumcision can affect a girl’s normal sexual function. Evidence in the medical literature on the effect of circumcision on male circumcision is not well established. Source: Nahid Toubia and S. Izett, Female Genital Mutilation: An Overview (Geneva: WHO, 1998), 3 If it is true that there is no research on the effect of circumcision on male sexual function, there is obviously no basis for the WHO’s and the UN’s assumption that it is so much less harmful and immoral than any form of female circumcision that no action should be taken even to investigate it, let alone restrict or regulate it. I addressed a set of questions to Mrs. Halimah Al-Warzazi, special rapporteur of the UN on traditional practices, in order to have a clear idea about the UN’s position and the reasons why it distinguishes between male and female circumcision. I reproduce here my questions and the answers I received in a letter dated January 7, 1997, with only minor formal modifications: Question. Are you fighting against male and female circumcision or only against one of them? If you fight against one of them, which one? Why do you neglect the other one? Answer. On the level of the UN, only female circumcision is considered a harmful practice that it is necessary to abolish. The question of the circumcision of female child is excluded therefore of the preoccupations of the UN. I consider that this practice, apart the fact that it is religious for the Jews and the Muslims, is a hygienic element that American physicians perform at the time of childbirths to all, be they Jews, Muslims, Catholics or other. Therefore, it doesn’t seem to me suitable making an amalgam between female circumcision considered as dangerous for the health and male circumcision that, on the contrary, is beneficial. Q. Do you agree that persons or groups who do not practice male and/or female circumcision may fight against these practices? For example do you accept that whites fight against male and/or female circumcision practiced by blacks, Christians fight against male/or female circumcision practiced by Muslims or Jews? If yes, why? If no, why? A. The question as asked seems to me of discriminatory character regarding to the color and the religion. If the UN fights against female circumcision, this is not for reason of color or religion, but to protect women and children of the multiple misdemeanors of this practice. Q. Do you accept religious male and/or female circumcision on children? On consenting adults? Whatever be the religion: Islam, Judaism, Animism? A. I share the medical opinion on circumcision of males whatever the religion of the children or the adults. Q. Do you accept cultural male and/or female circumcision on children? On consenting adults? Whatever be the culture: Western or non-Western culture? A. I don’t accept female circumcision. The refusal and the dismissal of this practice don’t have anything to do with culture. The United Nations consider that any breach to the physical integrity of women and little girls with the consequences which result from circumcision is a violation of human rights. Q. Do you accept that (non-medical) male and/or female circumcision for cultural or religious reasons be practiced by physicians on children? On consenting adults (indicate the age)? Physicians cannot cut the healthy finger or ear of a consenting adult. Do you consider this should be also the case for male and/or female circumcision? A. My answer evidently concerns solely female genital mutilation (female circumcision). I am for the total eradication. No physician should perform female circumcision. Q. Do you accept that the law forbids and punishes (non-medical) male and/or female circumcision? Even if (non-medical) male and/or female circumcision are practiced for religious or cultural reasons? Even if the victim is adult? What kind of punishment do you recommend? Against the parents of the child? Against the adult circumcised? Against the physician? A. The question of female genital mutilation because of its cultural character (it is not religious) must be solved with a lot of tact. Education and information must first precede punitive laws because these risk the wanted results of pushing parents to proceed to clandestine circumcision of their little girls. On the other hand, physicians should be punished. To note that lately, the Egyptian Government promulgated a law in this sense. As for the woman who would expose herself voluntarily to this practice, what is not frequent, the only action to undertake would be to bring her help in the event that she would require it. Q. Do you consider that parents can consent for their children in the practice of (non-medical) male and/or female circumcision? If yes, until which age? A. (No answer). Q. Some groups consider the fighting against male and/or female circumcision as imperialistic, anti-Semitic, anti-Islamic, anti-Blacks attitude? Do you worry about that accusation? What would be your answer to such accusation? Have you ever been accused? By whom? A. As long as the struggle against female circumcision stands on position of victim protection and the struggle against practices considered human rights violations, no one must get worried of what a person or a group of persons thinks. Today, this struggle is engaged with success. The fact that female genital mutilation is not anymore a taboo topic demonstrates that the international community is on the right path. I felt it was my duty to respond to Mrs. Al-Warzazi. Thus, in a letter dated February 14, 1997, to which I attached some of my articles, I wrote the following: Your arguments are very interesting, even though I don’t share them for three reasons: <ol> <li>It is wrong to accept any breach to a person’s physical integrity whatever is his or her sex or religion, except for a real, and present medical reason.</li> <li>The hygienic pretext is too narrow. One cleans the teeth and doesn’t pull them out, except when they are decayed beyond repair.</li> <li>American physicians perform male circumcision, but there are also in the U.S. physicians and nurses who are strongly opposed to this practice, contrary to medical deontology. The practice of slavery in the U.S. in the past doesn’t legitimize slavery today, nor should it!</li> </ol> Personally, I am opposed to male circumcision as much as female circumcision. To consider one and not the other is also a matter of sexual discrimination. I consider the UN as accomplice in this crime committed against children. I ask you to inform the subcommittee that elected you. Mrs. Al-Warzazi answered by fax dated May 16, 1997, as follows: Thank you for your letter and documents that you sent me. As for your position on male circumcision, I will present it to the Subcommittee, while telling it that the UN are not at all an accomplice to the fact that about hundred million women of by the world allow themselves to wear earrings because they have been pierced. I believe that it is a polemic that we could drag out a long time if I had to give you other examples. I don’t believe that it is just to impute with so much lightness a crime of this nature to our organization that made so many advances in human rights. To have an opinion is a thing that one has the right to see respected. But to impose it, undoubtedly, is an act of intolerance that the international community doesn’t stop fighting. Mrs. Al-Warzazi made reference to our correspondence in her report on the traditional practices of 1997. She says: Certain universities are beginning to take a closer look at the problem. In early January 1997, for example, a lecturer from the Swiss Institute of Comparative Law sent the Special Rapporteur a questionnaire that was to serve as a basis for a book on male and female circumcision. In her reply, the Special Rapporteur made a point of mentioning that circumcision of male children did not concern the United Nations, as only female circumcision was deemed a harmful practice to be eradicated. Consequently, it would seem inappropriate to consider together both female circumcision, which is harmful to health, and male circumcision, which has no undesirable effect and is even considered to be beneficial. Source: UN document E/CN.4/Sub.2/1997/10, 25.6.1997, par. 18. In her last report of 2000, Mrs. Al-Warzazi indicates that she received a few letters condemning male circumcision, but she insists her mandate is limited to female circumcision. She pretends that the harmful effects of male circumcision cannot in any way be compared or equated with the violence, danger, and risk faced by girl children and women. She also insists that male circumcision may be related to a lower risk of HIV transmission from women to men. Source: UN document E/CN.4/sub.2/1991/48, 12.6.1991, par. 27. Thus, it can be concluded that the religious bases of male circumcision, the trivialization of its health implications (compared, for example, to ear piercing), or even its beneficial effect are reasons the UN uses to justifying not leading a campaign against routine male circumcision. We can also say that female circumcision has a religious basis in the eyes of those who perform it, including even animists. On the other hand, the UN and its organizations have never made a study on the harmful effects of male circumcision. Let’s also recall that some forms of male circumcision are more harmful than some forms of female circumcision. What this discussion has illustrated is that the true reason behind the UN’s silence is political. We already spoke of this possibility in the social debate. I asked Dr. Leila Mehra from the WHO: “Why the WHO is concerned only with female circumcision and doesn’t consider male circumcision?” She responded in a meeting held in her Office in Geneva on January 12, 1992: “Male circumcision is mentioned in the Bible. Do you want to create problems for us with the Jews?” The same day, I met Mrs. Berhane Ras-Work, president of the Inter-African committee in her office in Geneva. Strangely enough, she gave me the same answer, illustrating that the two of them undoubtedly consulted each other before meeting with me. I tried to obtain clarifications from the WHO in Geneva on its repeated position, as I had done with the UN. But the responsible persons limited themselves by only sending publications on female circumcision, without answering my questions concerning male circumcision. I then turned to the regional office of the WHO in Alexandria. This office proceeded in the same way. I persisted, whereupon the office told me that if I wanted to have answers to my questions, I would have to assume an expert’s expenses. I reduced my questions to only one: The WHO took official position concerning female circumcision. Is there an official position of the WHO on male circumcision. If not, why? By email of January 5, 1999, Mr. Adil Salahi, public information officer, answered: Your correspondence with Dr. Hafez, Director, Health protection and promotion and Dr. R. Mahaini, Regional advisor on reproductive, family and community health, has been referred to me. I would like to tell you that they have dealt with you on trust, thinking that you are undertaking a serious study. However now that we have a clearer picture of your endeavors, you are advised that the WHO extends its assistance to all countries and communities, showing sincere respect to people’s traditions and beliefs. It condones no attempt to decry the religious beliefs of any community. Hence we wish to have nothing to do with your project or your writings. We will not engage in any further correspondence with you. This is the end of the matter. If we look in the documents of the CE, we notice they make no mention of male circumcision. This topic has never been discussed within the Council. A June 22, 1999, letter of the European Court reads: “the Council of Europe [addresses] problems raised inside by the various institutions that work there. If a particular problem was not taken in consideration, it is probably because it has not yet been denounced in adequate manner”. Another letter of the European Parliament of July 12, 1999, also confirmed that male circumcision has not been treated by this Parliament. <h2>Male and female circumcisions and non-discrimination</h2> <h3>1. The principle of non-discrimination</h3> The condemnation of female circumcision and the silence facing male circumcision, without a valid scientific justification to distinguish the two translate into: <ul> <li>a recognition of a right afforded women that is denied men;</li> <li>the condemnation of the African culture that practices female circumcision and the acceptance of Western culture that doesn’t participate in this practice but does practice male circumcision; and</li> <li>the refusal to protect children of Jews and Muslims by fear of political consequences.</li> </ul> The international and national legislatures, as well as the NGOs, that adopt the same position, violate a fundamental principle of human rights: the principle of non-discrimination. This principle is mentioned practically in all international documents and Western and African constitutions. We mention here some articles: The Charter of the United Nations Art. 1 - The purposes of the United Nations are [...] (3) To achieve international cooperation in solving international problems of an economic, social, cultural, or humanitarian character, and in promoting and encouraging respect for human rights and for fundamental freedoms for all without distinction as to race, sex, language, or religion. Art. 55 - [...] the United Nations shall promote: [...] (c) universal respect for, and observance of, human rights and fundamental freedoms for all without distinction as to race, sex, language, or religion. The Universal Declaration of Human Rights Art. 2 par. 1 - Everyone is entitled to all the rights and freedoms set forth in this Declaration, without distinction of any kind, such as race, color, sex, language, religion, political or other opinion, national or social origin, property, birth or other status. Art. 7- All are equal before the law and are entitled without any discrimination to equal protection of the law. All are entitled to equal protection against any discrimination in violation of the Declaration and against any incitement to such discrimination. The Convention on the Rights of the Child Article 2 par. 1 - States Parties shall respect and ensure the rights set forth in the present Convention to each child within their jurisdiction without discrimination of any kind, irrespective of the child’s or his or her parent’s or legal guardian’s race, color, sex, language, religion, political or other opinion, national, ethnic or social origin, property, disability, birth or other status. The Egyptian Constitution of 1971 Art. 40 – The citizens are equal in front of the law. They have the same rights and the same public duties, without discrimination for reason of sex, origin, language, religion or belief. The Oath of Geneva of the World Medical Association I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, or social standing to intervene between my duty and my patient. <a href="http://www.wma.net/">World Medical Association website</a> The Declaration on the rights of the patient of the WMA <ul> <li>Every person is entitled without discrimination to appropriate medical care.</li> <li>Every patient has the right to be cared for by a physician whom he/she knows to be free to make clinical and ethical judgments without any outside interference.</li> </ul> To avoid transforming the principle of non-discrimination in a propaganda slogan empty of any meaning, this principle must find application in decisions of the institutions that preach it. If these institutions violate it, their decisions become invalid even though these decisions have been taken in unanimity. To validate these decisions, it is necessary either to suppress the principle of non-discrimination of their laws, or to give a valid justification for the discrimination they practice. Taking into consideration this argument, the Amnesty International-Bermudas section stated that the decisions of Amnesty International against female circumcision are invalid since they don’t apply simultaneously to male circumcision. The statutes of Amnesty International indeed forbid the discrimination based on sex. Male circumcision is a violation of human rights, just like female circumcision. Therefore, Amnesty International must lead a campaign of struggle against these two practices. Source: LeYoni Junos, Bodily integrity for both: The obligation of Amnesty International to recognize all forms of genital mutilation of males as human rights violations (Bermuda: Amnesty International, 1998), 19-21. <h3>2. Absence of valid of reasons for discrimination</h3> (a) Difference between male and female circumcision There would be justification for distinguishing female circumcision from male circumcision if the two acts differed substantially. However, the distinction between these two practices is more illusionary than realistic. Both are violations of a minor’s physical integrity without his or her consent and without medical reason. Lightfoot-Klein interviewed people in Africa who perform female circumcision and in the United States who perform male circumcision. By juxtaposing their sayings, she proved that the two practices are similar. Her conclusions are as follows: Both groups claim that their respective sexual mutilation practices are minimal, painless, beautifying, medically indicated, hygienic, prophylactic, sexually improving, universal, medicalized, and harmless. Both excised African women and excised American men are reluctant to believe that they have lost anything. In their denial, they convince themselves of the illusion of their intactness by allowing, openly or tacitly, their own daughters and sons, respectively, to undergo the same procedure. They justify their attitudes throughout the belief that these surgeries are a matter of tradition and/or scientific or medical necessity. In light of these attitudes, any statement that sexual mutilation is harmful is resisted by excised women and men in an attempt to assure themselves of their normality, and to alleviate the guilt they would have for having condoned the circumcision of their own children. Lightfoot-Klein adds: Enlightened Westerners, existing in a world far removed geographically and psychologically from the strange and disturbing practices of sexual mutilation in Africa, may be tempted to disregard them as something that does not concern the West. The practice of female circumcision, which many Westerners regard as barbaric and irrational, however, has had its parallels, throughout history in secular male circumcision, as practiced in the United States. The reasons given for female circumcision in Africa and for routine male circumcision in the United States are essentially the same. Politically, the underlying similarities between male and female sexual mutilations are that both are perpetrated by force on the generally unanaesthetized, helpless bodies of unconsenting infants and children. Source: Hanny Lightfoot-Klein, Similarities in attitudes and misconceptions about male and female circumcision, in George C. Denniston and Marilyn Milos (eds), Sexual mutilations: A human tragedy (New York: Plenum Press, 1997), 135, 131 (b) Positive discrimination The legislature can positively discriminate in favor of an oppressed group to bring him up to par with a privileged group. So, one can encourage women in the domain of political rights or access to jobs by giving them privileges because they were deprived for a long time of these two rights. This “positive discrimination” stops when the number of women in these two domains becomes equal to that of men. This sort of discrimination, however, cannot be invoked in the domain of circumcision because male and female children are all victims of this practice. Furthermore, male children are victims in a greater number (13 million per year) than the female children (2 millions per year). (c) Gravity of female circumcision There may also be justification to discriminate between female and male circumcision if female circumcision were manifestly more serious than male circumcision, as many documents emanating of the WHO and other international and no-governmental organizations declare. Both female and male circumcision have several degrees. Certainly, the Pharaonic circumcision of women is more serious than male circumcision of the 1st and the 2nd degree. But there is no doubt that male circumcision of the first degree is equivalent to female circumcision of the first degree, or even more serious than the latter. We saw in the first part of this work that circumcised women of Oman consider male circumcision more severe than female circumcision performed in this country where only the tip of the hood of the clitoris is cut. Therefore, if we take into consideration the argument of the gravity of the operation, the legislature either needs to condemn all degrees of male and female circumcision or establish reprehensible and tolerated degrees in the two practices. But the legislature condemns all degrees of female circumcision from the lightest to the most severe, and tolerates all degrees of male circumcision from the lightest to the most severe. Even assuming that female circumcision is generally more severe than male circumcision, this fact doesn’t justify the acceptance of male circumcision, because male circumcision also constitutes a violation of the right to physical integrity. By analogy, one can say that the murder is a more serious offense than rape or theft. It doesn’t mean that the legislature has to be concerned solely with murder and let rapes and thefts go unpunished. The severe mutilation of female children in Africa doesn’t in any way diminish the gravity of the human rights violation inherent in mutilating the genitals of male children in a country such as the United States. The legislature cannot close its eyes to a violation of physical integrity of one group while at the same time condemn a violation of the physical integrity of another on the basis of differences in the gravity of the violations. The legislator must punish all medically unjustified violations, even though the severity of the punishment must correspond to the gravity of the specific violation. The generalization that female circumcision is severe and must be forbidden and punished, while male circumcision is insignificant and must be tolerated is a legal aberration. (d) Priority of the struggle against female circumcision Even if we were to admit that female circumcision is in general more severe than male circumcision (which is far from the truth), there would be justification to grant priority to abolishing female circumcision over male circumcision if we conclude that simultaneously fighting two battles could be harmful to both or even one battle. Movements that fight against female circumcision without addressing male circumcision frequently use this argument. The most generous concede male circumcision is important, but conclude that the issue comes in second place, after they eventually win the battle over female circumcision. Besides the fact that female circumcision is not more severe than male circumcision, such an argument is immoral and counterproductive. Such an argument is immoral because it is used to inflict an unjust pain on male children under the pretext that their sisters endure more than them. The injustice committed against girls doesn’t justify the injustice committed against boys, and the pain of girls doesn’t suppress the pain of boys. Circumcision is one of aspects of violence in society, and it influences human reports inside society regarding men and women. This violence can’t be tolerated against men and yet forbidden against women. If we permit the violence against men, this violence will be harmful to women sooner or later. Male circumcision aims to deprive women of their right to sexual pleasure with an intact man, as explains Maimonides. Source: Maimonides: <a href="http://www.cirp.org/library/cultural/maimonides/" rel="noopener" target="_blank">The Guide for the perplexed</a><a href="http://www.cirp.org/library/cultural/maimonides/">,</a> section III, chapter 49. Such an argument is also counterproductive. Indeed, families that perform female circumcision also perform male circumcision. The two operations often carry the same name, as it is the case in Arabic: taharah, purification. A family that knows these two practices cannot understand why it has the right to purify its boys but not its girls. And if we start distinguishing between men and women, one risks having a separation in the solidarity between the two groups. A circumcised man who doesn’t feel protected by women will be reticent to protect circumcised women. There would be disengagement on behalf of men. However, the battle against male and female circumcision needs the two groups’ effort. All suspicion on behalf of a group towards the other will only weaken their ranks. Boyd, an opponent of male circumcision, reports that at one film showing and forum he attended on female circumcision in Africa, it was announced at the outset that no discussion at all of male circumcision would be permitted. He got up and started to walk out, only to be booed and heckled by some of the women in the mostly female audience. One of his friends was devastated for months after something similar happened to him. Men and women will all win by remaining united, and they will all lose by dislocating themselves. Source: Billy Ray Boyd, Circumcision exposed: Rethinking a medical and cultural tradition (Crossing Press), 132 There was a similar incident at a seminar on circumcision organised by the Inter-African Committee set up pursuant to the Convention on the Rights of the Child to campaign against “traditional practices harmful to … children.” A Cameroonian researcher reports that he participated in a symposium organized by the Cameroonian branch of this Committee. I raised the issue of male circumcision and tried to argue that, even though it might be considered less drastic than its female counterpart, it violated the same fundamental principle of personal bodily integrity, and that the two were, therefore, best tackled together, especially as it is the former that is widespread all over Cameroon. Quite surprisingly, however, my arguments were rapidly brushed aside, as all other participants seemed to consider male circumcision quite unproblematic. Besides, as one of the organizers of the event pointed out to me, the terms of reference for which funding for the seminar was provided did not include male circumcision. A young lady even further told me during the coffee break that she considered my remarks typical of male patriarchal chauvinism, always seeking to divert attention from any serious problem affecting women to a non-problem affecting men. When I protested that I, in fact, considered myself a feminist, she only sneered. Godfrey B. Tangwa, Circumcision: An African point of view, in George C. Denniston, Frederick Hodges and Marilyn Milos (eds), Male and female circumcision: Medical, legal and ethical considerations in pediatric practice (New York, 1999), 188 Let’s note in this respect that movements against male circumcision are without exception also against female circumcision, even though the movements see in the laws forbidding this practice an implicit consecration of male circumcision. Facing these discriminatory laws, these movements tempt not to abolish them, but to spread them so that they cover also male circumcision. (e) Argument of virility Some argue male circumcision is different from female circumcision because the former is geared toward training young boys to develop skills associated with power and control, not to reinforce their submissiveness and make them feel they are second-class citizens as are the goals with female circumcision. They further argue that male circumcision does not damage the penis, the organ for sexual pleasure, contrary to female circumcision that destroys the organ for sexual pleasure in the female through the cutting of the clitoris. This argument is, however, not valid everywhere. Some groups see female circumcision as a means of reinforcing femininity and sexuality and encouraging their integration in society. Male circumcision, on the other hand, serves to reduce sexual pleasure in a man and affirm the domination of the father or the community over males. Even supposing this argument is valid in certain groups, it cannot serve as justification to forbid female circumcision and tolerate male circumcision. This sort of tolerance perpetuates the social clichés of man’s superiority over women. The Convention for the Elimination of All Forms of Discrimination against Women says in article 5: "States Parties shall take all appropriate measures (a) to modify the social and cultural patterns of conduct of men and women, with a view to achieving the elimination of prejudices and customary and all other practices which are based on the idea of the inferiority or the superiority of either of the sexes." It is, therefore, the duty of the international legislature to suppress male circumcision as a custom that reinforces the superiority of circumcised men over women and uncircumcised men, for the same reason as it must suppress female circumcision as mark of inferiority. Source: LeYoni Junos, Bodily integrity for both: The obligation of Amnesty International to recognize all forms of genital mutilation of males as human rights violations (Bermuda: Amnesty International, 1998), 8 (f) Many women reject the distinction If we review the organizations that fight against male circumcision, one notes that women form the iron of the spear in this battle. This is the case, for example, with NOCIRC, Nurses for the Child’s Rights, and Mothers Against Circumcision. Dr. Michel Odent said, in the fifth international symposium that took place in Oxford in 1998, that at the time of the first two international symposia on the circumcision, women were promoters and formed the majority of participants. It is only subsequently that men entered the fight and have ultimately presented specific technical research against male circumcision. Odent assigned this phenomenon to the fact that women are more sensitive than men. But it may also be possible some feel guilt for not having protected their male children against men who mutilated them. Finally, perhaps others are reacting against a frustrated sexual life with circumcised men. Moreover, men know they need the support of women. As George Denniston writes in this respect: One key to eradicating circumcision may lie with the women of America. When women learn that circumcision causes great pain, disrupts maternal bonding, and permanently disfigures female body, they will rise up to protect their sons. When women learn that circumcision deprives a man of his full sexual capacity, and that circumcision thereby deprives a woman of a fully equipped, fully functioning partner, they will act to stop this practice. Source: George C. Denniston, Tyranny of the victims: An analysis of circumcision advocacy, in George C. Denniston, Frederick Hodges and Marilyn Milos (eds), Male and female circumcision: Medical, legal and ethical considerations in pediatric practice (New York, 1999), 236 In any event, the protection of children is unquestionably the first duty of mothers. If they disengage themselves of this battle, the child will never find support on behalf of men. In Arabic language, the term mercy (rahmah) and the term womb (rahm) have the same root. The mother who carries the child in her womb is the most merciful person toward him. For this reason, the feminist movements that fight solely against female circumcision leaving male circumcision behind violate an essential law of the human life. One can even wonder if they don’t lack humanity and maternal instinct. (g) Political arguments As stated previously, the real reason behind the refusal of international and national legislatures and NGOs to commit themselves against male circumcision is undoubtedly political: the fear to be labeled an anti-Semite or anti-Muslim. If this conclusion proves exact, we are facing a politicization of human rights, which means that these organizations align themselves on political positions. To please the Jews and the Muslims, or because of fear of these two groups, they violate the child’s rights. In the process, they are losing their credibility for many. There is a reason this conclusion is not mentioned in these organizations’ documents. It is, in fact, unimaginable that they would overtly display their fear. But in moments of distraction or in tête-à-tête discussions, some confess the shameful: “Yes, we are afraid to be labeled anti-Semite or anti-Islam”; “Yes, we want to avoid problems with these groups”. I myself have heard these answers with my own ears several times on behalf of Mrs. Dr. Leila Mehra from the WHO, of Mrs. Berhane Ras-Work from the Inter-African committee and of others. Some will say it in a more diplomatic manner: “We act in the setting of the mandate that the UN confides us. And as we are only charged of female circumcision, we will therefore limit us to the latter”. This affirmation is clearly mentioned in the 2000 report of Mrs. Al-Warzazi discussed previously. Source: UN document E/CN.4/Sub.2/2000/17, 27.6.2000, par. 54-55. Thus, it is not difficult to conclude that if the silence concerning male circumcision is dictated by politics, the campaign against female circumcision is also dictated by politics. We mentioned that Oman has a very high rate of female circumcision, yet the UN, WHO and other organizations never worry about this country, contrary to what happens in Egypt. The president of Oman’s Women Association has speculated that Oman is not a political goal for many countries, contrary to Egypt. For her, the campaign against female circumcision is above all a political campaign. Certainly, we would not ask that the campaign against female circumcision stop, even though it is only a pretextual campaign to attack particular countries. “Make the good deeds and we will forgive you your reasons”. If we can save girls from this mutilation, we must be thankful to the campaign against this practice even though it hides its political aims. But what is scandalous is to stay silent in front of the millions of mutilated male children for political reasons. This double standard corrupts the worthiest human acts and can have counterproductive effects. Even the women committed against female circumcision can feel tricked and used for political ends. Dr. Amal Shafiq, a Muslim Egyptian woman, working in the setting of the UNICEF in Cairo, participated in a symposium in 1998 organized by the UNICEF in Geneva. She presented herself during the symposium as activist fighting against female and male circumcision. The person running the symposium, a Christian Swiss woman approached Dr. Shafiq and told her: “You do well to fight against female circumcision, but the male you don’t have to worry about it. It isn’t part of our activity”. Shocked, Dr. Shafiq telephoned me: “Why does a Christian Swiss defend male circumcision whereas an Israeli Jewish colleague sitting next to me campaigns against it?” Source: Extract from Chapter V, "Human rights", from Sami Aldeeb Abu-Sahlieh, Male and Female Circumcision among Jews, Christians and Muslims: Religious, Medical, Social and Legal Debate (Warren, Penn: Shangri-La Publications, 2001), 316-324. The text has been slightly edited for clarity and to bring some points up to date. <a href="http://www.sami-aldeeb.com/" rel="noopener" target="_blank">Full text available from Dr Aldeeb's website</a> <a href="http://blogdesamialdeeb.blog.tdg.ch/" rel="noopener" target="_blank">Sami Aldeeb's blog</a> (in French) <h3>Comment</h3> This remarkable account casts a disturbing light, not only on the hypocritical and sexist practices of the United Nations and World Health Organisation, but also on their recent decision to endorse and promote circumcision of men and boys as a tactic against HIV-AIDS in Africa and other underdeveloped regions with high rates of HIV infection. The astonishing letters from Mrs Al-Warzazi and Mr Adil Salahi show that they were already committed to promoting circumcision as an AIDS preventive way back in the early 1990s, over a decade before there was a shred of evidence that it any prophylactic effect. If Mrs Al-Warzazi was sincere in her statement that she "share[d] the medical opinion on circumcision of males", she should have been forcefully against the practice; at that time <a href="http://www.cirp.org/library/statements/">all medical authorities</a> that had issued a policy on the subject (British Medical Association, the American Academy of Pediatrics, the Canadian Pediatric Society and the Australian College of Paediatrics) were firmly opposed to it. These rude and dismissive responses to an eminent legal scholar are shocking in themselves, but more even seriously they would appear to demonstrate that the fundamental interest of UN bureaucrats is not to promote individual human rights (as required by the UN charter), but to advance the customs and practices of the ethnic/religious groups to which they belong. To this end, a health scare such as AIDS is a useful tactic for preserving a “traditional practice” condemned by the UN Convention on the Rights of the Child. It is obvious that the eagerness and alacrity with which Africans from circumcising cultures seized upon the WHO recommendations is because it was just the weapon they needed to force the reluctant to submit to the operation and silence the increasingly vocal critics of circumcision within their own communities. The Convention on the Rights of the Child, together with the writings of legal scholars and ethicists, had, by the early 1990s, clearly established that circumcision of minors (unless medically essential) was unethical and possibly illegal. But there was a loophole in both the Convention and the WHO's 1998 policy paper that allowed the conservative defenders of circumcision to claim that if there was a "demonstrated positive impact on health" (WHO 1998), or if circumcision was not a practice "prejudicial to the health of children", but (even better) in some way beneficial, it could be promoted and enforced more vigorously than ever before. The circumcision diehards have taken full advantage of these loopholes. It would thus appear that the WHO's insistence on circumcision as a medical or even "scientific" necessity also functions as a cover which allows the world's major circumcising cultures - Judaism, Islam, the United States and the many African tribal societies that have adopted the practice - to continue to enforce their traditional but increasingly discredited rites. </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Sami Aldeeb: Male and female circumcision darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h1>Circumcision and human rights</h1> <h3>Why international agencies should be concerned</h3> Neither the United Nations and its related organisations, nor the Council of Europe, nor any Western government (except in Scandinavia and South Africa) have seriously addressed the problem of male circumcision. So long as these institutions remain quiet we cannot expect bodies such as the Organisation of African Unity or the governments of African countries where circumcision remains common to take action. Some have tried to justify the practice by reference to religious or cultural rights, but such a justification also applies to female circumcision, which has been generally rejected as morally offensive and physically harmful. It is nonetheless true that both practices violate individual rights, notably the right to physical integrity and life, the right not to be subjected to cruel or inhuman treatment or torture, the right to modesty, and the obligation to respect the dead. <h2> <a id="hr1" name="hr1"></a>1. Male and female circumcision: Double standards at the United Nations</h2> The United Nations (UN) and its specialized organizations have always established a clear distinction between female circumcision, which they condemn, and male circumcision, which they are silent about, without ever making a scientific survey justifying the distinction. A distinction has already been made just at the semantic level. That is, these organizations used to use the term female circumcision, but changed to female genital mutilation in 1990, keeping the term circumcision for only male circumcision. Male circumcision has never been qualified in international documents as a mutilation. During the UN seminar in Ouagadougou (Burkina Faso) in 1991, participants asked for a way to dissociate, in the minds of people, male circumcision from female excision. Three reasons were invoked against female circumcision: it is based on superstitions, it is not mentioned in the Bible or the Koran, and it is harmful to women's health. As for male circumcision, it was assumed to have a hygienic value. A policy paper on female circumcision published by the World Health Organisation in 1998 attempted to justify distinguishing it from male circumcision be reference to the greater physical harm, though even that admitted that as rites they had much in common: Female circumcision is no different from male circumcision, as both are cutting rituals performed on a child with no demonstrated positive impact on health. One difference between the two practices is that male circumcision is a clear requirement of some religions while female circumcision is not. The most important difference, however, is that even the most minimal form of female circumcision can affect a girl's normal sexual function. Evidence in the medical literature on the effect of circumcision on male circumcision is not well established. Source: Nahid Toubia and S. Izett, Female Genital Mutilation: An Overview (Geneva: WHO, 1998), 3 If it is true that there is no research on the effect of circumcision on male sexual function, there is obviously no basis for the WHO's and the UN's assumption that it is so much less harmful and immoral than any form of female circumcision that no action should be taken even to investigate it, let alone restrict or regulate it. In her last report of 2000, Mrs. Halimah Al-Warzazi, special rapporteur of the UN on traditional practices, indicated that she had received a few letters condemning male circumcision, but insisted that her mandate was limited to female circumcision. She pretended that the harmful effects of male circumcision cannot in any way be compared or equated with the violence, danger, and risk faced by girl children and women. She also insisted that male circumcision may be related to a lower risk of HIV transmission from women to men. Thus, it can be concluded that the religious bases of male circumcision, the trivialization of its health implications, or even its beneficial effect are the reasons the UN uses to justify not leading a campaign against routine male circumcision. We can also say that female circumcision has a religious basis in the eyes of those who perform it, including even animists. On the other hand, the UN and its organizations have never made a study on the harmful effects of male circumcision. Let's also recall that some forms of male circumcision are more harmful than some forms of female circumcision. The true reason behind the UN's silence is political. I asked Dr. Leila Mehra from the World Health Organisation:"Why the WHO is concerned only with female circumcision and doesn't consider male circumcision?" She responded in a meeting held in her Office in Geneva on January 12, 1992: "Male circumcision is mentioned in the Bible. Do you want to create problems for us with the Jews?" The same day, I met Mrs. Berhane Ras-Work, president of the Inter-African committee in her office in Geneva. Strangely enough, she gave me the same answer, illustrating that the two of them undoubtedly consulted each other before meeting with me. <a href="https://www.circinfo.org/Aldeeb_UnitedNations.html">Further details of Dr Aldeeb's discussions with UN Officials</a> If we look in the documents of the Council of Europe, we notice they make no mention of male circumcision. This topic has never been discussed within the Council. A letter of the European Court (June 22, 1999) reads: "The Council of Europe [addresses] problems raised inside by the various institutions that work there. If a particular problem was not taken in consideration, it is probably because it has not yet been denounced in adequate manner". Another letter of the European Parliament of July 12, 1999, also confirmed that male circumcision has not been treated by this Parliament. <h2> <a id="hr2" name="hr2"></a>2. Male and female circumcisions and non-discrimination</h2> The condemnation of female circumcision and the silence facing male circumcision, without a valid scientific justification to distinguish the two translate into: <ul> <li>a recognition of a right afforded to women that is denied to men;</li> <li>the condemnation of the African culture that practices female circumcision and the acceptance of Western culture that doesn't participate in this practice but does practice male circumcision; and</li> <li>the refusal to protect children of Jews and Muslims by fear of political consequences.</li> </ul> The international and national legislatures, as well as the NGOs, that adopt the same position, violate a fundamental principle of human rights: the principle of non-discrimination. This principle is mentioned practically in all international documents and Western and African constitutions. We mention here some articles: The Charter of the United Nations Art. 1: The purposes of the United Nations are [...] (3) To achieve international cooperation in solving international problems of an economic, social, cultural, or humanitarian character, and in promoting and encouraging respect for human rights and for fundamental freedoms for all without distinction as to race, sex, language, or religion. Art. 55: [...] the United Nations shall promote: [...] (c) universal respect for, and observance of, human rights and fundamental freedoms for all without distinction as to race, sex, language, or religion. The Universal Declaration of Human Rights (1948) Art. 2, par. 1: Everyone is entitled to all the rights and freedoms set forth in this Declaration, without distinction of any kind, such as race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status. Art. 7: All are equal before the law and are entitled without any discrimination to equal protection of the law. All are entitled to equal protection against any discrimination in violation of the Declaration and against any incitement to such discrimination. The Convention on the Rights of the Child (1989) Article 2, par. 1: Parties shall respect and ensure the rights set forth in the present Convention to each child within their jurisdiction without discrimination of any kind, irrespective of the child's or his or her parent's or legal guardian's race, colour, sex, language, religion, political or other opinion, national, ethnic or social origin, property, disability, birth or other status. The Oath of Geneva of the World Medical Association (WMA) I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, or social standing to intervene between my duty and my patient. <a href="http://www.cirp.org/library/ethics/geneva/" rel="noopener" target="_blank">Further details about Oath of Geneva</a> The Declaration on the Rights of the Patient of the WMA <ul> <li>Every person is entitled without discrimination to appropriate medical care.</li> <li>Every patient has the right to be cared for by a physician whom he/she knows to be free to make clinical and ethical judgments without any outside interference.</li> </ul> To avoid transforming the principle of non-discrimination in a propaganda slogan empty of any meaning, this principle must find application in decisions of the institutions that preach it. If these institutions violate it, their decisions become invalid even though these decisions have been taken in unanimity. To validate these decisions, it is necessary either to suppress the principle of non-discrimination of their laws, or to give a valid justification for the discrimination they practice. <h2> <a id="hr3" name="hr3"></a>3. Circumcision and religious and cultural rights</h2> <h3>(a) Pretensions of communities</h3> There is no doubt that those who perform male and female circumcision consider this practice an external demonstration of their religion and culture. These two components very often are mixed: for the religious Jew, circumcision is the achievement of a divine order; for the atheistic Jew, it is the cultural mark attaching him to his history. The religious and cultural norms are imposed on families and then individuals within the community. Their violation implies sanctions that expose the contravening persons to ostracism: interdiction to participate in the religious or social feasts, marriage, and burial in community cemeteries. The respect for these religious and cultural interdictions reinforces the social cohesion. Because of the importance of the religious and cultural norms, the legislature has tried to recognize a community's right to live according to its religious norms and to practice its cultural norms. This was the case in the Roman Empire in its dealing with the Jews and other communities. It is also true today, this right being mentioned in many international and national documents, as indicated in the following documents. The Universal Declaration of Human Rights (1948) Art. 18: Everyone has the right to freedom of thought, conscience and religion; this right includes freedom to change his religion or belief, and freedom, either alone or in community with others and in public or private, to manifest his religion or belief in teaching, practice, worship and observance. Art. 27, par. 1: Everyone has the right freely to participate in the cultural life of the community. International Covenant on Economic, Social & Cultural Rights (1966) Art. 1, par. 1: All peoples have the right of self-determination. By virtue of that right they freely determine their political status and freely pursue their economic, social and cultural development. International Covenant on Civil and Political Rights (1966) Art. 18: (1) Everyone shall have the right to freedom of thought, conscience and religion. This right shall include freedom to have or to adopt a religion or belief of his choice, and freedom, either individually or in community with others and in public or private, to manifest his religion or belief in worship, observance, practice and teaching. (2) No one shall be subject to coercion which would impair his freedom to have or to adopt a religion or belief of his choice. (3) Freedom to manifest one's religion or beliefs may be subject only to such limitations as are prescribed by law and are necessary to protect public safety, order, health, or morals or the fundamental rights and freedoms of others. (4) The States Parties to the present Covenant undertake to have respect for the liberty of parents and, when applicable, legal guardians to ensure the religious and moral education of their children in conformity with their own convictions. Convention on the Rights of the Child Art. 8: (1) States Parties undertake to respect the right of the child to preserve his or her identity, including nationality, name and family relations as recognized by law without unlawful interference. (2) Where a child is illegally deprived of some or all of the elements of his or her identity, States Parties shall provide appropriate assistance and protection, with a view to speedily re-establishing his or her identity. Art. 14: (1) States Parties shall respect the right of the child to freedom of thought, conscience and religion. (2) States Parties shall respect the rights and duties of the parents and, when applicable, legal guardians, to provide direction to the child in the exercise of his or her right in a manner consistent with the evolving capacities of the child. (3) Freedom to manifest one's religion or beliefs may be subject only to such limitations as are prescribed by law and are necessary to protect public safety, order, health or morals, or the fundamental rights and freedoms of others. Art. 29, par. 1: States Parties agree that the education of the child shall be directed to: (c) The development of respect for the child's parents, his or her own cultural identity, language and values, for the national values of the country in which the child is living; the country from which he or she may originate, and for civilizations different from his or her own. Art. 30 - In those States in which ethnic, religious or linguistic minorities or persons of indigenous origin exist, a child belonging to such a minority or who is indigenous shall not be denied the right, in community with other members of his or her group, to enjoy his or her own culture, to profess and practice his or her own religion, or to use his or her own language. The right to perform circumcision as a religious or cultural demonstration is invoked by proponents of male and female circumcision. To this point, Professor Freeman of the London Law School has commented: "To deny a Jewish or Muslim child a circumcision is to undermine that child's right to cultural heritage and identity". Relying on Article 1, par. 1 of the Covenant on Economic Rights and the Covenant on Civil Rights, he adds: "It can be maintained that cultural identity, a sense of belonging to a religious and cultural group, is a fundamental human right." But he makes the following reservation: "This right does not mean that every religious practice can be tolerated in the name of multiculturalism. There is a balancing exercise to be undertaken to determine whether a particular procedure or treatment is in a child's best interests. The relative harms and benefits of ritual circumcision are such that a parent's decision to circumcise in the name of religion should not be questioned." Source: M. Freeman, A child's right to circumcision, BJU International 83 (Supp. 1), January 1999 From this quotation, it's clear Professor Freeman refers to female circumcision. But, in fact, proponents of this practice ask also for the right to perform female circumcision in the name of their culture and their religion, as much as the Jews do with male circumcision. As mentioned previously, Jomo Kenyatta doesn't hesitate to compare clitoridectomy in his tribe to male circumcision in the Jewish community: Clitoridectomy, like Jewish circumcision, is a mere bodily mutilation which, however, is regarded as the conditio sine qua non of the whole teaching of tribal law, religion, and morality. The initiation of both sexes is the most important custom among the Kikuyu. It is looked upon as a deciding factor in giving a boy or girl the status of manhood or womanhood in the Kikuyu community. Source: Jomo Kenyatta, Facing Mount Kenya: The Traditional Life of the Gikuyu (London 1985), 133 Africans ask not only to exercise this right in their respective countries, but also in Western countries where they immigrate. Reacting to the French trial against Malians in February 1999, the Republican Independent Daily of Mali, condemns what it calls "the racist and europeocentrist propaganda" and demands that one has "a little modesty, tolerance, respect of others or democratic attitude". It condemns the "Western campaign against the excision with pressures of all kinds, including political and economic pressures, which aims to detach slowly but surely the African young generation of its cultural values of origin". It sustains that "this practice didn't introduce blemish and problem of health or population which make the population practicing it inferior to others". On February 8, 1999, the President of the ADUM association (Afrique - Debout - Unie en Marche), in Paris, sent to the Paris court a motion of support of Hawa Guereou, the female Malian circumciser condemned in this trial. He wrote: We have the honor to submit to your High kindliness this clarification concerning the judgment of our mothers and sisters for the fact of excision on the French territory. The excision of girls, for us, is justified on the double level of the religion and customs. On the religious level: It exists since more than one century and was instituted by the Prophet Abraham. According to the Muslim religion, it is a measure of hygiene and holiness. As regards to customs the letter continued: The excision is not only a hygienic and cleanliness measure, but also a gynecological measure (it facilitates the childbirth). For us, it is normal to excise our girls. This is why we wish, if possible, to meet you to further illuminate the justice so that it is rendered in the best possible conditions, because we don't doubt that France is a State of rights and liberties. This is the position of proponents of male and female circumcision. The international and national legislatures don╒t share this position. A clear distinction is made between male circumcision, which remains tolerated, and female circumcision, which is forbidden. As for female circumcision, the majority of the participants in the seminar on traditional practices held in Ouagadougou in 1991, a seminar organized by the UN Commission on Human Rights, stated: "The explanations drawn of the cosmogony and those based on the religion must be assimilated to superstition and must be denounced as such. Neither the Bible, nor the Koran does prescribe to women to be excised". Thus, one depreciates the religious concepts not expressed in the Bible or in the Koran, concepts considered superstitions. We refer the reader to the position of the CE in this respect. One finds this distinction between male and female circumcision in legislation and positions of Western medical organizations. In these countries, male circumcision continues to be tolerated and is considered a religious and cultural practice, while female circumcision is rejected even though it's performed by people as part of their culture and religion. These countries don't allow culture and religion to be invoked as a justification for female circumcision, but they do for male circumcision. We provide the example of Switzerland and the United States. There is no law in Switzerland forbidding male circumcision. With regard to female circumcision, the Swiss Academy of Medical Sciences considered in its position of August 24, 1983, that this custom is "in opposition to our ethical principles "cruel and degrading". It added: "The guilty parties and their accomplices, doctors and auxiliary nursing staff, are violating in the most serious way, the moral principles applicable to the exercise of their duties". On 1 March 1993, the Federal council aligned itself with the position of the Central Committee, explaining "in Switzerland and in the remainder of Europe, the excision of the clitoris is considered as inhuman treatment according to article 3 of the European Convention of human rights". There is no law in the United States forbidding male circumcision. Regarding female circumcision, American federal law of 1995 forbids it, stating: "No account shall be taken of the effect on the person on whom the operation is to be performed of any belief on the part of that or any other person that the operation is required as a matter of custom or ritual." The American Academy of Pediatrics, in its Position Statement on Circumcision of March 1999, stated that although male circumcision "is not essential to the child's current well-being", it is "legitimate for parents to take into account cultural, religious, and ethnic traditions, in addition to the medical factors, when making this decision". The position of the Academy concerning female circumcision is completely different. In its statement of July 1998, this Academy recognizes that: <ul> <li>this "ritual genital procedure" has been a tradition since antiquity, that it has been performed by individuals from many religions, including Christians, Muslims, and Jews;</li> <li>"parents may feel obligated to request the procedure because they believe their religion requires female genital alteration";</li> <li>parents "believe that it will promote their daughter's integration into their culture, protect her virginity, and thereby guarantee her desirability as a marriage partner";</li> <li>"some proponents of the practice claim that it is required by the Islamic faith".</li> </ul> Despite all these arguments of cultural and religious order, the AAP rejects all forms of female circumcision, from the lightest to the most severe. According to the Academy, "The physical burdens and potential psychological harms associated with FGM violate the principle of non-maleficence, a commitment to avoid doing harm, and disrupt the accepted norms inherent in the patient-physician relationship, such as trust and the promotion of good health. More recently, FGM has been characterized as a practice that violates the right of infants and children to good health and well-being, part of a universal standard of basic human rights". It recommends that its members "educate and counsel the family about the health effects of FGM. Parents should be reminded that performing FGM is illegal and constitutes child abuse in the United States". This opposition to female circumcision is, in fact, a dismissal of the customs of other cultures, no more and no less. If we take into consideration the Academy's medical arguments, it would be necessary to reject male circumcision as well as female circumcision. And if one adopts the criterion of gravity, it would be necessary to permit the 1st degree of female circumcision (ablation of the hood of the clitoris) that corresponds to the 1st degree of male circumcision, and to forbid the other forms of these two practices. In this case, it would be necessary to also forbid Jewish circumcision that is the 2nd degree: ablation of the foreskin (milah) and ablation of the inner lining of the foreskin (periah). Alone, the ablation of the foreskin should be allowed. All other solutions reflect a cultural imperialism and are unjustified discrimination. Certainly, one can invoke the fact that the custom of female circumcision is contested by some people belonging to cultural and religious groups that perform it. But we find a similar contention within the Jewish and the Muslim communities concerning male circumcision. We limit ourselves here to three paragraphs of an article by Jenny Goodman, a Jewish British psychiatrist: In Judaism, and in Islam, the human being is considered to be made in the image of God, and God is conceptualized as perfect. So one could argue that interfering with god's perfect creation is a form of blasphemy. In Judaism there is a law of Shmirat Ha Guf, the guardian or protection of the body. Body-piercing, tattooing and amputation are all forbidden for the reason. Further, there is the Talmudic concept of Tsa'ar ba'alei chayyim, compassion for all living creatures. If compassion in all its fullness were applied to 8-day-old babies, circumcision would become impossible. The Talmud goes on to say that: "One should be more particular about matters concerning life and health than about ritual observance". It insists, for example, that even the laws of the sabbath must be broken to give medical treatment or comfort to a sick person or a postpartum woman. This is despite the fact that keeping the sabbath is one of the Ten Commandments; circumcision, significantly, is not. Jewish law is an evolving process that has always taken into account new developments in science and understanding, and attempted to integrate them. Given what is known about the life-threatening complications of neonatal circumcision, there is an argument from within Judaism to adapt Jewish law, so that the circumcision of helpless, non-consenting babies becomes forbidden, not demanded. Source: Jenny Goodman, A Jewish perspective on circumcision, in George C. Denniston, Frederick Hodges and Marilyn Milos (eds), Male and female circumcision: Medical, legal and ethical considerations in pediatric practice (New York, 1999), 24 Along the same lines, a British lawyer states that male circumcision is not bound to a determined date with the Muslims, and it is not a condition of adherence to the Jewish community. Therefore, it is possible to delay circumcision until the age of majority to give the child the right to decide for himself if he wants to be circumcised or not. By waiting, one doesn't violate religious norms. Certainly, a father may feel saddened or guilty from a religious point of view if he lets his child go uncircumcised, but this is not a sufficient reason to impose a circumcision on a child or establish that the operation is in the child's interest. Source: Christopher Price, <a href="http://www.cirp.org/library/legal/price2/">Male non-therapeutic circumcision: The legal and ethical issues</a>, in George C. Denniston, Frederick Hodges and Marilyn Milos (eds), Male and female circumcision: Medical, legal and ethical considerations in pediatric practice (New York, 1999) <h3>(b) Priority of individual fundamental rights</h3> Circumcision is certainly a religious and cultural practice that lives within communities. But it is also a practice that is imposed upon an individual who is generally a minor without medical reason. While communities have a right to perform religious and cultural acts, they must respect individual rights, mainly the right to adhere to religious beliefs and cultural customs, the right to physical integrity and life, the right to modesty, and the right to respect the dead. The question then arises what has priority: community or individual rights? A basic international human rights rule is that individual rights are considered fundamental and have priority over collective rights. In the name of tolerance toward religion or culture, a community cannot ask the legislature to close its eyes to violations of fundamental individual rights. This rule has clearly been expressed in the UN Declaration of Principles on Tolerance proclaimed and signed on November 16, 1995, by member states of the UNESCO. Article 1, par. 1 defines tolerance as follows: Tolerance is respect, acceptance and appreciation of the rich diversity of our world's cultures, our forms of expression and ways of being human. It is fostered by knowledge, openness, communication and freedom of thought, conscience and belief. Tolerance is harmony in difference. It is not only a moral duty, it is also a political and legal requirement. Tolerance, the virtue that makes peace possible, contributes to the replacement of the culture of war by a culture of peace. But this article adds in par. 2: "Tolerance is not concession, condescension or indulgence. Tolerance is, above all, an active attitude prompted by recognition of the universal human rights and fundamental freedoms of others. In no circumstance can it be used to justify infringements of these fundamental values. Tolerance is to be exercised by individuals, groups and States." The par. 3 of the article 18 of the Covenant on Civil and Political Rights states: "Freedom to manifest one╒s religion or beliefs may be subject only to such limitations as are prescribed by law and are necessary to protect public safety, order, health, or morals or the fundamental rights and freedoms of others." This limitation is repeated in par. 3 of article 14 of the Convention on the Rights of the Child. Article 4 of the Declaration on the Elimination of Violence against Women, adopted December 20, 1993, by the General Assembly of the UN reads: "States should condemn violence against women and should not invoke any custom, tradition or religious consideration to avoid their obligations with respect to its elimination". Article 2 considers female circumcision an instance of violence against women. In a case involving a conflict between the religious liberty of parents and child's right to physical well-being, the U.S. Supreme Court has ruled: "Parents may be free to become martyrs themselves. But it does not follow they are free "to make martyrs of their children before they have reached the age of full and legal discretion when they can make that choice for themselves". Commenting this decision, an opponent to male circumcision writes: "The religious beliefs of the parents, over which the child has no control, cannot be used to excuse harming the child's temporal interests nor can they entitle the parent to control the child for the parent's benefit". Source: Van Howe RS, Svoboda JS, Dwyer JG, Price CP. <a href="http://www.cirp.org/library/legal/vanhowe5/">Involuntary Circumcision: the legal issues</a>. BJU Int 1999; 83, Suppl 1:63-73 It is appropriate at this point to recall the Geneva oath of the WMA: "I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, or social standing to intervene between my duty and my patient." This quotation means that the physician must not be influenced by religious or cultural reasons in his medical intervention. Thus, in a case involving a conflict between the right of the community or parents and the fundamental rights of the individual, it is the latter that has priority. Therefore, religious norms, whether mentioned in the Bible or the Koran or embodied in superstitions or animist beliefs, cannot be invoked to deprive an individual of his fundamental rights. It would take entirely too much space to list the Biblical and Koranic norms that different societies consider obsolete and contrary to human rights. If each community were allowed to apply all its religious or cultural norms to the detriment of individual fundamental rights, humanity would sink back into barbarism. This principle is clear, but its application to circumcision is less clear. Proponents of male and female circumcision refuse to apply it and feel communal religious norms have priority over individual rights. As for national and international legislatures and NGOs opposed to only female circumcision, they apply this principle only to female circumcision, giving religious and cultural communities the right to circumcise their boys and, thus, depriving them of their individual rights. It is important to note that circumcised people, men or women, are marked for life on their flesh. They don't even have the right as an adult to change their religion and get rid of the religious mark their parents imposed on them. Circumcision is, therefore, a breach of current and future liberty. The child certainly belongs to a Muslim and Jewish family, but international documents grant the child the right after a certain age to choose a religion different from his parents'. Thus, a child should also have the right to choose whether to have a circumcision, a religious mark, or not. It is not astonishing that Muslim and Jewish communities perform circumcisions. Both of these communities remain even today attached to the old concept of religious liberty: an obligation to enter, and no entitlement to leave. Those that abandon their religion are considered apostates, an offence punished even today in certain Muslim countries by death penalty and in Israel and in Muslim countries of the deprivation of a certain number of civil rights. The imposition of circumcision is the expression of this concept, aiming to force people to remain in the community by marking them physically as one marks livestock. Rabbis have aggravated the operation of male circumcision to make it difficult or even impossible for restoration of the foreskin. This is the reason these two communities consider any critique against circumcision as an attack against the community. This position doesn't differ from the position of U.S. slave masters who considered abolitionist campaigns as an infringement on their property and even their religious convictions. Let's add here that the interdiction of female circumcision and the allowance of male circumcision are contrary to the principle of sexual non-discrimination concerning religious liberty. It is interesting here to briefly discuss the intellectual progressive position of Margaret Somerville, Professor of Law at McGill University, Montreal. She explains that she began her campaign attacking only female circumcision before she discovered male circumcision was also unjustified at the medical, ethical, and legal level. Despite her discovery, she kept silent for seven years before overtly expressing her opinion: "The main reason that I have taken so long to speak publicly against routine male circumcision was my great fear of, in some way, supporting anti-Semitism or anti-Muslim feelings". Somerville explains that Western society generally gives pre-eminence to the rights of individuals, not only at the expense of claims of the community, but sometimes without any thought as to what needs to be done if a community is to be maintained or even to survive. In the context of a discussion of infant male circumcision carried out for religious reasons, we need to recognize people's rights to belong to a community of faith and belief, and to bring their children into this community with them. We must, therefore, take care to not intentionally harm them through attacking their beliefs or practices, especially a religion to which we do not belong, or at least not to do so without overwhelming justification for our actions. Somerville is in favour of some sort of limitation or prohibition of male and female circumcision, but she suggests that it would be necessary to make an exception in favour of religious circumcision if a person believes that it is a central tenet of his religion and a fundamental, an absolute religious obligation. But in this case, it is necessary to reduce the pain to a minimum. So it would not be permitted to perform the religious circumcision without anaesthesia. On the other hand, the least harmful and invasive form of circumcision that would fulfil religious requirements must be the practice adopted. For instance, historical research shows that for the first 2,000 years of Jewish history, a much less radical circumcision procedure was used than that employed today. Finally, the fully informed consent of both parents must be obtained. Somerville asks whether it is possible to delay the operation until the boy is competent to give personal informed consent. This issue is relevant in the Muslim faith where some male circumcision is carried out at an older age. But Somerville indicates that the law does not allow people below the age of majority to consent to non-therapeutic interventions. Evidently, Somerville does not plead for the delay if the child is from Jewish parents, because Jewish norms impose circumcision on the eighth day. Source: Margaret Somerville, Respect in the context of infant male circumcision: Can ethics and law provide insights?, in George C. Denniston, Frederick Hodges and Marilyn Milos (eds), Male and female circumcision: Medical, legal and ethical considerations in pediatric practice (New York, 1999) Somerville presented her ideas during the Fifth International Symposium on Genital Integrity that took place in Oxford in 1998. When she finished her presentation, a Jewish physician from Israel rushed toward her full of anger and asked: "Of what right do you allow my parents to cut my genitalia? My genitalia belong exclusively to me and my parents don't have any right to dispose of them in the name of religion". Many other participants expressed the same discontent about her mitigated position that tries to appease the Jewish and Muslim community. They feel that if one begins to open the door to allowing male circumcision by respecting the feelings of these two communities, one should then accept female circumcision for this same reason. And, they ask, where will this all end: should we also allow the law of retaliation (eye for eye and a tooth for tooth), the amputation of a thief's hand, the stoning of adulterers, and the death penalty for apostasy because these norms are traditional religious norms? In sum, should many other obsolete religious norms be reintroduced? If one objects to circumcision in the name of the individual religious liberty, we could also forbid the baptism of children. Baptism differs from circumcision in many ways, but primarily because it doesn't leave a physical mark; moreover, we all wash our children daily with water. But some people agree with this argument. Indeed, a growing number of Christians are no longer baptizing their children and, thus, the children are making their own decisions when they are adult. There is a similarity between circumcision and baptism by immersion. At a baptism I attended of a three-year-old son of a Greek Orthodox Palestinian family in Switzerland, I noted the child was publicly naked and then handed over to a priest who dipped him three times in baptismal waters. The child screamed and shouted with all his strength, while his parents and friends showed their joy by singing Arabic songs. The child's mother told me that her son had nightmares during the month following the baptism. There can be no doubt that this type of baptism is contrary to the rules of compassion. Strangely enough, society would be outraged if somebody treated a cat or a dog in his way The nearest accepted social custom to circumcision is probably tattooing as a religious sign. Copts tattoo their children, boys and girls, by a cross sign. There is no doubt that this practice on minors is contrary to individual religious liberty. We will see later that the Bible and the narratives of Muhammad forbid tattooing. And even though positive laws don't yet regulate this practice, those who tattoo generally refuse to proceed on minors without the authorization of parents for fear of judicial pursuit. Some argue that because it's okay for parents to impose education on their children that it's also okay to impose circumcision on them. There is a great difference, however, between education that prepares a child to be an active member of society and circumcision, which does not. If one didn't impose education on a child, it would lead to an enormous collective danger. To delay a circumcision until a child reaches an adult age constitutes no damage to society and the act doesn't prepare a circumcised child to be an active member of society. On the contrary, performing a circumcision at a young age exposes the child to physical and psychological dangers. <h2> <a id="hr4" name="hr4"></a>4. Circumcision and the right to physical integrity and life</h2> Male or female circumcision is an infringement of physical integrity that reduces the natural functions and drives and leads to physical, psychic, and sexual complications and sometimes death. For this reason, it is a violation of the rights to physical integrity and life. These two rights are among the most important human rights. Laws of all countries of the world, those of the West or the Third-world, mention them, impose penal sanctions for their violations, and provide civil reparation against those who violate them. The international legislature has explicitly placed the right to life at the forefront of the rights it guarantees. We give here some examples. The Universal Declaration of Human Rights Art. 3: Everyone has the right to life, liberty and security of person. The Covenant on Civil and Political Rights Art. 6, par. 1: Every human being has the inherent right to life. This right shall be protected by law. No one shall be arbitrarily deprived of his life. The Convention on the Rights of the Child Art. 6 (1): States Parties recognize that every child has the inherent right to life. (2) States Parties shall ensure to the maximum extent possible the survival and development of the child. The European Convention of Human Rights Art. 2, par. 1: Everyone's right to life shall be protected by law. No one shall be deprived of his life intentionally save in the execution of a sentence of a court following his conviction of a crime for which this penalty is provided by law. Strangely, none of these four documents mentions the right to physical integrity. The only two international documents that mention this right are the American Convention of Human Rights of 1969 and the African Charter of Human Rights of 1981. The American Convention on Human Rights Art. 4, par. 1: Every person has the right to have his life respected. This right shall be protected by law and, in general, from the moment of conception. No one shall be arbitrarily deprived of his life. Art. 5, par. 1: Every person has the right to have his physical, mental, and moral integrity respected. <a href="https://en.wikipedia.org/wiki/American_Convention_on_Human_Rights">Further information and full text of convention</a> The African Charter of Human Rights Art. 4: Human beings are inviolable. Every human being shall be entitled to respect for his life and the integrity of his person. No one may be arbitrarily deprived of this right. <a href="http://www1.umn.edu/humanrts/instree/z1afchar.htm">Further information and full text of charter</a> It's interesting to ponder why the UN and Europe did not include the right to physical integrity in its key documents. Vasak writes: It is by the interdiction of torture, cruel, inhuman or degrading treatments and of the medical or scientific experimentation without the free consent of the interested person that appears the worry of the international Community to defend and to preserve the physical and moral integrity of the person. This explanation is not very satisfactory because national constitutions themselves expressly mention the right to physical integrity. By returning to the travaux preparatoires of Article 3 of the Universal declaration, we notice that this right was mentioned in different projects, but was suppressed in final versions. It appears that the right to physical integrity was assumed to be included in the right to security mentioned in Article 3. But as Verdoodt says, article 3 is quite vague. He explains that only some countries participating in the redaction "gave an interpretation that includes the right to physical integrity in the legal notion of security of person", adding that this article doesn't include "any explicit condemnation against the lack of protection of the state against the criminal tentatives". According to Verdoodt, it would be necessary "to refer to the article 5, that forbids the cruel, inhuman or degrading treatments, to include the right to physical integrity in the Declaration". Source: Albert Verdoodt, Naissance et signification de la Declaration universelle des droits de l'homme (Louvain 1964), 165 The travaux preparatoires of the European convention of human rights don't explain why its redactors excluded the right to physical integrity. In response to our question to the Court of Human Rights in Strasbourg as to why, Wolfgang Peukert, Chief of the unit of Jurisprudence Research and Documentation, answered (June 22, 1999), that "the physical integrity is protected by articles 3 and 8 of the European convention of human rights". These two articles state: Art. 3: No one shall be subjected to torture or to inhuman or degrading treatment or punishment. Art. 8, par. 1: Everyone has the right to respect for his private and family life, his home and his correspondence. It's not clear how one can deduce from these two articles the right to physical integrity. The next question is whether the implicit goal of the drafters of these documents was to avoid male circumcision. To answer this question, we need to discuss the historical setting of the Universal declaration and the European convention, both of which are post-WWII documents. By writing these two documents, the drafters tried to take solid resolutions to address the horrors of World War II. They particularly wanted to ensure that the horrors of concentration camps for Jews and other undesired groups would never be repeated. By not mentioning the right to physical integrity, it's possible the drafters wanted to avoid hurting the Jewish community that practices male circumcision. Indeed, the primary drafter of the Universal declaration was Professor Rene Cassin, of the Jewish religion. This hypothesis should one day be confirmed or invalidated by future researchers, but it cannot be completely discarded today. It's important to note that only a few people are aware of the absence of the right to physical integrity in the UN documents and the European convention; in fact, even law professors consistently have expressed their astonishment at this mystery. Even though the right to physical integrity is not expressly mentioned in the UN documents and the European convention, it doesn't mean the right can't be found implicitly within other rights, including articles 3 and 5 of the Universal declaration and article 3 of the European Convention on Human Rights and Bioethics. In addition, the following could be added. The Convention on the Rights of the Child Art. 24 (1): States Parties recognize the right of the child to the enjoyment of the highest attainable standard of health. (3) States Parties shall take all effective and appropriate measures with a view to abolishing traditional practices prejudicial to the health of children. Art. 36: States Parties shall protect the child against all other forms of exploitation prejudicial to any aspects of the child╒s welfare. The International Code of Medical Ethics of the WMA A physician shall in all types of medical practice, be dedicated to providing competent medical service in full technical and moral independence, with compassion and respect for human dignity. A physician shall act only in the patient's interest when providing medical care which might have the effect of weakening the physical and mental condition of the patient. Geneva Convention on treatment of prisoners of war Let's signal also that the four Geneva Conventions which set the standards in international law for humanitarian treatment of the victims of war forbid infringements on physical integrity. Regarding mutilations, Article 3, par. 1 states: "the following acts are and shall remain prohibited at any time and in any place whatsoever with respect to the above-mentioned persons: <ul> <li>violence to life and person, in particular murder of all kinds, mutilation, cruel treatment and torture;</li> <li>outrages upon personal dignity, in particular, humiliating and degrading treatment."</li> </ul> This rule applies "without any adverse distinction founded on race, colour, religion or faith, sex, birth or wealth, or any other similar criteria." It is true that <a href="https://en.wikipedia.org/wiki/Geneva_Conventions">the Geneva Convention</a> applies specifically to the treatment of prisoners of war and to civilians caught in war zones, but it is reasonable to suppose that the framers of the convention were trying to give prisoners the same rights as were already enjoyed by the average citizen. If such a rule must be applied in war, a fortiori it must be applied in peace, and if applicable to prisoners it must certainly be applied to free citizens. <h2> <a id="hr5" name="hr5"></a>5. Circumcision, degrading treatment and torture</h2> Degrading treatment and torture are forbidden by numerous international documents. The Universal Declaration on Human Rights Art. 5: No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment. The Covenant on Civil and Political Rights Art. 7: No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment. In particular, no one shall be subjected without his free consent to medical or scientific experimentation. The Convention on the Rights of the Child Article 37: States Parties shall ensure that: (a) No child shall be subjected to torture or other cruel, inhuman or degrading treatment or punishment. Neither capital punishment nor life imprisonment without possibility of release shall be imposed for offences committed by persons below eighteen years of age. In addition to these documents, others that forbid degrading treatment and torture, include "Principles of Medical Ethics Relevant to the Role of Health Personnel, Particularly Physicians, in the Protection of Prisoners and Detainees Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment", adopted by the General assembly of the UN in 1982. The Declaration of Tokyo of the WMA (1975) confirms these principles: <ul> <li>The doctor shall not countenance, condone or participate in the practice of torture or other forms of cruel, inhuman or degrading procedures, whatever the offence of which the victim of such procedure is suspected, accused or guilty, and whatever the victim's belief or motives, and in all situations, including armed conflict and civil strife.</li> <li>The doctor shall not be present during any procedure during which torture or other forms of cruel, inhuman or degrading treatment are used or threatened.</li> <li>A doctor must have complete clinical independence in deciding upon the care of a person for whom he or she is medically responsible. The doctor's fundamental role is to alleviate the distress of his or her fellow men, and no motive whether personal, collective or political shall prevail against this higher purpose.</li> </ul> <h3>Application to male and female circumcision</h3> In what way are these principles applicable to female and male circumcision? Proponents of female circumcision don't agree that this practice qualifies as degrading treatment or torture. Even opponents of this practice are reluctant to consider it such even though they don't minimize the pain that it can generate. We have already mentioned the case of the Somalian Waris Dirie who condemns female circumcision, but says she doesn't blame her parents because they did what they thought was important for their daughter. Dorkenoo writes: "Female genital mutilation does not fit into a neat traditional category of torture, e.g. dictatorial government torturing political prisoners. Female genital mutilation is gender-based violence which happens in the home, is condoned by the family and the community at large and over a period of time has been accepted as culture. As a human rights issue it falls into the category of citizen upon citizen abuse. It is not governments who are forcing girls to be mutilated." Source: Efua Dorkenoo, Cutting the Rose: Female Genital Mutilation: The practice and its prevention (London 1994), 70 International human rights bodies obviously do not share this point of view. The Commission of Human Rights in Resolution 49 of 1996 stated that female circumcision was violence against the women and asked governments "To enact and enforce legislation protecting girls from all forms of violence, including female infanticide and prenatal sex selection, genital mutilation, incest, sexual abuse, sexual exploitation, child prostitution and child pornography." The Sub-committee for the Prevention of the Discrimination and the Protection of Minorities refers in Resolution 8 of 1997 to article 5 of the Universal Declaration of Human Rights and Article 7 of the Covenant on Civil and Political Rights, both of which address torture or cruel, inhuman, or degrading treatment, and called upon member states to take the necessary measures to eliminate female circumcision. This UN position is confirmed in many documents of the Council of Europe. It should also be noted that the president of the Inter-African Committee considers female circumcision as a "true operation of torture with disastrous physical and moral consequences and aftermaths whose victims often endure during all the remaining of their life". Nor do proponents of male circumcision agree that male circumcision qualifies as degrading treatment or torture. They deny or minimize a child's pain and assert that circumcision is an act of love, performed in the child's interest. Professor Freeman, in fact, says that it is not circumcision, but the Jewish and Muslim parent's refusal to circumcise their children that constitutes an abuse. He adds: "Far from ritual male circumcision constituting abuse or a prejudicial traditional practice, or a threat to a child's bodily integrity, it is argued here that male Jewish and Muslim babies have the right to be circumcised". He says the majority of Jewish and Muslim adults appreciate what others put them through. "To them, cultural and religious identity, the sense of belonging to a group, is of greater significance than minor invasive treatment administrated when they were unaware of it". He adds: "To deny a Jewish or Muslim child a circumcision removes from him the ability to participate in the religious life of his community and as such undermines his freedom of religion". The silence of the international legislature regarding male circumcision seems to indicate it doesn't consider the practice a degrading treatment or torture. The American legislature forbids abuse inflicted on children for religious reasons, including female circumcision but excluding male circumcision. Opponents of male circumcision do not share their opinion. Ashley Montagu writes: "In recent years, we have suddenly discovered that the abuse of children is rather more frequent than was generally believed. Today, now that child abuse has come to be recognized as a widespread psychopathology in America, it may be easier for people to perceive circumcision as a form of child abuse." Source: Ashley Montagu, Mutilated humanity (Nocirc: San Francisco, 1991) J Steven Svoboda, the president of Attorneys for the Rights of Children, writes: "No objective observer who has witnessed a circumcision can seriously dispute that the procedure inflicts severe pain or suffering on the child. Circumcision does constitutes torture. Article 3 of the Declaration against torture prohibits any state from permitting or tolerating torture or other cruel, inhuman and degrading treatment or punishment. The United States, by failing to take action against circumcision, as well as by subsidizing and performing the procedure, is also violating this article." Source: J. Steven Svoboda, Routine infant male circumcision: Examining the human rights and constitutional issues, in George C. Denniston and Marilyn Milos (eds), Sexual mutilations: A human tragedy (New York, 1997) The chairwoman of the Amnesty International-Bermudas section also says male circumcision is torture. She invokes here the UN reports relative to crimes committed during the war in Yugoslavia. These reports describe as torture various forms of sexual violence inflicted on prisoners, including rape, castration, and male circumcision. The Fourth report on War Crimes in the former Yugoslavia 1992 (Part II) reports the following under the headline "Torture of prisoners": A US surgeon from California spent 2 weeks in Bosnia-Herzegovina (including time at Kosevo hospital in Sarajevo) in late August and early September performing remedial urological surgery. The doctor reportedly found that Muslim and Mujahedin irregular troops - some from Afghanistan and Saudi Arabia - had routinely performed crude, disfiguring, non-medical circumcisions on Bosnian Serb soldiers, and he treated one 18-year-old Bosnian Serb soldier who was so brutally circumcised that eventually the entire organ required amputation. <a href="http://www.haverford.edu/relg/sells/reports/4thB.html">Full report here</a> On October 6, 1992, the UN Security council requested the Secretary General to establish a Commission of Experts to examine and report on violations of international humanitarian law committed in the territory of former Yugoslavia. The Commission of experts' final report (S/1994/674) concluded that universal jurisdiction existed for "crimes against humanity", which are considered "elementary dictates of humanity to be recognized under all circumstances"; applicable "to all contexts"; and "no longer dependent on their linkage to crimes against peace or war crimes". These "crimes against humanity", the report established, include "violence to life and person, in particular murder of all kinds, mutilation, cruel treatment and torture; taking of hostages; outrages upon personal dignity, in particular humiliating and degrading treatment". The report added that "rape and other sexual assaults" constitute "torture or inhuman treatment" which wilfully cause "great suffering or serious injury to body or health". In part IV, the report details the nature of sexual assault or abuse of men as follows: There have also been instances of sexual abuse of men as well as castration and mutilation of male sexual organs. Men are also subjected to sexual assault. They are forced to rape women and to perform sex acts on guards or each other. They have also been subjected to castration, circumcision or other sexual mutilation. <a href="http://www.ess.uwe.ac.uk/comexpert/IV_E-V.htm#IV.F">Full report here</a> <h2> <a id="hr6" name="hr6"></a>6. Circumcision and the right to modesty</h2> Laws of all countries of the world punish infringements on modesty. Respect for a child's modesty is demanded by the Convention on the Rights of the Child: Article 16, par. 1: No child shall be subjected to arbitrary or unlawful interference with his or her privacy, family, home or correspondence, nor to unlawful attacks on his or her honour and reputation. Art. 34: States Parties undertake to protect the child from all forms of sexual exploitation and sexual abuse. For these purposes, States Parties shall in particular take all appropriate national, bilateral and multilateral measures to prevent: (a) The inducement or coercion of a child to engage in any unlawful sexual activity; (b) The exploitative use of children in prostitution or other unlawful sexual practices; (c) The exploitative use of children in pornographic performances and materials. The respect for modesty is affirmed in medical ethical norms. The Oath of Hippocrates (d. 377 B.C.) states: "Whatever house I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves." The WMA Declaration on the Rights of the Patient states: "The patient's dignity and right to privacy shall be respected at all times in medical care and teaching, as shall his/her culture and values." The Charter for Children in Hospital (1993) states: "Children shall be treated with tact and understanding and their privacy shall be respected at all times." In order to carry out a circumcision, the circumciser undresses the child, manipulates his genitalia, and cuts them. In a Jewish circumcision, the traditional religious rule (still observed by ultra-orthodox Jews) provides for the circumciser to put the child's penis in his mouth following the cutting. There can be no doubt that this behaviour is an infringement of the penal norms relative to modesty (and paedophilia) and is a frequent cause of disease transmission from circumciser to child, including tuberculosis, syphilis and herpes, sometimes leading to death. Opponents to female circumcision in Egypt don't hesitate to use these norms to support their opposition to female circumcision. The vice-president of the Egyptian Cassation Court has written that the physician who touches a woman's breast commits an infringement of a woman's right to modesty, except in cases where a medical reason exists. The same rule applies if one touches a girl's genitalia. Professor Al-Saghir of the law faculty of Ain Shams writes: It is not permitted to denude genitalia of others than for the medical reasons. With regard to female circumcision, it is not permitted to discover the genitalia than if the circumcision is an obligation. However, it is neither obligation nor sunnah. In the same way, it is not part of medical act since it doesn't heal an illness of the girl, female organs not being in themselves an illness. Therefore, the ablation of any part of a female sexual organ is comparable to an ablation of any other healthy organ such as a finger. The one that perform this operation, whether he is a physician, nurse or other, is guilty of the crime of reach to modesty. To support his position, Al-Saghir mentions an unpublished Egyptian judgment of 1994 that qualified female circumcision in this way. Another unpublished judgment of 1995 did the same regarding a male circumcision performed by a male nurse on a seven-year-old child. Al-Saghir argues circumcision is an aggravated breach of modesty because it is performed on a minor by using the constraint. Even if the minor agrees to a circumcision, his consent can't be taken into consideration because his is a minor by law. Muslim jurists are very sensitive to the argument of modesty in relation to male and female circumcision. They insist that a person of the same sex must perform the circumcision. So a woman should circumcise a girl or a woman, and a man should circumcise a boy or a man. If the person being circumcised is an adult man, Al-Nazawi (d. 1162) says he must let the circumciser see only the part to be circumcised and he must hide the rest of his body. The book Al-fatawi al-hindiyyah says that in this case, the man should circumcise himself so that he doesn't expose his genitalia to others. If he doesn't know how to perform the circumcision, he should buy a female slave who knows the profession. Al-Sawi (d. 1825) says the man doesn't have to have a circumcision in this case. <h2> <a id="hr7" name="hr7"></a>7. Circumcision and respect for the dead</h2> Respect for the human cadaver has been imposed on humanity since time immemorial. Whoever attacks a cadaver commits an act of profanation. To our knowledge, the international legislature doesn't expressly address human rights after death, unless we consider this right to be included within the articles that protect human dignity and forbid cruel, inhuman, and degrading treatment. Laws of all countries of the world carefully provide that the human cadaver and the place where it is buried should not be profaned. For example, article 262 par. 1 of the Swiss Penal Code provides: "Everyone who desecrates or publicly offends a human cadaver shall be punished with imprisonment or with a fine". According to strict Jewish tradition, the fetuses of dead male children should be circumcised before being buried. Similarly, the same procedure may be performed on the Jews who died uncircumcised. Circumcision constitutes a burial condition in a Jewish cemetery. This last issue was the subject of an agitated debate in the Knesset, the Israeli Parliament. Circumcision of the dead is extolled by certain Muslim jurists. There is no doubt that such a practice is a profanation of the dead. Certainly the refusal to bury a dead person in a cemetery because he is not circumcised must constitute religious discrimination. Even though such a repugnant act is not regulated by international or national legislation, it is undoubtedly the duty of intellectuals to denounce it publicly as contrary to good customs and morals. Source: Extract from Chapter V, "Human rights", from Sami Aldeeb Abu-Sahlieh, Male and Female Circumcision among Jews, Christians and Muslims: Religious, Medical, Social and Legal Debate (Warren, Penn: Shangri-La Publications, 2001), 324-336. The text has been slightly edited for clarity and to bring some points up to date. <a href="http://www.sami-aldeeb.com/" rel="noopener" target="_blank">Full text available from Dr Aldeeb's website</a> <a href="http://blogdesamialdeeb.blog.tdg.ch/" rel="noopener" target="_blank">Sami Aldeeb's blog</a> (in French) </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Sami Aldeeb: Circumcision and human rights darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> The argument for widespread, and ideally universal, circumcision these days relies on the proposition that we are facing a public health crisis to which circumcision is the only answer. One circumcision promoter has gone so far as to describe circumcision as “a biomedical imperative for the 21st century”. [1] Whatever the problems Africa and certain other developing nations may face, there is no evidence that any Western or developed nation, much less Australia, is threatened with any such crisis. Quite apart from its air of unreality, such “ten minutes to midnight” health alarmism ignores of the principles of risk management, which require that a full assessment of risk consequence, likelihood, mitigation strategies and risk tolerance be undertaken before it is possible to reach any conclusions about the degree of risk inherent in taking or not taking certain actions. Individuals have different levels of risk tolerance, and they have the right to develop their own strategies for handling health risks, and striking the appropriate balance between dangers and pleasures. The health industry is not entitled to pre-empt their options. Today’s circumcision promoters perform what in books on clear thinking is called a logical slide. They present a mass of data and claim that it is evidence (indeed, proof) that parents should circumcise their baby boys; but in fact, even if their data were valid, what it is evidence for is an argument that an adult male should get himself circumcised. And you might expect that a few cautious males would take this advice, especially if they were sexually promiscuous – except that if they were sexually promiscuous they would not be cautious, and it is a strange fact that very few adult men do get themselves circumcised. Most men are understandably reluctant to hurt their own penis, but hurting somebody else’s body is a different matter, especially if it can be done with the conscience-salving rationalisation that it is “for his own good”. The Victorian-Edwardian doctors who wished to introduce widespread and preferably universal circumcision were not able to convince the uncircumcised adults of their day (who were the ones at risk of syphilis) to get themselves circumcised, but they succeeded in persuading the uncircumcised fathers to cut their boys (who, being children, were not at risk). <h3>"Do it to him, not to me"</h3> This has always been the strategy of the circumcision lobby: not to convince men to circumcise themselves, but to convince parents (today, particularly mothers) to circumcise their children. I recall a discussion with an uncircumcised father of young children who said that if it were proved that circumcision gave a man protection against HIV he would get his own boys circumcised. When I suggested that, since he was the sexually active one and they were not at risk, it would be both fairer and more logical to leave the boys alone and get himself circumcised, he looked at me in disbelief and mumbled something to the effect that the operation was too dangerous and painful for adults, and that in any case, he was used to his foreskin and would miss it. Enough said. The demand for universal routine circumcision has never been justified because its proponents have failed to specify what would have to be established to make their case worth considering. In order to make a convincing case that prophylactic circumcision without consent was justified you would need to prove (a) that the boy had a high risk of contracting a fatal and incurable disease before reaching the age of consent unless he was circumcised; (b) that circumcision would certainly eliminate the risk or reduce it by a degree proportional to the sacrifice of the body part; and (c) that there was no other practical way of reducing the risk by the same degree. No such proof has ever been attempted, let alone achieved. A century ago E. Harding Freeland urged universal circumcision of young boys as a preventive of the world’s then most feared disease, syphilis. He was, however, less evasive than today’s circumcision promoters, and made no bones about the fact that he was advocating “the universal practice of an operation which has for its object the wholesale removal of a certain healthy structure as a preventive measure”. Unlike today’s circumcision advocates, he admitted that he therefore had to provide “good evidence” that (1) the operation was free from risk; (2) the removal of the foreskin would inflict no physical disability on the individual; and (3) the benefits of the amputation were substantial and commensurate with the sacrifice. He failed dismally to establish any of these, but his counterparts today do not even make the attempt. [2] The diseases most commonly cited these days as necessitating widespread circumcision are HIV-AIDS and cervical cancer. Both are irrelevant to children, however, because each is a sexually transmitted infection to which children, not being sexually active, are not at risk. The case for cervical cancer is invalid for the additional reason that, as Sarah Waldeck points out, the person bearing the risk and suffering the deprivation is not the person reaping the benefit. [3] There is little enough warrant in Western law or custom to coerce a person for the sake of his own health; there is none at all for the proposition that a person should be forcibly deprived of a functioning body part for the benefit of an unknown third party. <h3>HIV-AIDS</h3> There is evidence from Africa that circumcised men who have frequent unprotected intercourse with infected female partners are less vulnerable to infection with HIV, and world health authorities have recommended circumcision of sexually active adult men as an adjunct to controlling the spread of AIDS in severely affected regions of Africa. There has, however, been no suggestion from responsible authorities that such measures are appropriate in developed nations or in places, such as Australia, with a low incidence of female to male transmission. The Australian Federation of AIDS organization has stated that circumcision has no role in the management of HIV in Australia, where the disease is largely confined to specific sub-cultures. [4] In any case, protection against HIV would not be a justification for circumcising infants or children, since they are not sexually active and thus not at any risk of contracting the disease (unless through surgery itself.) Even in Africa the recommendations of the World Health Organisation have been contested, and its gung-ho approach to what it calls the circumcision roll-out has been attacked by the South African Medical Journal as costly, ineffective, a violation of accepted principles of bioethics and human rights, culturally insensitive and smacking of medical colonialism. [5] It has also been criticized by child health and human rights experts as neither medically necessary nor ethically permissible. [6] To cite the African data as an argument for circumcision of male infants and boys in Australia would be irresponsible and inappropriate. <h3>Medical ethics and public health</h3> In this context it is useful to recall the framework proposed by Hodges et al for balancing the requirements of human rights with the those of public health. In an important article published in the Journal of Medical Ethics in 2002, they considered prophylactic interventions in children and how conflicts between the demands of public health and human rights might be resolved. Noting that such interventions were traditionally justified on the grounds of “best interests of the child” and/or “public health”, they proposed two sets of criteria which had to be met before an intervention could be accepted as ethical. The criteria for the “best interests of the child” argument were (1) presence of clinically verifiable disease, deformity or injury; (2) least invasive and most conservative treatment option; (3) net benefit to the patient and minimal negative impact on patient’s health; (4) competence to consent to the procedure; (5) standard practice; (6) individual at high risk of developing the disease. The criteria for the “public health benefit” argument were: (1) substantial danger to public health; (2) condition must have serious consequences if transmitted; (3) effectiveness of the intervention; (4) invasiveness of the intervention; (5) whether individual receives an appreciable benefit not dependent on speculation about future behaviour; (6) the health benefit to society must outweigh the human rights cost to the individual. The authors evaluated several interventions against one or other of these sets of criteria, and neonatal circumcision against both of them. They concluded that while immunisation generally satisfied the “best interests” and “public health” justifications, circumcision failed to satisfy either of them. Such an intervention was thus impermissible because it was performed on a minor without consent; the human rights cost to the individual exceeded the proven public health benefit; and the disease could be avoided through appropriate behavioural choices. [7] There is, in fact, evidence that Australia’s abandonment of circumcision in the 1980s-90s has actually improved child health outcomes. A major study by the Australian Institute of Health and Welfare in 2005 found that there had been a significant improvement in child health outcomes between the early 1980s and 2000 – the very period when routine circumcision disappeared – and no evidence at all of any “explosion of genito-urinary problems” as predicted by certain circumcision promoters. [8] A further study by the AIHW released in 2009 confirmed this picture and noted that the only child health problems that seemed to be getting more serious were diabetes and asthma. [9] A recent cost utility analysis of neonatal circumcision found that even if the extreme claims of advocates were true, the associated complications and adverse outcomes would cancel out and exceed the benefit to health. [10] In places such as Australia, with a past history of widespread circumcision, it is common to find misconceptions about the normal development of the penis and the correct care of the natural (uncut) penis, especially in rural areas. Many people, including doctors, continue to believe that the foreskin should be retractable soon after birth, or at 3 or 4 years at the latest, and that it should be forcibly retracted for cleaning purposes as soon as possible. These ideas are incorrect, since it is quite common for the foreskin not to become retractable until puberty; this rarely causes any problems, and no action is needed unless the boy is experiencing pain or discomfort. [11] Premature or forcible retraction is one of the most common causes of foreskin problems and the real source of the urban myth that the normal penis is prone to problems and “difficult to look after”. It is also often assumed that minor foreskin problems (discomfort arising from tightness, minor skin infections, minor urethral infections, persistent phimosis etc) cannot be cured by conservative treatment but require amputation. The normal rule in modern medical practice is medical treatment first, followed by surgical intervention only if medical treatment fails; this rule has often not been, but should be, applied to the penis as much as to other parts of the body. Most foreskin problems can be successfully treated with conservative measures that do not require surgery, let alone amputation of tissue, and such medical treatments are the preferred approach today. References <ol> <li>Brian Morris, “Why circumcision is a biomedical imperative for the 21st century”, BioEssays, November 2007</li> <li>E. Harding Freeland, “Circumcision as a preventive of syphilis and other disorders”, Lancet 1900 (2), 29 December, 1869-71</li> <li>Sarah Waldeck, <a href="http://www.cirp.org/library/legal/USA/waldeck1/">Using circumcision to understand social norms as multipliers</a>, University of Cincinnati Law Review, Vol. 72, 2003, 455-526;</li> <li>Australian Federation of AIDS Organisations, Briefing Paper, 23 July 2007,<a href="http://www.afao.org.au/"> Male circumcision has no role in the Australian AIDS epidemic</a>.</li> <li>D. Sidler, J. Smith, H. Rode, “Neonatal circumcision does not reduce HIV/AIDS infection rates”; A. and J. Myers, “Editorial: Rolling out male circumcision as a mass HIV/AIDS intervention seems neither justified nor practicable”, both in South African Medical Journal, Vol. 98, No. 10, October 2008. <a href="http://www.cirp.org/library/disease/HIV/">Both available at CIRP</a> </li> <li>Robert Van Howe and J. Steven Svoboda, <a href="https://www.circinfo.org/vanhowe1.html">Neonatal circumcision is neither medically necessary nor ethically permissible: A reply to Clark et al</a>, Medical Science Monitor, Vol. 14, 2008</li> <li>Hodges FM, Svoboda JS, Van Howe RS. <a href="http://www.cirp.org/library/ethics/hodges3/">Prophylactic interventions on children: balancing human rights with public healt</a>h. J Med Ethics 2002;28: 10-16</li> <li> <a href="http://www.aihw.gov.au/">Australian Institute of Health and Welfare</a>, A Picture of Australia’s Children (Canberra: AIHW 2005).</li> <li>AIHW, <a href="http://www.aihw.gov.au/publications/index.cfm/title/10704">A Picture of Australia’s Children 2009</a> (Canberra 2009)</li> <li>Van Howe RS. <a href="http://www.cirp.org/library/procedure/vanhowe2004/">A cost-utility analysis of neonatal circumcision</a>. Medical Decision Making 2004;24:584-601</li> <li>Dan Bollinger, “The penis-care information gap: Preventing improper care of intact boys”, THYMOS: Journal of Boyhood Studies, Vol. 1, Fall 2007, 205-219.</li> </ol> Further information <a href="https://www.circinfo.org/Circumcision_and_public_health.html">Circumcision and public health (2): Is circumcision a biomedical imperative for the 21st century?</a> <a href="http://www.cirp.org/library/treatment/phimosis/">Further information on phimosis</a> <a href="http://www.cirp.org/library/hygiene/">Information on care of the normal penis from CIRP</a> <a href="http://www.circumstitions.com/Care.html">Foreskin care at Circumstitions</a> In recent years there has been a subtle shift in the propaganda put out by the circumcision promoters. In the past they stressed the necessity of circumcision for individual hygiene, but these days they increasingly they talk about circumcision as a vital element in a public health strategy. The reason for the shift of emphasis is as simple as it is sinister: finding that their arguments about individual health or bodily aesthetics are having little impact on parents, they are hoping that if they can whip up a big enough scare about supposed threats to public health, they will be able to pressure medical authorities, and even governments, to force parents to get their baby boys circumcised. This is what they mean when they say that the evidence for the protective effect of circumcision against certain diseases is “compelling”: sufficient, that is, for the authorities to compel people to get themselves or their children circumcised. <h2> <a id="mandatory" name="mandatory"></a>Arguments for mandatory circumcision</h2> These arguments for widespread, and ideally mandatory, circumcision rely on the proposition that we are facing a public health crisis to which circumcision is the only answer. One circumcision promoter has gone so far as to describe circumcision as “a biomedical imperative for the 21st century”. [1] These arguments rely almost entirely on data collected in various underdeveloped and usually poverty-stricken Third World countries, all with epidemic levels of many kinds of disease, not to mention political instability, ethnic/religious violence, economic collapse and social chaos. Trying to blame the foreskin for these endemic problems reminds one of other occasions on which the innocent have been made the scapegoats. The circumcision promoters managed to get circumcision programs going in Africa by linking it with reproductive health; now they are trying to get them going in developed countries by linking circumcision with public health. One thing is clear: whatever the problems Africa and certain other developing nations may face, there is no evidence that any Western or developed nation, much less Australia, is threatened with any kind of health crisis. Quite apart from its air of unreality, such “ten minutes to midnight” health alarmism ignores the principles of risk management, which require that a full assessment of risk consequence, likelihood, mitigation strategies and risk tolerance be undertaken before it is possible to reach any conclusions about the degree of risk inherent in taking or not taking certain actions. Individuals have different levels of risk tolerance, and they have the right to develop their own strategies for handling health risks, and striking the appropriate balance between dangers and pleasures. The health industry is not entitled to pre-empt their options. But leaving these ethical considerations aside, and despite the claims of the circumcision promoters, there is no proof that circumcision has ever improved child or public health outcomes in developed nations, and plenty of evidence that circumcision is, on the contrary, a menace to personal and individual health. [1] Brian Morris, “Why circumcision is a biomedical imperative for the 21st century”, BioEssays, November 2007 <h2> <a id="death" name="death"></a>Deaths from circumcision</h2> Far from circumcision improving the health of South Africans, the traditional circumcision rite performed among the Xhosa people results in the death of about 100 boys each year, and many more severely injured. Last year (2009) the death toll was 91, and so far this year (10 July 2010) it stands at 47. <a href="http://www.circumstitions.com/">Further details at Circumstitions</a> You might well expect nothing better when complex surgeries are carried out in unsanitary and primitive conditions, but a recent study has found that even in the sterile wards of United States hospitals, circumcision may kill as many as 100 boys each year. The study, by researcher Dan Bollinger, concluded that approximately 117 neonatal deaths (within the first 28 days of birth) due directly or indirectly to circumcision occur annually in the United States, or one out of every 77 male neonatal deaths. This compares with 44 neonatal deaths from suffocation, 8 in automobile accidents and 115 from Sudden Infant Death Syndrome, all of which losses have aroused deep concern among child health authorities and stimulated special programs to reduce mortality. Not so long ago the American Academy of Pediatrics <a href="http://stats.org/stories/2010/choking_hot_dog_feb23_10.html">issued an official warning</a> against the risk of death by ... choking on hotdogs, estimated to cause only 5 child deaths per year (and presumably none in the neonatal period). Bollinger’s figures have been questioned and have yet to be confirmed, but even if the death toll is half the estimate (60 deaths a year) it would still be alarming. <a href="https://www.circinfo.org/USA_deaths.html">Further details on this site</a> In recent years there has also been a spate of deaths in Britain, arising from ritual circumcision of boys among the Muslim community. If this level of harm were seen as a result of female genital cutting, there would be screams for action to protect girls; but since it is only boys who are affected, the response circumcision promoters is to demand yet more circumcision as a public health imperative. (<a href="https://www.circinfo.org/news.html#News9">See News page</a>). <a href="http://www.circumstitions.com/death.html" rel="noopener" target="_blank">Further information at Circumstitions</a> <h2> <a id="injury" name="injury"></a>Physical and psychological injury</h2> There has never been a comprehensive study of adverse circumcision outcomes (euphemistically known as complications), but judging from the dozens of articles that appear annually in medical journals, all discussing the best means of repairing circumcision damage, there is reason to believe that circumcision imposes a severe burden on the health resources of countries where it is common. And the burden of repairing circumcision damage is additional to the medical resources committed to the original surgery. Unlike in underdeveloped countries, such as Turkey, Iran or Nigeria, where the incidence of serious adverse outcomes from circumcision runs as high as 20 per cent, [1] it is clear that deaths or serious complications from circumcision are not common in developed countries. Australia has an enviable record with respect to deaths from circumcision, none having been reported since 1993. There is, however, no room for complacency. As well as good medical practice, the absence of such reports is as much a consequence of the declining and now low incidence of infant circumcision and the difficulty of attributing deaths to circumcision when they are the result of later complications, such as infection, or of long term sequelae, such as depression and suicide. As shown on the above table, several authorities agree that there is no reliable record of mortality, and the Australian Institute of Health and Welfare has admitted that their statistics cannot identify deaths due indirectly to circumcision: “We have information on circumcision and there are external cause codes for complications of medical and surgical care. However, it is not possible to tell if the complication was a result of the circumcision. For example, the circumcision may have been undertaken in a previous admission, and the patient readmitted with a complication. If this was the case, we couldn’t tell that it was the same patient and we wouldn’t know for sure that the complication was due to the circumcision.” [2] It is a similar picture with respect to complications, the incidence of which is the subject of wide disagreement. In 1970 Leitch suggested a rate of 15.5 per cent, including 8 per cent requiring a second operation to tidy up the mess left by the first [3], while more recently the Royal Australasian College of Physicians cites estimates ranging from an implausible 0.06 per cent to an equally unlikely 55 per cent, depending on definition. It seems to regard a likely incidence as falling within the range of 2 to 10 per cent, and it warns that “serious complications, such as bleeding, septicaemia and meningitis may occasionally cause death”. [4] If the rate of complications is 15, 10 or even only 2 per cent, it is apparent that the small number of cases that get publicly reported represent only the tip of the iceberg; this under-reporting contributes to the illusion that circumcision is a safe and “harmless” operation. [5] References <ol> <li>Ozdemir E. <a href="http://www.cirp.org/library/complications/ozdemir/">Significantly increased complications risk with mass circumcision</a>. British Journal of Urology 1997; 80: 136-139; Yegane RA, Kheirollahi AR, Salehi NA, et al. Late complications of circumcision in Iran. Padiatr Surg Int, 2006; 22: 442-445. A study of neonatal circumcision in Nigeria found a complication rate of 20.2 percent, with 3.1 per cent of the operations resulting in amputation of part of the glans – Okeke LI, Asinobi AA, Ikuerowo OS. Epidemiology of complications of circumcision in Ibadan, Nigeria. BMC Urology, 2006; 6: 21</li> <li>Narelle Grayson, Hospitals and Mental Health Services Unit, AIHW, email message to Shane Peterson, 14 January 2004</li> <li>I.O.W. Leitch, <a href="http://www.cirp.org/library/general/leitch1/">Circumcision: A continuing enigma</a>, Australian Paediatric Journal, Vol. 6, 1970, 60</li> <li><a href="http://www.racp.edu.au/page/health-policy-and-advocacy/paediatrics-and-child-health">RACP Policy statement on circumcision, 2009</a></li> <li>Circumcision practitioners in Australia boast that the method they usually employ, the plastibell device, is painless, non-surgical and completely safe. All these claims are false and misleading. Because the foreskin is densely networked with nerves, cutting (or any rough handling) there is extremely painful; EMLA cream commonly used to dull the pain is not fully effective and is not recommended for use on the very young. Because the removal of the foreskin involves the amputation of tissue, it is certainly surgery. And there are over a dozen references in the medical literature to complications arising from use of the plastibell device. As recently as 2007 a baby boy in Canada died as a direct consequence of a plastibell circumcision. <a href="http://www.cirp.org/library/complications/EMLA/">Details of the dangers of EMLA cream</a> <a href="http://www.cirp.org/library/death/">Further information about deaths</a> <a href="http://www.cirp.org/library/complications">Further information about complications</a> </li> </ol> <h3>Circumcision complications a public health problem</h3> In the United States, where circumcision remains common, the incidence of complications runs at near-epidemic levels and constitutes a serious public health problem in itself, as this comment from a pediatric surgeon indicates: Unfortunately, 70-80% of neonatal circumcisions are performed by obstetricians, who can neither manage their complications (2-5% incidence) nor obtain proper informed consent (defined as outlining risks and benefits of a procedure, as well as alternatives-including nothing) for neonatal circumcision. Currently, the American College of OB-GYN (ACOG) have no paramenters for training (learning and performing neonatal circumcision, managing complications) of residents, who then go out and continue this practice. In my practice, as a pediatric urologist, I manage the complications of neonatal circumcision. For example, in a two year period, I was referred 275 newborns and toddlers with complications of neonatal circumcision. None of these were “revisions” because of appearance, which I do not do. 45% required corrective surgery (minor as well as major, especially for amputative injury), whereupon some could be treated locally without surgery. Complications of this unnecessary procedure are often not reported, but of 300 pediatric urologists in this country who have practices similar to mine … well, one can do the math, to understand the scope of this problem … let alone, to understand the adverse cost-benefit aspect of complications (>$750,000) in this unfortunate group of infants and young children. Fortunately, neonatal circumcision is on the decline as parents become educated, but the complications still continue. Source: M. David Gibbons, MD, Associate Professor, Pediatric Urology, Georgetown University School of Medicine and George Washington School of Medicine. Posted at <a href="http://www.menshealth.com/">Men’s Health Magazine</a> on “The debate over circumcision: Should all males be circumcised?” in the comments section At one United States clinic, surgical operations to correct the damage done by circumcision represents 7.4 per cent of all cases seen. Source: Rafael V. Pieretti, Allan M. Goldstein and Rafael Pieretti-Vanmarcke, Late complications of newborn circumcision: A common and avoidable problem, <a href="http://www.springerlink.com/content/9w834626551u8087/">Pediatric Surgery International,</a> 26 (5), May 2010 <h3>Meatal stenosis</h3> One of the most common complications of circumcision is meatal stenosis, ulceration and narrowing of the urethral opening of the penis. This is not only painful for the boy and ugly to look at, but may inhibit urination (with potentially drastic consequences). Nearly all such conditions require a further surgical operation. There is a vast medical literature on this problem; here is the abstract of one United States study. The objective of this study was to prospectively document the incidence of meatal stenosis in boys. The study included a consecutive sample of boys whose visit with the physician included a genital examination in a private primary care pediatric practice in rural northern Wisconsin. Meatal stenosis was diagnosed in boys from 1.94 to 12.34 years of age. The diagnosis was made in 24 of 329 circumcised boys who were Tanner I development and older than 3 years of age (7.29%, 95%CI=4.48- 10.10%). Nearly all required meatotomy to resolve their symptoms. All of the boys with meatal stenosis were circumcised neonatally (exact OR=3.54, 95%CI=0.62-∞). The ratio of circumcised boys to noncircumcised boys in this study provided 80% power to demonstrate a 21.4% difference in the incidence of meatal stenosis between circumcised and noncircumcised Tanner I boys 3 years and older. Meatal stenosis may be the most common complication following neonatal circumcision. The frequency of this complication and the need for surgical correction need to be disclosed as part of the informed consent for neonatal circumcision. A careful meatal examination is indicted in any circumcised boy with abdominal or urinary complaints. Robert Van Howe, Incidence of Meatal Stenosis following Neonatal Circumcision in a Primary Care Setting, Clin Pediatr. 2006;45:49-54 <a href="http://www.circumstitions.com/Complic.html" rel="noopener" target="_blank">Further information on complications at Circumstitions</a> <a href="http://www.cirp.org/library/complications/" rel="noopener" target="_blank">Further information on complications at CIRP</a> <h3>Psychological harm and effects on sexuality</h3> In addition to immediate complications, circumcision has a wide range of harmful impacts on individual psychology (shame, resentment, anger, sometimes lading to severe psychological problems, depression and suicide), and an adverse effect on body image and sexual function. These are too numerous to cover here, but details and links to further information can be found on the <a href="https://www.circinfo.org/account.html">Injury and Harm Page</a> of this site. <a href="https://www.circinfo.org/controversy.html#sex" rel="noopener" target="_blank">See also circumcision and sexual function</a>. <h2> <a id="health" name="health"></a>Circumcision does not improve health outcomes</h2> The evidence above indicates that circumcision is a significant cause of ill-health and injury. We shall also find that there is plenty of evidence that circumcision has never contributed to improved health outcomes, neither individual nor social. <h3>USA bombs out on child health</h3> You might think, and a circumcision promoter would think, that a few deaths and mangled penises were a reasonable price to pay if widespread circumcision was producing substantially better health outcomes in the survivors. Unfortunately, a recent report by the Organisation for Economic Cooperation and Development on child health found that on many measures the United States scored so badly that it was on a par with Turkey and Mexico. The study of all thirty countries in the OECD ranked the USA 24th in overall child health and safety and 23rd in material well being. Under health and safety the OECD measured the incidence of low birth weight, infant mortality, breast-feeding, vaccination for pertussis (whooping cough) and measles, mortality in children 0-19 years and suicide. In addition, it measured the number of births to teenage girls (15-19 years). On all these indicators except suicide the USA scored very badly, and its high rate of teen births placed it right off the scale and up with Mexico and Turkey. Such figures throw serious doubt on the claim that circumcision improves child health outcomes. On the basis of these OECD figures it is clear that the countries with the lowest incidence of circumcision (northern Europe and Japan) have the healthiest children and those with the highest incidence of circumcision (Turkey and the USA) have the least healthy. <a href="https://www.circinfo.org/newsindepth.html#oecd">Further details on this site</a> <h3>Australia: Child health improves as incidence of circumcision falls</h3> In Australia, reports by the Australian Institute of Health and Welfare in 2004 and 2009 found substantial improvements in child health outcomes in the 20 years from 1983 to 2003. This was the very period during which circumcision all but disappeared, falling from around 40 percent of boys in the early 1980s to less than 10 per cent in the mid-1990s. If circumcision was as essential to health as its promoters claim, you would expect to find evidence in these surveys, but what these studies suggest is that as the incidence of circumcision has fallen, child health has improved. Advocates such as Brian Morris and circumcision practitioners such as Terry Russell have predicted epidemics of genito-urinary disease as a result of Australia’s abandonment of circumcision in the 1970s to 1990s, thus setting a test for their own claims. According to the AIHW, these epidemics have not arrived, and their claims fail by their own benchmark. Nor did such epidemics occur in Britain following the abandonment of circumcision in the 1950s, in New Zealand in the 1960s, or Canada in the 1990s. <h3>Recent study finds circumcision of zero benefit to health</h3> The preceding studies may perhaps be dismissed because they did not specifically cover the particular diseases that circumcision is supposed to prevent. But in January 2010 an article in the American journal Annals of Family Medicine, by Caryn Perera and other researchers in Adelaide, subjected the claims of the circumcision lobby to an exhaustive review, and concluded that its value for child health was close to zero. When the literature was considered as a whole (rather than cherry picked for papers supporting a particular thesis) there was no proof that circumcision of infants or boys provided any significant protection against urinary tract infections, sexually transmitted infections or cancer of the penis. There was evidence from Africa that circumcision of sexually active adult men provided some limited protection against sexually-transmitted HIV, but the authors of the paper pointed out that these results were irrelevant both to Australia and to children. Their conclusion was that “Current evidence fails to recommend widespread neonatal circumcision for these [health-related] purposes.” Source: Safety and Efficacy of Nontherapeutic Male Circumcision: A Systematic Review, by Caryn L. Perera, BA, Grad Cert EBP, Franklin H. G. Bridgewater, MBBS, FRACS, Prema Thavaneswaran, BSc (Hons), PhD and Guy J. Maddern, PhD, FRACS; Annals of Family Medicine, Volume 8, Issue 1, January/February 2010 <a href="https://www.circinfo.org/newsindepth.html#benefit">Further details on this site</a> <h3>Circumcision benefits and costs</h3> More generally, a cost utility analysis of neonatal circumcision found that even if the extreme claims of advocates were true, the associated complications and adverse outcomes would cancel out and exceed the benefit to health. Published in the US journal Medical Decision Making, the study concludes that the procedure both adds to health costs and reduces the overall health of the individual, and can therefore be justified on neither economic nor medical grounds. Abstract: A cost-utility analysis, based on published data from multiple observational studies, comparing boys circumcised at birth and those not circumcised was undertaken using the Quality of Well-being Scale, a Markov analysis, the standard reference case, and a societal perspective. Neonatal circumcision increased incremental costs by $828.42 per patient and resulted in an incremental 15.30 well-years lost per 1000 males. If neonatal circumcision was cost-free, pain-free, and had no immediate complications, it was still more costly than not circumcising. Using sensitivity analysis, it was impossible to arrange a scenario that made neonatal circumcision cost-effective. Neonatal circumcision is not good health policy, and support for it as a medical procedure cannot be justified financially or medically. Source: Van Howe RS. <a href="http://www.cirp.org/library/procedure/vanhowe2004/">A cost-utility analysis of neonatal circumcision</a>. Medical Decision Making 2004;24:584-601 <h2> <a id="sti" name="sti"></a>Circumcision and sexually transmitted infections</h2> When the circumcision promoters speak about the necessity for circumcision as a public health measure, they generally cite the high incidence of sexually transmitted infections (STIs), and follow this up with claim that circumcision greatly reduces the risk of such infections. It may be true that the incidence of common STIs is increasing in Australia, but the most likely cause of this is increasing promiscuity among young people and the falling age at which sexual activity begins. There is no proof that it has anything to do with the presence or absence of the foreskin, or indeed of analogous structures in the female genitalia. The evidence in medical journals as to whether the presence or absence of the foreskin makes any difference to the outcome is contradictory and inconclusive; every study which claims to find a correlation has been criticised as flawed or countered by other studies that find no connection at all. Some studies find that circumcised men are more vulnerable to some STIs. Dickson et al 2008 “These findings are consistent with recent population-based cross-sectional studies in developed countries, which found that early childhood circumcision does not markedly reduce the risk of the common STIs in the general population in such countries.” Source: Dickson NP, Van Rood T, Herbison P, Paul C., Circumcision and risk of sexually transmitted infections in a birth cohort. J Pediatr 2008;152: 383-7. National Health and Lifestyle Survey, USA, 1992 (N=1511) “We find no significant differences between circumcised and uncircumcised men in their likelihood of contracting sexually transmitted diseases.” Source: Laumann, EO, Masi CM, Zuckerman EW. Circumcision in the United States. Journal of the American Medical Association 1997;277(13): 1052-7. British National Survey of Sexual Attitudes and Lifestyles, Britain, 2000 (N=4762) “We did not find any significant differences in the proportion of circumcised and uncircumcised British men reporting ever being diagnosed with any STI … We also found no significant associations between circumcision and being diagnosed with any one of the seven specific STIs.” Source: Johnson AM, Mercer CH, Evans B. et al. Sexual behaviour in Britain: Partnerships, practices, and HIV risk behaviours. Lancet 2001;358(9296): 1835-42; and Dave SS, Johnson AM, Fenton KA, et al. Male circumcision in Britain: Findings from a national probability sample survey. Sex Trans Infect 2003;79: 499-500. Australian Study of Health and Relationships, Australia, 2001-2002 (N=10,173) “No significant protective effect of circumcision is discernible for genital warts, chlamydia, genital herpes, gonorrhoea, non-specific urethritis or pubic lice.” [4] Source: Richters J, Smith AMA, de Visser RO, et al. Circumcision in Australia: Prevalence and effects on public health. Int J STD AIDS 2006;17: 547-54. <a href="https://www.circinfo.org/sti.html" rel="noopener" target="_blank">Further details, with links to articles, on STI page of this site</a> Circumcision increases risk of urethritis Most recently, another Australian study of almost 4300 men carried out by researchers from La Trobe University, Victoria, and the University of NSW has found that circumcision does not reduce the risk of contracting most sexually transmitted infections (STI), but significantly increases the risk of non-specific urethritis (the clap) and slightly reduces the risk of penile candidiasis (an easily cured fungal infection). The observed incidences of HIV and syphilis were so low that it was not possible to conclude that circumcision had any protective against these STIs. The authors of the study, published in the Australian and New Zealand Journal of Public Health, comment that findings from an earlier Australian survey showing slightly higher rates of sexual performance difficulties among older uncircumcised men had been used to support the procedure. It had previously been thought that uncircumcised men found greater difficulty maintaining an erection and were more likely to experience pain during intercourse. The new study found that on these measures there was no difference between circumcised and uncircumcised men in the over-50s age group. The conclusion of the study is that that “circumcision appears to have minimal protective effects on sexual health in the Australian context.” Source: Jason A. Ferris, Juliet Richters, Marian K. Pitts, Julia M. Shelley, Judy M. Simpson, Richard Ryall, and Anthony M. A. Smith. Circumcision in Australia: Further evidence on its effects on sexual health and wellbeing. Australian and New Zealand Journal of Public Health, Vol. 34 (2), April 2010, 160-64 <a href="https://www.circinfo.org/newsindepth.html#nsu" rel="noopener" target="_blank">Further details on this site</a> <h3>Fear of venereal disease always used to generate panic responses</h3> Despite this avalanche of evidence, history seems to be repeating itself. Prevention of STIs has been one of the main selling points for circumcision of male infants and boys since the late nineteenth century and today. Based almost entirely on the dubious evidence of a single publication by the English syphilis expert authority Jonathan Hutchinson in the 1850s, Anglo-American doctors became convinced that circumcision would infallibly protect men from syphilis (the AIDS of that era). Beginning in the late nineteenth century, millions of baby boys in Britain, the USA and Australia were circumcised in the hope that it would overcome the health crisis then thought to be threatening the nation. As it turned out, circumcision had no impact on the incidence of syphilis at all, the prevalence of which was reduced by screening, early treatment, safe sex (especially condoms), and finally defeated when penicillin was introduced in the 1940s. The most important early measure in controlling syphilis was not medical at all but social: reducing the stigma attached to the disease so that people were no longer afraid to seek treatment. Babies and children cannot catch venereal disease Even if circumcision did confer significant protection against venereal disease, it would be a shameful waste of health resources, not to say grossly unethical, to circumcise babies for this reason. STIs are a problem faced by sexually active adults – and more particularly by sexually adventurous adults who pick up numerous partners and fail to practise safe sex. Anybody can catch an STI if they engage in risky sexual behaviour; nobody need get them if they play it safe. Infants and children are not at risk of STIs, because they do not engage in the kinds of sexual activity that expose them to infection. STIs are an adult problem, and if an adult male prefers to get himself circumcised instead of wearing a condom, that is his privilege. He is not entitled to impose that choice on an innocent and not-at-risk child. It is even hard to see why circumcision would be a rational step for a sexually promiscuous adult. Nearly all STIs (with the obvious exception of AIDS) can be quickly cured with antibiotics, and the few that cannot (such as genital herpes) are mild in effect and can be kept under control by other drugs. Chlamydia, for example, can be cured with a single pill, and even a serious disease such as syphilis is still eliminated from the body by a course of penicillin. An adult may choose to get himself circumcised instead if he thinks that would be more effective, but it would be an irresponsible diversion of health resources, as well as grossly unethical, to impose that choice on sexually inactive children. <h2> <a id="hiv" name="hiv"></a>Circumcision and HIV-AIDS</h2> As the study by Perera et al observed, the only evidence for circumcision having any prophylactic efficacy came from Africa, where there was some evidence that adult males who got circumcised had a slightly lower risk of contracting HIV through unprotected intercourse with an infected female partner. And we are speaking of a “slightly lower risk” because a risk reduction of between 50 and 60 per cent cannot be considered impressive, particularly when compared with the 90 to 95 per cent protection offered by a condom, and the even greater assurance that would be provided by a vaccine, when that happy day arrives. Even in Africa the recommendations of the World Health Organisation have been contested, and its gung-ho approach to what it calls the circumcision roll-out has been attacked by the South African Medical Journal as costly, ineffective, a violation of accepted principles of bioethics and human rights, culturally insensitive and smacking of medical colonialism. [1] It has also been criticized by child health and human rights experts as neither medically necessary nor ethically permissible. [2] To cite the African data as an argument for circumcision of male infants and boys in Australia would be irresponsible and inappropriate. As the authors of the paper also point out, there is no evidence that circumcision of infants or boys (neonatal circumcision) has any effect in reducing susceptibility to HIV infection in adulthood (though this point is usually taken for granted by circumcision promoters), and there is evidence that in developed AIDS is more prevalent among the circumcised: see HIV-AIDS page for details. Africa has unique health problems. The circumcision trials were on adult men and can no more be extrapolated to children than the World Health Organisation recommendations for the underdeveloped world can be transferred to a developed country like Australia, where there is a low (even negligible) incidence of female to male transmission. In Australia, unlike Africa, AIDS is not a heterosexual epidemic, but a relatively rare disease confined to specific sub-cultures. In any case, because it is a disease of promiscuous adults, children are not at any risk of infection – unless, of course, by surgery. When they become sexually active boys are old enough to understand the issues and make their own decisions about how to manage the risks of sexual activity with others. The Australian Federation of AIDS Organisations has stated clearly that circumcision has no relevance to Australia’s AIDS problem. On top of all this, although wild claims were made for the protective effect of circumcision following a few clinical trials (none of which were randomised in the correct manner, and all of which were terminated prematurely), there is so far no evidence that the widespread circumcision in Africa now being funded thanks to Mr Bush and Bill Gates is having any effect in reducing the incidence of HIV. On the contrary, wherever you look (United States, Africa, Malaysia), AIDS infections seems to be soaring among circumcised populations. <a href="https://www.circinfo.org/hiv.html" rel="noopener" target="_blank">Further information about HIV-AIDS on this site</a> <a href="https://www.circinfo.org/africa.html" rel="noopener" target="_blank">Further information about AIDS in Africa on the Africa page</a> <a href="https://www.circinfo.org/AIDSnews.html">AIDS infections soar among circumcised populations</a> <a href="http://www.circumstitions.com/HIV-SA.html" rel="noopener" target="_blank">Doubts emerging about African circumcision trials</a> So let’s have no more of this ridiculous pretence that AIDS in Australia represents some catastrophic health crisis to which a drastic measure such as universal circumcision is the only answer. Such ten-minutes-to-midnight alarmism is nothing more than irresponsible scaremongering. The evidence in developed countries such as Australia is overwhelmingly that circumcision is harmful to the individuals and an unnecessary burden on health and medical resources. The less circumcision there is, the healthier (and happier) we will all be. HIV references 1. D. Sidler, J. Smith, H. Rode, “Neonatal circumcision does not reduce HIV/AIDS infection rates”; A. and J. Myers, “Editorial: Rolling out male circumcision as a mass HIV/AIDS intervention seems neither justified nor practicable”, both in South African Medical Journal, Vol. 98, No. 10, October 2008. <a href="http://www.cirp.org/library/disease/HIV/">Both available at CIRP</a> 2. Robert Van Howe and J. Steven Svoboda, Neonatal circumcision is neither medically necessary nor ethically permissible: A reply to Clark et al, Medical Science Monitor, Vol. 14, 2008: <a href="https://www.circinfo.org/vanhowe1.html">available on this site</a>. </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource The "public health" case for circumcision darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h1>Circumcision is not primarily a medical question:</h1> <h2>Circumcision debate must be reframed as a human rights issue</h2> For many years the so-called “circumcision decision” was framed as a simple medical question: did the claimed “health benefits” outweigh the risk of complications – the old pros and cons calculus. Since any surgery in hygienic modern conditions has a pretty low complication rate, when the question was framed in such limited terms, it was not hard for the circumcision advocates to win the toss. Even in its own terms, however, this equation was inadequate, as it failed to take account of the value of the foreskin as a functional body part, the loss of which might be a physical harm even without complications. The risk/benefit trade-off was devised for therapeutic procedures, where there was a pathological condition that required treatment – e.g. a gangrenous finger, that might have to be amputated to prevent the infection spreading to the rest of the body; it was not relevant to non-therapeutic procedures on normal, healthy body parts. Even if it were a simple risk/benefit equation, it is not clear that the decision had to be taken by adults on behalf of infants and children, and not by the actual owner of the foreskin: why shouldn’t he be the one to decide whether the benefits outweighed the risks? Although this medical discourse still dominates debates over whether non-therapeutic circumcision should be performed on non-consenting minors, it is no longer the only discourse. Ignoring the troglodytes in the American Academy of Pediatrics, who are still framing the question as a simplistic risk/benefit calculation, there are increasing calls from human rights, legal, bioethical and child health experts for the debate to reframed as a human rights issue. This perspective underpins policy statements on circumcision issued by the <a href="https://www.circinfo.org/doctors.html#bma">British Medical Association</a>, the <a href="https://www.circinfo.org/Dutch_circumcision_policy.html">Royal Dutch Medical Association</a> and, with rather less conviction, the <a href="https://www.circinfo.org/doctors.html#current">Royal Australasian College of Physicians</a>, and it has been given a powerful boost by the <a href="https://www.circinfo.org/Circumcision_and_law.html">decision of an appeal court</a> in Cologne, Germany, that medically unnecessary circumcision of a minor is unlawful because it constitutes bodily harm and violates his right to bodily integrity. Hot on the heels of this development is a comprehensive report on the legal status of circumcision by the <a href="https://www.circinfo.org/Tasmania_law_reform.html">Tasmania Law Reform Institute</a>, which recommends that the practice be legally prohibited in most instances (with exceptions for recognized religious and ethnic sub-cultures) and strictly regulated. As Dr Robert Darby argued in <a href="http://www.openforum.com.au/content/should-circumcision-be-illegal">a post at Open Forum</a>, “the judgement of a district court in Cologne – that medically unnecessary circumcision of a four year old boy constituted bodily harm and was thus unlawful – has revolutionised the debate about male genital cutting and brought to a head the controversy that has been simmering since the passage of the United Nations Convention on the Rights of the Child (1989). The argument is no longer about whether boys should be circumcised for so-called “health reasons”, but whether any non-therapeutic circumcision (NTC) of minors should be permitted.” It is symptomatic of the limited reach of the medical discourse, and the tunnel vision of its spokesmen, that the <a href="http://www1.umn.edu/humanrts/instree/k2crc.htm">Convention on the Rights of the Child</a> has hardly figured in recent media debates on circumcision, despite the media’s claim to be presenting a “balanced view”. (“Balance” in the case of a recent SBS program meant a panel stacked with 4 pro-circumcision speakers vs 1 against, and an audience that continually heckled the latter.) Article 24 (3) of the convention states clearly: “States Parties shall take all effective and appropriate measures with a view to abolishing traditional practices prejudicial to the health of children.” Although this clause refers to children and is not gender-specific it has usually been interpreted as applying only to female circumcision, not to male, despite the fact that Article 2 of the convention states that signatories shall respect: “the rights set forth in the present Convention to each child within their jurisdiction without discrimination of any kind, irrespective of the child’s or his or her parent’s or legal guardian’s race, colour, sex, language, religion, political or other opinion, national, ethnic or social origin, property, disability, birth or other status.” In other words, according to the Convention on the Rights of the Child, all children, male and female, have the right to be protected from genital cutting. The backwardness of the media contrasts with the vigour of the human rights debate in independent forums and personal blogs: <h2>Difficulties facing circumcision critics</h2> Charli Carpenter attends a conference on genital integrity in Helsinki and considers why circumcision critics have had such difficulty convincing the “official” human rights bodies that circumcision of male minors is an issue with which they should be concerned. She notes although they have sought to shift the discussion away from “questions of health or gender equity and toward the tension between children’s bodily integrity rights and the rights of parents to religious freedom”, they have been at a disadvantage in the first two of these debates: While there is no scientific consensus on the benefits and risks of infant circumcision (as indicated by the American Academy of Pediatrics’ report accompanying its recently revised policy statement on the issue), the absence of a consensus against circumcision for health reasons has made it easy for the mainstream human rights movement to avoid speaking out on the issue, particularly since the reconceptualization of circumcision as a preventive health measure by the World Health Organization. In political terms the “burden of proof” is on the intactivist movement rather than on the medical establishment so long as the issue is framed around questions of medical necessity or benefit, and frankly the movement is outmatched by the mainstream medical establishment in resources, professional access, and … “expert authority.” <a href="http://duckofminerva.blogspot.co.nz/2012/10/human-rights-activism-on-cutting-edge.html" rel="noopener" target="_blank">Read the full discussion at Duck of Minerva</a> <h2>Circumcision: His body, his choice</h2> In Holland, Gert van Dijk, bioethics adviser with the Royal Dutch Medical Association, argues that because circumcision infringes a child’s right to physical integrity and his own religious freedom, a powerful policy of deterrence should be established. <a href="http://www.theeuropean-magazine.com/819-van-dijk-gert/820-medical-and-ethical-arguments-against-male-circumcision" rel="noopener" target="_blank">Read the full article in The European Magazine</a> <h2>If children lack rights, adults don’t have them either</h2> In Australia, Robert Darby replies to the argument of self-styled libertarian Brendan O’Neill that the state should not intervene between parents and their children, and hence that parents are entitled to decide whether their children should be circumcised. He argues that this position is inconsistent with both liberal and libertarian principles for the simple reason that if children lack rights, adults don’t have them either. Much as one hesitates to extend the reach of the state, the fact remains that no other force has the power or authority to protect children from abuse within the family. Children are both powerless and voiceless; it is no business of the state to enforce morality through legal sanctions, but even libertarian philosophers agree that the state has a legitimate interest in preventing people from harming other people. If the state is not allowed to intervene to restrain parents from harming their children, who or what else is going to undertake the responsibility? <a href="http://www.onlineopinion.com.au/view.asp?article=14158" rel="noopener" target="_blank">Read the full article at Online Opinion</a> <h2>Passivity of the United Nations challenged</h2> The United Nations has been extremely reluctant to even discuss circumcision of male minors as a human rights issue. When Sami Aldeeb was researching male and female circumcision for a major scholarly study and sought information from the human rights section, <a href="https://www.circinfo.org/Aldeeb_UnitedNations.html">he was told to get lost</a> as soon as they realised he was critical of male circumcision. Such wilful blindness and blatant discrimination has been challenged by the International Humanist and Ethical Union, which has recently presented papers to the United Nations Human Rights Council naming non-therapeutic circumcision as a human rights issue that requires the council’s attention. As <a href="http://circumstitionsnews.blogspot.co.nz/">Circumstitions News</a> reports: At the session of September 17, IHEU representative Josephine Mackintosh told the Council: The recent German [Cologne district] court ruling outlawing non-therapeutic infant male circumcision correctly places the welfare, and the “fundamental rights and freedoms” of vulnerable children above the unrestrained expression of adult beliefs. The court correctly determined that: non-therapeutic cutting of a child’s body is an assault; that children are unable to give informed consent; that surrogate parental consent is not valid for an operation with no clinical indication and with the potential to cause serious harm; and that children have a right to be protected from bodily harm. Such determinations cannot legitimately be overridden by adults convinced that children might be harmed by denying them this forced, irreversible surgery to their most intimate body parts. When the children become adult they can freely decide whether or not to undergo the procedure. We understand, and have some sympathy with the sensitivities of certain religious groups which may feel threatened or even attacked by the judgment, particularly in the light of recent history. But it would be wrong to describe this judgment as religious persecution, or anti-Semitic; some Jewish voices are calling for an end to the practice and there is even an association called Jews Against Circumcision. Powerful groups must not be permitted to impose their views on the vulnerable on ideological or theological grounds in contravention of international law. The Royal Dutch Medical Association and seven other Dutch scientific associations concluded in 2010 that the procedure can be harmful and that it violates the boy’s human rights to autonomy and physical integrity. The German judgment is therefore both laudable and overdue. Reflecting as it does States’ obligations under the ICCPR, it should be followed by all member states. Source: <a href="http://circumstitionsnews.blogspot.co.nz/2012/09/united-nations-humanists-put.html">Humanists put circumcision ethics on UN agenda</a>, Circumcision News, 17 September 2012 <h2>Bodily integrity is a human right</h2> Writing in The Conversation, two human rights experts argue that even if the old arguments about health benefits were valid (which they are not), it would still not be permissible to perform amputative surgery on a non-consenting minor because such an action would be a blatant violation of his human rights. As they point out, “Circumcision without consent or any immediate medical necessity on a healthy adult male would clearly be in breach of his human rights. So how is infant male circumcision without consent any different?” Circumcision promoters refer monotonously to the right of parents to choose medical procedures for their children, forgetting that this right is confined to beneficial and recommended treatments that are unquestionably in the child’s best interests. Unnecessary surgical amputations, especially those on a boy’s best friend, are not in this category. Claire Mahon and Alexandra Phelan, <a href="http://theconversation.edu.au/infant-male-circumcision-stop-violating-boys-human-rights-8517">Infant male circumcision: stop violating boys' human rights</a>, The Conversation, 9 August 2012 <h2>If female circumcision violates the human rights of girls and women ...</h2> ... it follows logically that male circumcision must violate the human rights of boys. If girls have a human right to genital integrity, it follows that boys must also enjoy that right. A human right is a right that applies to all humans, regardless of gender or age, simply by virtue of their humanity; it has nothing to do with the culture of their parents. Despite this, the policy statement on female genital mutilation released by the Royal Australasian College of Physicians takes a far stronger line in defence of female bodies than its policy on male circumcision. For the RACP’s position to be logically consistent there are only two possibilities here: either a girl’s right not to have any part of her genitals injured by FGM is a not a human right at all, but gender-specific right, applicable only to females; or boys are not human. Neither possibility seems very likely, and the shabby truth appears simply to be that the RACP is in the grip of the usual sexist double standard on genital mutilation, whereby the slightest nick to the female genitals is an outrage that must be abhorred and opposed, while the most ruthless and brutal circumcision of a boy is a harmless snip that must be allowed and may be applauded. <a href="https://www.circinfo.org/Female_genital_mutilation.html" rel="noopener" target="_blank">Double standards and discrimination in the RACP's policy on female genital mutilation</a> <h2>Circumcision debate is about human rights, not health</h2> In an article at The Conversation, Brian Earp and Robert Darby argue that the debate about routine (non-therapeutic) circumcision of minors not about health, but about bioethics and human rights. While United States authorities are trying to turn the clock back by limiting their analysis to the pro-circumcision medical literature, the rest of he world has moved on. The issue is not whether the risk of complications outweighs the claim of future benefits, but whether any medically unnecessary circumcision of a minor is ethically permissible and indeed legal. Brian Earp and Robert Darby, <a href="http://theconversation.edu.au/tradition-vs-individual-rights-the-current-debate-on-circumcision-10199">Tradition vs individual rights: the current debate on circumcision</a>, The Conversation, 2 November 2012 <h2>German-Turkish Green MP defends Cologne circumcision judgement and criticises politicians for caving in to religious pressure</h2> An op-ed in support of the Cologne judgement in the Frankfurter Allgemeine Zeitung was written by Memet Kilic, Green member of the German parliament. Despite his Turkish-Muslim background, he supports the Cologne judgement that non-therapeutic circumcision of a non-consenting minor is unlawful under German law, and criticise the Merkel government for steam-rolling a bill to make circumcision of children legal whenever desired by their parents. He points out that the bill privileges certain religious groups by allowing them to have circumcisions performed without anaesthetic or the presence of a medical practitioner - conditions otherwise mandated under health regulations. As he argues, in a secular state laws that apply to everybody; they should not, therefore, be written to suit the requirements of particular sub-cultures. <a href="https://www.circinfo.org/Memet_Kilic_op-ed_FAZ.html">English translation of "Freedom is more important that tradition", on this site</a> <h2> <a id="crin" name="crin"></a>Children's Rights Organisation calls circumcision a human rights violation</h2> A report by the International NGO Council on Violence against Children on harmful traditional practices has turned the spotlight on male circumcision and argues that non-therapeutic (medically unnecessary) circumcision of male minors constitutes a serious human rights violation. The organisation has not previously discussed circumcision of boys, but in its latest report (October 2012) it states that “a children’s rights analysis suggests that non-consensual, non-therapeutic circumcision of boys, whatever the circumstances, constitutes a gross violation of their rights, including the right to physical integrity, to freedom of thought and religion and to protection from physical and mental violence.” The relevant paragraphs are reproduced below. Male circumcision Male circumcision has been largely neglected in mainstream debates on harmful practices because of its strong religious connections, particularly with Judaism and Islam, and its general acceptance in many societies. ... Until recently, male circumcision has generally been challenged only when carried out by non-medical personal in unhygienic settings without pain relief. But a children’s rights analysis suggests that non-consensual, non-therapeutic circumcision of boys, whatever the circumstances, constitutes a gross violation of their rights, including the right to physical integrity, to freedom of thought and religion and to protection from physical and mental violence. When extreme complications arise, it may violate the right to life. It is reported that male circumcision can result in numerous physical, psychological, and sexual health problems during the surgery, afterwards, and throughout adulthood, including haemorrhage, panic attacks, erectile dysfunction, infection (in severe forms leading to partial or complete loss of the penis), urinary infections, necrosis, permanent injury or loss of the glans, excessive penile skin loss, external deformity, and in some cases even death. There are now substantial established campaigns against non-therapeutic, non-consensual circumcision of boys and growing support to end it, particularly within the medical community. For example, the Royal Dutch Medical Association (KNMG) has publicly taken a children’s rights position that: “children must not be subjected to medical proceedings that have no therapeutic or preventative value.” In addition, in 2011 the then Ombudsman for Children in Norway advocated that boys should not be circumcised for non-therapeutic reasons until they are old enough to give their informed consent and that parents should not be able to consent on behalf of their children. Most recently, in 2012 a German court ruled that male circumcision constitutes a violation of physical integrity as a child is “permanently and irreparably changed by the circumcision” and that the practice is also in conflict with the child’s right to religious freedom. The WHO review quoted three randomized controlled trials suggesting that circumcision reduces the risk of acquiring HIV infection in males. But this potential health benefit does not override a child’s right to give [i.e. to withhold] informed consent to the practice. The decision to undertake circumcision for these reasons can be deferred to a time where the risk is relevant and the child is old enough to choose and consent for himself. Source: Council on Violence against Children, <a href="http://www.crin.org/violence/search/closeup.asp?infoID=29619">Violating children’s rights: Harmful practices based on tradition, culture, religion or superstition</a>, pp 21-22 The <a href="http://www.crin.org/">Children’s Rights International Network</a> is an international non-government organisation that urges rights (rather than charity) for children. <h2> <a id="oluchi" name="oluchi"></a>Protecting boys from circumcision:</h2> <h3>Canadian law expert urges dialogue and legal reform</h3> Boys should be protected from circumcision and other permanent genital alterations until they are old enough decide the matter for themselves. This is the argument of Canadian legal expert Aniaka Oluchi, who suggests that legal reform and stricter regulation of circumcision is needed to secure the best interests of the child. Although the most obvious way for the law to proceed with enforcing circumcision prohibitions is through criminal prosecution under existing provisions of the Criminal Code which prohibit aggravated assault and conspiracy to assault, legal measures alone will probably not suffice to eliminate infant male circumcision, unless there is a desire for change on the part of those who undertake the practice and pressure from public opinion. Accordingly, Oluchi argues that the most fruitful way ahead is through respectful dialogue with leaders of circumcising communities and civil actions by those injured by circumcision against those responsible. Because there are no valid medical indications for routine circumcision in infancy or childhood, and parents cannot consent to a unnecessary medical operations that are not in a child’s best interests, any consent they give for circumcision is invalid in law, and the operator is committing an assault. He can therefore be sued for battery. Abstract: It has been suggested that where circumcision is carried out for religious reasons as opposed to cultural, traditional and other reasons, it is not, and should not be unlawful. Viewed from the point of view of the child, it is argued, first, that circumcision has lost its religious significance and that it is sustained only by habit. Second, assuming that there is still some genuinely held religious belief behind the practice, such belief cannot and should not be used to legitimate what may otherwise be a crime. However, the challenge posed by the amorphous concept of the best interests of the child which may, after all, not be met by a legal prohibition of, or prosecution for infant circumcision is acknowledged. Nevertheless, several approaches exist which the law might adopt to protect the best interests of the child. Ultimately, the paper concludes that a child is better left to decide himself, upon attaining maturity, if he wants to be genitally altered, a conclusion which accords with a growing position in the literature. Source: Aniaka Oluchi, In the Best Interest of the Child: Should Exception be Made for Infant Male Circumcision on Religious Grounds? <a href="http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2240101">Available at Social Science Research Network</a> <h2>Medical, ethical and legal aspects of circumcision in Australia</h2> <h3>Robert Darby’s submission to Tasmania Law Reform Institute Inquiry into male circumcision</h3> Oluchi’s suggestion that the civil law should play a greater role in protecting boys from circumcision is supported by Dr Robert Darby, who argues in his submission to the Tasmania Law Reform Institute inquiry into male circumcision that the laws should be reformed to make it easier for men who believe they have been harmed by circumcision to sue those responsible and recover damages. This would involve extending the period in which a victim of circumcision is allowed to initiate a court action, and requiring him only to prove harm and not (as at present) also negligence on the part of the operator as well. Abstract: Circumcision of minors, unless necessary to cure an injury, deformity or disease that cannot be treated in any other way, is already (technically) illegal under both the common law and numerous specific provisions of Tasmanian laws covering assault, injury, wounding, mistreatment etc. Since social custom (as the Queensland Law Reform Commission observed in 1993) tolerates and to some extent approves of the practice, however, we do not see prosecutions being launched, and there have been very few civil suits for damages. That being the case it is difficult to imagine that the government would ever contemplate legislation even half as strong as the sections of the criminal code prohibiting female genital mutilation, or at least not until circumcision of males is generally regarded with a similar degree of revulsion. It follows that the most promising way to protect boys from unnecessary and unwanted surgery is by tighter regulation of circumcision, public education and legal reform. These would take the form of (1) much stricter regulation of the procedure by the medical professional and regulatory bodies, backed up by specific legislation if necessary; (2) public education to counteract the scaremongering of alarmist circumcision promoters and opportunistic medical practitioners; and (3) making it easier (by reforms to legislation covering limitations and torts) for aggrieved men who feel harmed by circumcision in infancy or childhood to sue those responsible. Source: Robert Darby, Medical, Ethical and Legal Aspects of Routine Circumcision: Submission to the Tasmania Law Reform Institute Inquiry into Non-Therapeutic Male Circumcision. <a href="http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2276538">Available at the Social Science Research Network</a> <a href="https://www.circinfo.org/Tasmania_law_reform.html">Further information about the TLRI inquiry into male circumcision</a> <h2> <a id="advance" name="advance"></a>As human rights advance … circumcision advocates have nowhere left to hide</h2> The terms of the debate about non-therapeutic circumcision of minors have changed. The issue is no longer whether the so-called “benefits” outweigh the risks, or even whether the benefits outweigh the risks and harms. (As for the troglodytes who still mutter about pros and cons …) Coming on top of the <a href="https://theconversation.com/tradition-vs-individual-rights-the-current-debate-on-circumcision-10199" rel="noopener" target="_blank">judgement of a German court</a> that circumcision is bodily harm and that it violates the child’s right to religious freedom, a leading legal philosopher now argues that boys have an inherent right not to be circumcised without medical need. In a paper forthcoming in Health Matrix, Stephen Munzer argues that current norms of autonomy and bodily integrity give male minors “a moral, anticipatory right-in-trust not to be circumcised without a medical indication.” Even more remarkably, it is now conceded by a prominent defender of religious/cultural circumcision that the practise is harmful and does violate the rights of the child. Writing in the Journal of Applied Philosophy, Joseph Mazor acknowledges the physical and moral harms of circumcision and admits that the child has “a right of moderate strength” not to be subjected to “presumably harmful circumcision”. Both Munzer and Mazor go on to argue that, given the importance of circumcision within the cultural/religious communities that follow this tradition, the practice should not be criminalised. This is a fair point, far less important than the vital concession that circumcision is harmful and does violate the rights of the child to bodily integrity, personal autonomy and <a href="https://www.circinfo.org/ethics.html#recent" rel="noopener" target="_blank">an open future</a>. If it is now admitted that NTC is harmful and does violate the rights of the child, there can be no justification for medical authorities recommending the practice or “routinely” performing it on demand, or even sitting awkwardly on the fence; or for government agencies to encourage it (e.g. through health insurance coverage etc); and there is a strong argument for appropriate agencies to take measures to discourage it by removing incentives and imposing disincentives – in the same way as government programs have sought to discourage harmful practices such as smoking tobacco, without actually making it illegal. However these details are resolved, the debate now is not about whether or not circumcision should be performed, but about the best and most effective means of <a href="http://euromind.global/en/brian-d-earp-and-rebecca-steinfeld/?lang=en" rel="noopener" target="_blank">discouraging the practice</a>. In the background is a further question: whether non-therapeutic circumcision of minors is or should be illegal. <h3>Boys have a “moral right” not to be circumcised</h3> A straw – or perhaps a haystack – in the wind is a recent paper by legal philosopher Stephen Munzer giving detailed consideration to the question of whether male minors have a moral right not to be circumcised without medical need, and concludes that they do. Male minors, he argues, have “a moral anticipatory right-in-trust not to be circumcised without a medical indication.” The basis for this position rests on four key factors: (1) the permanent loss of functional tissue; (2) the “salience” of the penis in physical, psychological and cultural terms; (3) the limits on parental rights to modify their children’s bodies; and (4) the principle of gender equity. Although Munzer does not endorse criminalisation (taking account of the importance of circumcision to the cultures that practise it as a religious or cultural rite) he reaches the firm conclusion that it is morally wrong and that boys have the same right to genital integrity as currently enjoyed by girls. And if they do have such a right, society must eventually acknowledge its obligation to take action to translate that principle into practical reality. Abstract This Article argues that male minors have a moral anticipatory right-in-trust not to be circumcised without a medical indication. Based on norms of autonomy and bodily integrity, this Article’s treatment of children’s rights, parental rights, religious freedom, and tolerance offers arguments accessible to readers of many ethical, political, and intellectual persuasions. Three direct arguments rest on (1) the loss of non-renewable functional tissue, (2) genital salience, and (3) limits on a parental right to permanently modify their sons’ bodies. This Article also compares circumcision to a rare form of female genital cutting; the comparison contains the seed of an argument sounding in (4) gender equality. In current circumstances, however, it is unwarranted to treat nontherapeutic circumcision as a crime or subject it to burdens under tort, family, or administrative law. Stephen Munzer. Examining nontherapeutic circumcision. Health Matrix 28 (1) 2018: 1-77 (in press). <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3180209" rel="noopener" target="_blank">Full text at SSRN</a>. <h3>Mazor’s qualified defence of religiously motivated circumcision</h3> Abstract This article considers the question of how much weight the infringement of children's right to bodily integrity should be given compared with competing considerations. It utilises the example of circumcision to explore this question, taking as given this practice's opponents’ view of circumcision’s harmfulness. The article argues that the child’s claim against being subjected to (presumably harmful) circumcision is neither a mere interest nor a right so strong that it trumps all competing interests. Instead, it is a right of moderate strength. Indeed, even the aggregate strength of children’s rights against the practice of (presumably harmful) circumcision as a whole is not so weighty so as to always trump competing interests. The harms are not sufficiently serious to justify such a status. And the expressive wrongs associated with non‐negligently benevolent harming are much less serious than those associated with intentional harming. The debate over banning circumcision thus cannot be conducted only in terms of competing rights. Competing interests, such as those that would be set back by the departure of religious citizens, should be considered as well and might plausibly justify allowing even a rights-infringing practice to continue. Joseph Mazor. <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/japp.12275" rel="noopener" target="_blank">On the Strength of Children’s Right to Bodily Integrity: The Case of Circumcision</a>. Journal of Applied Philosophy, on-line first, 24 May 2018. There will be continuing argument over how harmful these harms are; but once the reality of harm is conceded, there can be no going back to tired old clichés such as pros and cons or benefits and risks. It may be while before troglodytes such as the American Academy of Pediatrics catch up (let alone Prof Morris), but once it is agreed (as Mazor concedes and Munzer argues) that NTC of minors is morally wrong, it places pressure on government, the medical profession, regulatory agencies, bioethical watchdogs etc to take some sort of action to discourage it, and certainly to ensure that nothing is done to promote it. We are really entering new territory. </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource The circumcision decision: a legal or a human rights question darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <ol> <li>William E. Brigman, <a href="http://www.cirp.org/library/legal/brigman/">Circumcision as child abuse: The legal and constitutional issues</a>, Journal of Family Law, Vol. 23, 1985</li> <li>David Richards. <a href="http://www.cirp.org/library/legal/richards/">Male Circumcision: Medical or Ritual?</a> 3 J Law Medicine 371 (1996).</li> <li>Christopher Price, <a href="http://www.cirp.org/library/legal/price/">Male Circumcision: an ethical and legal affront</a>, Bulletin of Medical Ethics, No. 128, May 1997: 13-19</li> <li>Abbie J. Chessler, <a href="http://www.cirp.org/library/legal/chessler/">Justifying the Unjustifiable: Rite v. Wrong</a>, 45 Buffalo L. Rev. 555 (1997)</li> <li>Elizabeth Zechenter, In the name of culture: Cultural relativism and the abuse of the individual. Journal of Anthropological Research 53 (3), 1997: 319-347 (Special issue on universal human rights versus cultural relativity).</li> <li>Jacqueline Smith, <a href="http://www.cirp.org/library/legal/smith/">Male Circumcision and the Rights of the Child</a>, in Mielle Bulterman, Aart Hendriks and Jacqueline Smith (eds.). To Baehr in Our Minds: Essays in Human Rights from the Heart of the Netherlands. Utrecht: Netherlands Institute of Human Rights, 1998 (SIM Special No. 21): 465-498</li> <li>Ross Povenmire, <a href="http://www.cirp.org/library/legal/povenmire/">Do parents have the legal authority to consent to the surgical amputation of normal, healthy tissue from their infant children? The practice of circumcision in the United States</a>, Journal of Gender, Social Policy & the Law, Vols. 8-7, 1998-1999</li> <li>Van Howe RS, Svoboda JS, Dwyer JG, Price CP. <a href="http://www.cirp.org/library/legal/vanhowe5/">Circumcision: the legal issues</a>. BJU Int 1999; 83, Suppl 1:63-73.</li> <li>Gregory J. Boyle, J. Steven Svoboda, Christopher P. Price, J. Neville Turner, <a href="http://www.cirp.org/library/legal/boyle1/">Circumcision of healthy boys: Criminal assault?</a> Journal of Law and Medicine, Vol. 7, 2000</li> <li>Arif Bhimji, <a href="http://www.courtchallenge.com/papers/court1.html">Infant male circumcision: A violation of the Canadian charter of rights and freedoms</a>, Health Care Law (Toronto) 2000, January 1:1-33</li> <li>J. Steven Svoboda, Robert Van Howe and James Dwyer, <a href="http://www.cirp.org/library/legal/conundrum/">Informed consent for neonatal circumcision: An ethical and legal conundrum</a>, Journal of Contemporary Health Law and Policy, Vol. 17, 2000, 61-133</li> <li>Margaret Somerville, <a href="http://www.intact.ca/canary.htm">Altering baby boys’ bodies: The ethics of infant male circumcision</a>, in The Ethical Canary: Science, Society and the Human Spirit (Toronto: Viking, 2000)</li> <li>Christine Mason, <a href="http://www.cirp.org/library/legal/mason1/">Exorcising excision: Medico-legal issues arising from male and female genital surgery in Australia</a>, Journal of Law and Medicine, Vol. 9, 2001</li> <li>Frank Bates. <a href="http://www.cirp.org/library/legal/bates1/">Males, medical mutilation and the law: some recent developments</a>. 9 Journal of Law and Med 68 (2001).</li> <li>Frederick Hodges et al, <a href="http://www.cirp.org/library/ethics/hodges3/">Prophylactic interventions on children: Balancing human rights with public health</a>, Journal of Medical Ethics, Vol. 28, 2002, 10-16</li> <li>S.K. Hellsten, <a href="http://www.cirp.org/library/ethics/hellsten1/">Rationalising circumcision: From tradition to fashion, from public health to individual freedom – Critical notes on cultural persistence of the practice of genital mutilation</a>, Journal of Medical Ethics, Vol. 30, 2004, 248-53</li> <li>Marie Fox and Michael Thomson, <a href="http://www.cirp.org/library/legal/UKlaw/fox-ijcr-2006/">Short Changed? The Law and Ethics of Male Circumcision/</a>. International Journal of Children’s Rights 2005;13:161–181</li> <li>Fox M, Thomson M. <a href="http://www.cirp.org/library/legal/UKlaw/fox-thomson2005/">A covenant with the status quo? Male circumcision and the new BMA guidance to doctors</a>. J Med Ethics 2005;31:463-9.</li> <li>Suzanne Bouclin, <a href="http://www.cirp.org/library/legal/Canada/bouclin2005/">An examination of legal and ethical issues surrounding male circumcision: The Canadian context</a>, Int J Mens Health 2005;4(3): 205-22.</li> <li>Kirsten Bell, <a href="http://www.cirp.org/library/anthropology/bell1/">Genital Cutting and Western Discourses on Sexuality</a>. Medical Anthropology Quarterly 19(2) 2005 :125–148</li> <li>Wim Dekkers, Cor Hoffer and Jean-Pierre Wils, Bodily integrity and male and female circumcision, Medicine, Health Care and Philosophy (2005) 8:179–191</li> <li>Clark P.A., <a href="http://www.cirp.org/library/ethics/clark2006/">To circumcise or not to circumcise?: A Catholic ethicist argues that the practice is not in the best interest of male infants</a>. Health Prog 2006; 87(5): 30-9;</li> <li>Robert Darby and J. Steven Svoboda, <a href="http://www.historyofcircumcision.net/index.php?option=com_content&task=view&id=33&Itemid=56">A rose by any other name: Rethinking the differences/similarities between male and female genital cutting</a>, Medical Anthropology Quarterly, Vol. 21, September 2007. <a href="http://www.arclaw.org/resources/articles/rose-any-other-name-rethinking-similarities-and-differences-between-male-and-fema">Full text available as PDF here</a>.</li> <li>Ranipal Narulla, “Circumscribing circumcision: Traversing the moral and legal ground around a hidden human rights violation”, Australian Journal of Human Rights, Vol. 12, 2007, 89-118</li> <li>Geoff Hinchley, “<a href="https://www.circinfo.org/Hinchley_BMJ.html">Is infant male circumcision an abuse of the rights of the child? Yes</a>!” British Medical Journal, Vol. 335, 8 Dec. 2007, p. 1180.</li> <li>Doctors Opposing Circumcision, <a href="http://www.doctorsopposingcircumcision.org/DOC/statement0.html">Genital Integrity Policy Statement</a>, June 2008</li> <li>Robert Van Howe and J. Steven Svoboda, <a href="http://www.medscimonit.com/abstracted.php?level=5&icid=865808">Neonatal circumcision is neither medically necessary nor ethically permissible: A reply to Clark et al</a>, Medical Science Monitor, Vol. 14, 2008</li> <li>Wim Dekkers, “Routine (Non-Religious) Neonatal Circumcision and Bodily Integrity: A Transatlantic Dialogue”, Kennedy Institute of Ethics Journal, Vol. 19 (2), 2009, 125–146</li> <li>Robert Darby and J. Steven Svoboda, “A rose by any other name: Symmetry and asymmetry in male and female genital cutting”, in Chantal Zabus (ed.), Fearful Symmetries: Essays and Testimonies around Excision and Circumcision (Amsterdam and New York: Rodopi, 2009). Full text available as PDF here: <a href="https://www.circinfo.org/documents/RoseByAnyOtherName-Zabus.pdf">RoseByAnyOther%20Name-Zabus</a><a></a>.</li> <li>Robert Darby and Laurence Cox, “Objections of a sentimental character: The subjective dimension of foreskin loss”, in Chantal Zabus (ed.), Fearful Symmetries: Essays and Testimonies around Excision and Circumcision (Amsterdam and New York: Rodopi, 2009). Full text available as PDF here: <a href="https://www.circinfo.org/documents/ObjectionsSentimental-Zabus.pdf">ObjectionsSentimental-Zabus</a><a></a> </li> <li>Howard Gilbert, Time to reconsider the lawfulness of ritual male circumcision, European Human Rights Law Review, Vol. 3, 2007, 279-294</li> <li>Debra DeLaet, <a href="http://www.tandfonline.com/doi/abs/10.1080/14754830903324795">Framing male circumcision as a human rights issue? Contributions to the debate over the universality of human rights</a>. Journal of Human Rights 8 (4) 2009: 405-426.</li> <li>Marie Fox and Michael Thomson, Older minors and circumcision: Questioning the limits of religious actions, Medical Law International, Vol. 9, 2008, 283-310; also in George Denniston, Frederick Hodges and Marilyn Milos (eds), Genital Autonomy: Protecting Personal Choice (New York and Leiden: Springer 2010). Book may be purchased <a href="https://www.amazon.com/Genital-Autonomy-Protecting-Personal-Choice/dp/9048194458/ref=pd_rhf_p_t_1">from Amazon</a>. Individual chapters may be bought from <a href="http://www.springerlink.com/content/978-90-481-9445-2#section=758210&page=1&locus=0">the publishers, SpringerLink</a>.</li> <li>John Tobin. The international obligation to abolish traditional practices harmful to children’s health: What does it mean and require of states? <a href="http://hrlr.oxfordjournals.org/" rel="noopener" target="_blank">Human Rights Law Review</a> 9:3 (2009): 373-396.</li> <li>David Shaw, <a href="http://ce.rsmjournals.com/cgi/content/abstract/4/4/181">Cutting through red tape: Non-therapeutic circumcision and unethical guidelines</a>, Clinical Ethics, Vol. 4, 2009, 181-186</li> <li>Marie Fox and Michael Thomson, <a href="https://www.circinfo.org/Circumcision_and_women.html">Foreskin is a feminist issue</a>, Australian Feminist Studies, Vol. 24, 2009, 195-210</li> <li>Marie Fox and Michael Thomson. <a href="http://jme.bmj.com/content/36/12/798.abstract">HIV/AIDS and circumcision: lost in translation</a>. Journal of Medical Ethics 2010;36:798-801</li> <li>Brian Earp, <a href="http://blog.practicalethics.ox.ac.uk/2011/08/circumcision-is-immoral-should-be-banned/">Circumcision is immoral, should be banned</a>, Practical Ethics, Oxford University, August 2011.</li> <li>David Lang, Elective child circumcision and catholic moral principles. <a href="http://www.ncbcenter.org/">National Catholic Bioethics Quarterly</a>, Spring 2012.</li> <li>Brian Earp, Inking arms, piercing ears, and removing foreskins: The inconsistency of parental consent laws in the State of Georgia. <a href="http://blog.practicalethics.ox.ac.uk/2012/01/georgia-mother-arrested-for-allowing-10-year-old-to-get-a-tattoo/">Practical Ethics Blog, 25 January 2012</a>.</li> <li>Claire Mahon and Alexandra Phelan. <a href="https://theconversation.com/infant-male-circumcision-stop-violating-boys-human-rights-8517">Infant male circumcision: Stop violating boys' human rights.</a> The Conversation, 9 August 2012.</li> <li>Debra Delaet. Genital Autonomy, Children’s Rights, and Competing Rights Claims in International Human Rights Law. <a href="http://booksandjournals.brillonline.com/content/journals/15718182" rel="noopener" target="_blank">International Journal of Children’s Rights</a> 20 (2012): 554-583.</li> <li>Brian Earp and Robert Darby. <a href="https://theconversation.com/tradition-vs-individual-rights-the-current-debate-on-circumcision-10199">Tradition vs individual rights: The current debate on circumcision</a>. The Conversation, 2 November 2012.</li> <li>Toby Lichtig, Circumcision: time to cut it out? The religious culture wars have a new battleground. Is male circumcision a harmless ethnic signifier or the infliction of genuine harm on a child? <a href="http://rationalist.org.uk/articles/2856/circumcision-time-to-cut-it-out">New Humanist, 29 August 2012</a> </li> <li>Marjolein Van Den Brink and Jet Tigchelaar. <a href="http://www.corteidh.or.cr/tablas/r30541.pdf">Shaping genitals, shaping perceptions: A frame analysis of male and female circumcision</a>. Netherlands Quarterly of Human Rights, Vol. 30 (4), 2012: 431-459.</li> <li>Barry Lyons, Male infant circumcision as a “HIV Vaccine”. <a href="http://phe.oxfordjournals.org/">Public Health Ethics</a> 6 (1), April 2013: 90-103.</li> <li>The ethics of non-therapeutic male circumcision, Journal of Medical Ethics Vol 39, July 2013. <a href="https://www.circinfo.org/Journal_of_medical_ethics_July13.html">See summary on this site.</a> </li> <li>Aniaka Oluchi, In the Best Interest of the Child: Should Exception be Made for Infant Male Circumcision on Religious Grounds? <a href="http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2240101">Available at Social Science Research Network</a> </li> <li>Robert Darby, Medical, Ethical and Legal Aspects of Routine Circumcision: Submission to the Tasmania Law Reform Institute Inquiry into Non-Therapeutic Male Circumcision. <a href="http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2276538">Available at the Social Science Research Network</a> </li> <li>J. Steven Svoboda. <a href="https://dx.doi.org/10.1080/23269995.2013.804757">Promoting genital autonomy by exploring commonalities between male, female, intersex, and cosmetic female genital cutting</a>. Global Discourse: An Interdisciplinary Journal of Current Affairs and Applied Contemporary Thought. on-line first, 6 July 2013.</li> <li>Robert S. Van Howe. <a href="https://dx.doi.org/10.1080/23269995.2013.805515">Infant male circumcision in the public square: Applying the public reason of John Rawls</a>. Global Discourse: An Interdisciplinary Journal of Current Affairs and Applied Contemporary Thought. On-line first, 25 June 2013.</li> <li>Eliyahu Ungar-Sargon. <a href="https://dx.doi.org/10.1136/medethics-2013-101598">On the impermissibility of infant male circumcision: A response to Mazor (2013)</a>. Journal of Medical Ethics, on-line first 6 September 2013.</li> <li>Michael Glass. <a href="https://dx.doi.org/10.1136/medethics-2013-101626">Forced circumcision of men</a>. Journal of Medical Ethics, on-line first, 6 September 2013.</li> <li>Diana Aurenque and Urban Wiesing, German law on circumcision and its debate: How an ethical And legal issue turned political. <a href="http://onlinelibrary.wiley.com/doi/10.1111/bioe.12077/abstract">Bioethics, early view, 23 December 2013</a>.</li> <li>Patrick Testa and Walter E. Block. Libertarianism and circumcision. <a href="http://www.ijhpm.com/?_action=articleInfo&article=2849">International Journal of Health Policy and Management</a>. On-line first, 26 May 2014.</li> <li>M. Cumhur. <a href="http://turkpsikiyatri.com/Data/UnpublishedArticles/179rfy.pdf">Ethical evaluation of non-therapeutic circumcision</a>. Turkish Journal of Psychology, June 2014.</li> <li>Eldar Sarajlic. <a href="http://link.springer.com/article/10.1007/s11158-014-9254-x" rel="noopener" target="_blank">Can culture justify infant circumcision?</a> Res Publica, Vol 20 (4), November 2014: 327-343. DOI 10.1007/s11158-014-9254-x.</li> <li>Beth Maina Ahlberg and Kezia Muthoni Njoroge. ‘Not men enough to rule!’: Politicization of ethnicities and forcible circumcision of Luo men during the post-election violence in Kenya. Ethnicity and Health, Vol 18 (5), 2013. DOI http://dx.doi.org/10.1080/13557858.2013.772326.</li> <li>David Shaw. Circumcision in the original position: Why children would not choose it (A reply to Ahmad). <a href="http://onlinelibrary.wiley.com/doi/10.1111/bioe.2014.28.issue-9/issuetoc" rel="noopener" target="_blank">Bioethics</a>, Vol 28 (9), 2014: 501-502.</li> <li>Thomas Hainz. The Enhancement of Children versus Circumcision: A Case of Double Moral Standards? <a href="http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1467-8519" rel="noopener" target="_blank">Bioethics</a>, e-pub ahead of print, 17 December 2014. doi: 10.1111/bioe.12141.</li> <li>K.G. Behrens. Why physicians ought not to perform virginity tests. <a href="http://jme.bmj.com/" rel="noopener" target="_blank">Journal of Medical Ethics</a>. e-pub ahead of print, 20 January 2015. doi: 10.1136/medethics-2014-102344.</li> <li>Robert Darby. <a href="https://kiej.georgetown.edu/" rel="noopener" target="_blank">Risks, Benefits, Complications and Harms: Neglected Factors in the Current Debate on Non-Therapeutic Circumcision</a>. Kennedy Institute of Ethics Journal 25 (1), March 2015, 1-34.</li> <li>Brian Earp. Female genital mutilation and male circumcision: toward an autonomy-based ethical framework <a href="https://www.dovepress.com/female-genital-mutilation-and-male-circumcision-toward-an-autonomy-bas-peer-reviewed-article-MB" rel="noopener" target="_blank">Medicolegal and Bioethics 5</a>, 12 May 2015.</li> <li>Robert Darby. The mysterious disappearance of the object of inquiry: Jacobs’ and Arora’s defence of circumcision. American Journal of Bioethics, Vol. 15 (5), May 2015: 70-72. <a href="https://www.academia.edu/17264543/The_childs_right_to_an_open_future_Is_the_principle_applicable_to_non-therapeutic_circumcision">Full text at Academia.edu</a> </li> <li>Brian Earp. In defence of genital autonomy for children. Journal of Medical Ethics, online first, 20 January 2016. The full version of the paper, with supplementary material, may be read at Brian’s <a href="https://www.academia.edu/19117334/In_defence_of_genital_autonomy_for_children" rel="noopener" target="_blank">Academia Page</a> or at <a href="https://www.researchgate.net/publication/285578712_In_defence_of_genital_autonomy_for_children" rel="noopener" target="_blank">ResearchGate</a>.</li> <li>Robert Van Howe. The American Academy of Pediatrics and Female Genital Cutting: When National Organizations are Guided by Personal Agendas. Ethics and Medicine, Vol. 27 (3), Fall 2011.</li> <li>Robert Darby. <a href="http://blogs.bmj.com/medical-ethics/2016/02/25/should-doctors-perform-minor-forms-of-female-genital-mutilation-fgm-as-a-compromise-procedure-to-respect-culture/" rel="noopener" target="_blank">Male and Female Genital Cutting: A Sex-Neutral Approach?</a> Journal of Medical Ethics Blog, 25 February 2016.</li> <li>Robert Darby. <a href="http://quillette.com/2016/03/03/female-genital-cutting-harm-human-rights-and-the-possibility-of-a-sex-neutral-approach/" rel="noopener" target="_blank">Female Genital Cutting: Harm, Human Rights and the Possibility of a Sex-Neutral Approach</a>. Quillette, 3 March 2016.</li> <li>J. Steven Svoboda, Peter Adler, Robert Van Howe. <a href="http://lme.sagepub.com/content/44/2/263.abstract?ct" rel="noopener" target="_blank">Circumcision is unethical and unlawful</a>. Journal of Law, Medicine and Ethics 44 (2), June 2016.</li> <li>Robert Darby. <a href="http://sgo.sagepub.com/content/6/2/2158244016649219" rel="noopener" target="_blank">Targeting Patients Who Cannot Object? Re-Examining the Case for Non-Therapeutic Infant Circumcision</a>. Sage Open, 3 June 2016.</li> <li>Brian Earp, Between Moral Relativism and Moral Hypocrisy: Reframing the Debate on “FGM”. Kennedy Institute of Ethics Journal, Vol. 26, No. 2, June 2016: 105–144. <a href="https://www.academia.edu/10197867/Between_moral_relativism_and_moral_hypocrisy_reframing_the_debate_on_FGM_" rel="noopener" target="_blank">Full text here</a>.</li> <li>Robert Darby, Moral Hypocrisy or Intellectual Inconsistency? A Historical Perspective on Our Habit of Placing Male and Female Genital Cutting in Separate Ethical Boxes. Kennedy Institute of Ethics Journal, Vol. 26, No. 2, June 2016: 155–163. <a href="https://www.academia.edu/27422264/Moral_hypocrisy_or_intellectual_inconsistency" rel="noopener" target="_blank">Full text here</a>.</li> <li>Arianne Shahvisi. <a href="https://www.circinfo.org/news_2017.html#shahv" rel="noopener" target="_blank">Why UK doctors should be troubled by female genital mutilation legislation</a>. Clinical Ethics, online first, 15 December 2016.</li> <li>Brian Earp and Robert Darby, Circumcision, Sexual Experience, and Harm: Reply to Stephen R. Munzer’s “Secularization, Anti-Minority Sentiment, and Cultural Norms in the German Circumcision Controversy”, University of Pennsylvania Journal of International Law, April 2017. <a href="http://pennjil.com/brian-earp-robert-darby-circumcision-sexual-experience-and-harm-reply-to-stephen-r-munzers-secularization-anti-minority-sentiment-and-cultural-norms-in-the-german-circumcision-cont/" rel="noopener" target="_blank">Full text with original article and other commentaries</a>.</li> <li>Earp, B. D., & Steinfeld, R. (2017). <a href="http://euromind.global/en/brian-d-earp-and-rebecca-steinfeld/?lang=en" rel="noopener" target="_blank">Gender and genital cutting: A new paradigm</a>. In T. G. Barbat (Ed.), Gifted Women, Fragile Men. Euromind Monographs - 2, Brussels: ALDE Group-EU Parliament.</li> <li>J. Steven Svoboda. <a href="http://journalofethics.ama-assn.org/2017/08/msoc2-1708.html" rel="noopener" target="_blank">Nontherapeutic Circumcision of Minors as an Ethically Problematic Form of Iatrogenic Injury</a>. AMA Journal of Ethics 19 (8), August 2017: 815-824.</li> <li>Robert S Van Howe. <a href="http://onlinelibrary.wiley.com/doi/10.1111/bioe.12363/full" rel="noopener" target="_blank">Response to Vogelstein: How the 2012 AAP Task Force on circumcision went wrong</a>. Bioethics, early view, 9 July 2017.</li> <li>Brian D. Earp, Lauren M. Sardi & William A. Jellison. False beliefs predict increased circumcision satisfaction in a sample of US American men. Culture, Health and Sexuality, on-line first, December 2017. <a href="https://www.academia.edu/35001238/False_beliefs_predict_increased_circumcision_satisfaction_in_a_sample_of_US_American_men" rel="noopener" target="_blank">Full text here</a>.</li> <li>Brian Earp & Robert Darby. Circumcision, Autonomy and Public Health. <a href="https://academic.oup.com/phe/advance-article-abstract/doi/10.1093/phe/phx024/4764011" rel="noopener" target="_blank">Public Health Ethics</a>. On-line first, December 2017. <a href="https://www.academia.edu/35054253/Circumcision_autonomy_and_public_health" rel="noopener" target="_blank">Full text here</a>.</li> <li>Sara Johnsdotter. Girls and Boys as Victims: Asymmetries and dynamics in European public discourses on genital modifications in children. Paper delivered to International Seminar FGM/C: From Medicine to Critical Anthropology Rome, 24-25 November 2017. <a href="https://www.academia.edu/35343412/Girls_and_Boys_as_Victims_Asymmetries_and_dynamics_in_European_public_discourses_on_genital_modifications_in_children" rel="noopener" target="_blank">Full text here</a>.</li> <li>Kai Moller. <a href="https://doi.org/10.1080/20403313.2017.1339535" rel="noopener" target="_blank">Ritual male circumcision and parental authority</a>. Jurisprudence: An International Journal of Legal and Political Thought 8 (3) 2017: 461-479.</li> <li>Brian Earp & David Shaw. Cultural bias in American medicine: The case of infant male circumcision. Journal of Pediatric Ethics Vol 1, Summer 2017, 8-26. <a href="https://www.researchgate.net/publication/316527603_Cultural_bias_in_American_medicine_the_case_of_infant_male_circumcision" rel="noopener" target="_blank">Full text here</a>.</li> <li>Arianne Shahvisi & Brian Earp. The law and ethics of female genital cutting. In: S. Creighton & L.-M. Liao (Eds.) Female Genital Cosmetic Surgery: Interdisciplinary Analysis & Solution. Cambridge: Cambridge University Press. <a href="https://www.academia.edu/35591618/The_law_and_ethics_of_female_genital_cutting" rel="noopener" target="_blank">Full text here</a>.</li> <li>Brian Earp. M<a href="https://theconversation.com/unconstitutional-us-anti-fgm-law-exposes-hypocrisy-in-child-protection-109305" rel="noopener" target="_blank">ichigan FGM case exposes glaring inconsistencies in legal status of circumcision</a>. The Conversation (UK), 11 January 2019.</li> <li>Rationalist Society of Australia. <a href="https://www.rationalist.com.au/campaigns/genital-autonomy-white-paper/" rel="noopener" target="_blank">Genital Autonomy White Paper</a>.</li> <li>Tim Hammond & Adrienne Carmack. <a href="https://www.tandfonline.com/doi/full/10.1080/13642987.2016.1260007" rel="noopener" target="_blank">Long-term adverse outcomes from neonatal circumcision reported in a survey of 1,008 men: an overview of health and human rights implications</a>. International Journal of Human Rights. On-line first, 21 February 2017. Full text at Tim Hammond's <a href="https://www.academia.edu/34735298/Long-term_adverse_outcomes_from_neonatal_circumcision_reported_in_a_survey_of_1_008_men_an_overview_of_health_and_human_rights_implications" rel="noopener" target="_blank">Academia.edu page</a> </li> </ol> </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Significant articles on medical ethics, human rights and the law darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h1>Medicare should not pay for medically unnecessary circumcision</h1> A recent review of Medicare found evidence that between 2 and 3 billion dollars are spent inappropriately each year. The review, by Dr Tony Webber as Director of the Professional Services Review, noted that Medicare’s no-questions-asked policy led to serious financial abuses and failed to take account of the medical business environment. “The MBS [Medical Benefits Schedule] is riddled with misdirected incentives for practitioners … and has many examples of good public policy being thwarted by the MBS rules”, Webber writes. Among the scandals, he mentions cases where “the Safety Net was used in effect to subsidise cosmetic procedures such as surgery for designer vaginas at $5000-$6000 each” (Tony Webber, “What is wrong with Medicare?”, Medical Journal of Australia, 16 January 2012.) What is equally scandalous about Medicare is that it continues to subsidise cosmetic procedures such as surgery for “designer penises” – namely, non-therapeutic (medically unnecessary) circumcision of male infants and boys. There is no reason at all why the over-stretched health budget should continue to waste taxpayers’ money by paying for an operation, usually on non-consenting children, that medical authorities judge to be medically unnecessary, risky, potentially harmful, and contrary to accepted principles of medical ethics and human rights, including the principle of gender equity. The Commonwealth Sex Discrimination Act, Section 3 (b), states that the Act applies to the administration of Commonwealth laws and programs, while Section 22 (b) makes it illegal to discriminate on the basis of sex in the provision of goods, services and facilities. It could be argued that the exclusion of female circumcision from the MBS is a breach of this provision, since it denies to women a benefit given to men; whether or not circumcision is regarded as a benefit or a deprivation, it is certainly anomalous that the MBS specifically denies coverage for cutting procedures on the female genitals while providing no-questions-asked coverage for comparable procedures on the genitals of boys. Medicare should never have covered a non-therapeutic procedure such as circumcision. When Medibank was first introduced in 1975, Australian medical authorities <a href="https://www.circinfo.org/doctors.html">had already determined</a> that boys should not be circumcised; and when it was re-established as Medicare by the Hawke government in 1984-85 they had reaffirmed and strengthened their policy. Unfortunately, the politicians and health bureaucrats seem to have been behind the times. It is high time that medically unnecessary (non-therapeutic) circumcision was dropped from the Medical Benefits Schedule, and Medicare confined to its stated requirement to cover only “procedures that are clinically necessary”. UPDATE 2015 In response to calls for public comment on various reviews of the Medical Benefits Schedule, aimed at eliminating outdated or inappropriate services, <a href="https://www.darboninstitute.org/medicare_should_not_cover_non_therapeutic_circumcision" rel="noopener" target="_blank">a detailed submission on why Medicare should not cover non-therapeutic circumcision was prepared and submitted</a>. <h2> <a id="medi1" name="medi1"></a>1. Medicare should not cover non-therapeutic circumcision</h2> Dr Robert Darby’s letter to Medical Journal of Australia in response to Tony Webber’s article Any review of Medicare arising from Tony Webber’s critique [1] must reconsider its coverage of non-therapeutic circumcision. Australia is the only country in the world to provide a no-questions-asked rebate for such procedures, despite the fact that most have no medical indication and in defiance of Medicare’s own guidelines. These state that benefits are not payable for “medical services that are not clinically necessary”, nor “surgery for cosmetic reasons”. [2] A medical procedure is clinically necessary only if required to correct a diagnosed disease, injury or other pathological condition that cannot be treated conservatively. Surgery for any other reason, particularly cultural or social reasons, is cosmetic surgery, intended merely to alter the appearance of the body part in question. As the Royal Australasian College of Surgeons points out, “male non-therapeutic circumcision is not clinically necessary as it does not treat an underlying pathological process.” [3] The issue is doubly serious in that most circumcision procedures are on infants and other minors, few of whom present any pathology requiring surgery, thus contradicting the policy of the Royal Australasian College of Physicians that routine circumcision is not warranted. Since minors cannot give consent, payments for such operations are questionable from a bioethical and human rights perspective, and may even be unlawful. [4] There have been several calls to delete non-therapeutic circumcision from the Medical Benefits Schedule, including Spilsbury et al, who point out that “the potential savings to the public purse would be considerable if elective and discretionary circumcision was removed from the Medicare schedule in line with other cosmetic surgeries, leaving rebates for the genuine medically indicated circumcision.” [5] In 1985 the government did drop circumcision from the MBS, only to reinstate it after objections from Jewish community leaders, leading to the myth that the original decision aroused a community backlash. Recent research has established that the decision represented sound public policy, was widely supported, and that the objections were based on a sense of discrimination: their real concern was that the rebate was deleted only for boys younger than six months. [6] It is not clear why the government, rather than restoring the rebate, did not resolve the problem by requiring a medical indication at all ages, as would have been the simplest and most equitable course of action. It now has the opportunity to rectify this mistake. Medicare should no more fund the designer penises created by circumcision than the designer vaginas created by other cosmetic procedures. References 1. Webber, TD. What is wrong with Medicare? Med J Aust 2012; 196 (1): 18-19. 2. “What does Medicare cover?”, at http://www.medicareaustralia.gov.au/public/claims/what-cover.jsp. Accessed 21 January 2012. 3. Australian Safety and Efficacy Registry of New Interventional Procedures – Surgical. Report No. 65: Male non-therapeutic circumcision. Adelaide: Royal Australasian College of Surgeons, 2008. 4. Adler, P. Is it lawful to use Medicaid to pay for circumcision? J Law Med 2011; 19: 335-353. 5. Spilsbury K, Semmons JB, Wisniewski ZS, Holman CD. Routine circumcision practice in Western Australia 1981–1999. ANZ J Surgery 2003; 73(8): 610-614. 6. Darby, R. Scientific advice, traditional practices and the politics of health-care: The Australian debate over public funding of non-therapeutic circumcision, 1985. Hygiea Internationalis: An Interdisciplinary Journal for the History of Public Health 2011; 10: 53-73. Available at http://www.ep.liu.se/ej/hygiea/. Accessed 21 January 2012. (This letter was sent to the Medical Journal of Australia in response to Tony Webber’s article, but was not published.) <h2> <a id="medi2" name="medi2"></a>2. Medicare should not pay for medically unnecessary circumcision: Our viewpoint</h2> Although Australian medical authorities do not recommend circumcision as a routine or prophylactic procedure, Medicare continues to provide an automatic rebate for such operations, whether medically required or not. The propriety, ethics and even the lawfulness of this policy have been questioned in two recent studies, one by an American legal expert who argues that payments for non-therapeutic circumcision by the United States health insurance program Medicaid are unlawful; and the other by Australian medical historian Dr Robert Darby, who has examined the attempt by the Hawke government to drop circumcision from the Medical Benefits Schedule in 1985. He dispels the myth that the decision aroused widespread protest and shows, on the contrary, that it represented sound public policy and was widely supported. Taken together, these analyses raise serious questions about current Medicare policy on the circumcision rebate; here Robert Darby argues that, for reasons of consistent public policy, financial prudence and respect for established principles of human rights and gender equity, the rebate should be abolished except for cases of proven medical need. <h3>Introduction</h3> The Australian government is under pressure to balance budgets, give more recognition to individual human rights, promote gender equity and protect children from harm. One simple way to make progress on all these fronts is to drop non-therapeutic circumcision from the Medical Benefits Schedule. Medicare currently provides an automatic, no-questions-asked rebate for circumcision, despite the fact that the vast majority of these operations have no medical indication, and in defiance of Medicare’s own guidelines. These state that benefits are not payable for “medical services which are not clinically necessary”, nor “surgery for cosmetic reasons”. A medical procedure is clinically necessary only if it is essential to correct a diagnosed disease, injury, deformity or other pathological condition that has not responded to conservative (non-surgical) treatment. As the Royal Australasian College of Surgeons points out, “male non-therapeutic circumcision is not clinically necessary as it does not treat an underlying pathological process.” Surgery for any other reason, particularly cultural or social reasons, is essentially cosmetic surgery, intended to alter the appearance of the body part in question. According to its own published guidelines, Medicare should not cover such procedures. <h3>Opinions of medical authorities</h3> It is strange that it still does so, considering that Australian medical authorities have sought to discourage routine (medically unnecessary) circumcision since the early 1970s. In fact, the government did drop circumcision from the MBS in 1985, only to restore it a few weeks later, for obscure reasons, explained below. Nonetheless, Australian medical authorities have maintained their opposition to the practice, with the result that the incidence of circumcision in Australia continues to decline. The most recent statement (October 2010) by the Royal Australasian College of Physicians states clearly: “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.” Stronger statements have been issued by the British Medical Association, the Canadian Pediatric Society, the Royal Dutch Medical Association, the South African Medical Association, and medical authorities in Denmark, Finland, Norway and Sweden. Even in the United States, where circumcision is deeply entrenched as a medicalised cultural ritual, the American Academy of Pediatrics does not recommend the operation or regard it as medically desirable, much less as necessary. This being the case, a study by a US legal expert argues that payments for non-therapeutic (medically unnecessary) circumcision by the United States health insurance scheme Medicaid violate the protocols for benefits under this program and are thus unlawful. The article, in the December 2011 issue of the Journal of Law and Medicine, shows that the federal and state Medicaid acts stipulate that physicians and patients can use Medicaid to pay for medical services only when they are clinically necessary. This provision clearly excludes non-essential medical services, and some states expressly exclude cosmetic surgery from the list of covered treatments. In addition, federal and state Medicaid law require diagnosis of a medical condition and recommendation of an effective treatment before any benefit is payable. Medicare has not been the subject of such a study, but it is quite possible (given the guidelines) that its own payments for non-therapeutic circumcision are not authorised by Parliament and are thus unlawful. <h3>Why Medicare should not pay for circumcision</h3> There are at least five other main reasons why non-therapeutic circumcision should be dropped from the MBS. These relate to the absence of a convincing health case; conformity with international practice; principles of ethics and human rights; gender equity; and financial prudence. 1. No health case for routine circumcision It is not only the authorities mentioned above that have examined the medical literature and concluded that there is no health case for routine circumcision of infants or boys. A survey by British experts Malone and Steinbrecher acknowledged the medical claims for routine circumcision, but concluded that the only definite indications in childhood were phimosis caused by balanitis xerotica obliterans and recurrent balanoposthitis. Preputial adhesions, ballooning on urination, and a non-retractile foreskin do not require treatment. Relative indications (meaning that therapeutic circumcision could be warranted in individual cases) were recurrent urinary tract infections plus an abnormal tract. They point out that most circumcisions are done for religious cultural reasons, and that complications “are well documented and can be drastic”. A study by researchers in Adelaide, published in Annals of Family Medicine, subjected the claims of the circumcision lobby to an exhaustive review, and concludes that its value for child health was close to zero. When the literature is considered as a whole (rather than cherry picked for papers supporting a particular thesis) there is no proof that circumcision provides any significant protection against urinary tract infections, sexually transmitted infections or cancer of the penis The only evidence for prophylactic efficacy came from Africa, where there was evidence that adult males who got themselves circumcised had a slightly lower risk of contracting HIV through unprotected intercourse with an infected female partner. And I say “slightly lower risk” because I do not consider a risk reduction of between 40 and 60 per cent to be impressive, particularly when compared with the 90 to 95 per cent protection offered by a condom. As the authors of the paper comment, Africa has unique health problems. The circumcision trials were on adult men and can no more be applied to children than the World Health Organisation recommendations for the underdeveloped world can be transferred to a developed country like Australia. In Australia, unlike Africa, HIV-AIDS is not a heterosexual epidemic, but a relatively rare disease confined to specific sub-cultures – homosexual men and injecting drug users. It is well established that these groups can derive no protection from circumcision at all. In any case, because it is a disease of promiscuous adults, children are not at any risk of infection – unless, of course, by surgery. When they become sexually active boys are old enough to understand the issues and make their own decisions about how to manage the risks of sexual activity with others. The Australian Federation of AIDS Organisations has stated that circumcision has no relevance to Australia’s HIV problem, and their conclusion has been endorsed by a paper in the Australian and New Zealand Journal of Public Health, which argues that circumcision is not a surgical vaccine and is not appropriate as an HIV control tactic in developed countries such as Australia. 2. International practice Australia is the only country in the world that provides automatic coverage of circumcision through the health budget. This policy is despite the fact that most State governments (Victoria, Western Australia, Tasmania, New South Wales and South Australia) do not provide free coverage of circumcision in public hospitals, and it is in sharp contrast with the practice of comparable developed nations. <ul> <li>In Britain the National Health Service has never included routine circumcision among its free procedures, and covers it only as a therapeutic procedure in cases of medical necessity. The same is true of New Zealand.</li> </ul> <ul> <li>In Canada, where medical insurance is the responsibility of the provinces, the only province to include circumcision in its cover is Manitoba; and even there doctors refuse to charge the state but bill the parents.</li> </ul> <ul> <li>In the United States, the federal government provides the funds for public health insurance to the states, which make their own decisions as to which services they cover. When the program was introduced in 1965 all states covered circumcision, but since then 18 of the 50 states have ceased to fund it, and more are likely to do so as budgetary constraints intensify.</li> </ul> Circumcision is not funded by the governments of Israel, Turkey, Indonesia, Iran or any other predominantly Islamic country where the procedure is widely practised as a cultural/religious ritual, not even when the operation is performed in hospitals rather than (as is traditional) in the boy’s home. The Dutch national health insurance service withdrew coverage of non-therapeutic circumcision in 2004 when it was realised that 90 per cent of the procedures were done for religious/cultural rather than for health-related reasons. 3. Ethics and human rights For a surgical intervention to be ethically acceptable (and indeed legal) the fundamental requirement is that the person must give informed consent. An adult male can consent to having himself circumcised (it’s his choice), but the question becomes difficult when parents wish to circumcise their children because minors can no more consent to surgery than to sexual relations with adults. Circumcision of children thus deprives them of choice and amounts to coercion. The problem is especially relevant to Medicare, since the vast majority of the circumcision procedures that it covers involve children. In FY 2010-11, of 25,842 circumcision procedures funded by Medicare, 22,491 (88%) were on boys aged under 10 years, and of these 18,503 (71% of the total) were aged less than 6 months. Very few of these operations could be regarded as therapeutic or clinically necessary. An additional 2641 procedures were on males aged 10 years or more, but Medicare provides no breakdown as to how many of these are adults and how many are still minors, though it is clear enough that very few adult males elect to have themselves circumcised. Surrogate consent for surgery on minors is valid only for life-saving medical treatment, or where the procedure is manifestly in the best interests of the child and passes the imputed judgement test – that is, it is an operation the child would choose for himself if he were a competent adult. It has been strongly argued that, in the absence of a life-threatening disorder, surrogate consent for non-therapeutic surgery such as circumcision is ethically problematic and may not be legally valid. When there is no urgency to intervene, it is best to wait until the child can make his own choice. In addition to informed consent, leading bioethicists propose five conditions that must be met in order for a medical procedure to be ethically permissible. Beneficence — Does the proposed procedure provide a net therapeutic benefit to the patient, considering the risk, pain, and loss of normal function? Non-maleficence — Does the procedure avoid permanently diminishing the patient in any way that could be avoided? Proportionality — Will the final result provide a significant net benefit to the patient in proportion to the risk undertaken and the losses sustained? Justice — Will the patient be treated as fairly as we would all wish to be treated? Autonomy — Lacking life-threatening urgency, will the procedure honour the patient’s right to his or her own likely choice? Could it wait for the patient’s assent? Non-therapeutic circumcision of minors fails all these tests. It is not beneficent because it does not provide a therapeutic benefit (nor even a relevant prophylactic benefit, since a child is at zero risk of sexually transmitted infections ). It is malefic because it diminishes the genitals. It is disproportional because the net gain (if any) is out of proportion to the loss, harm and risk of complications. It is unjust because adult preferences show clearly that if he had a choice in the matter the boy would refuse the operation. Finally, circumcision fails to respect the boy’s autonomy and preserve his future options as an adult individual. The British Medical Association and the Royal Dutch Medical Association have issued particularly strong warnings that non-therapeutic circumcision of minors is likely to breach accepted principles of bioethics and potentially of the law. In its policy statement (May 2010) the latter states: “Non-therapeutic circumcision of male minors is contrary to the rule that minors may only be exposed to medical treatments if illness or abnormalities are present, or if it can be convincingly demonstrated that the medical intervention is in the interest of the child, as in the case of vaccinations”; and further that such interventions violate “the child’s right to autonomy and physical integrity.” The RACP agrees: “The option of leaving circumcision until later, when the boy is old enough to make a decision for himself does need to be raised with parents and considered. … The ethical merit of this option is that it seeks to respect the child’s physical integrity, and capacity for autonomy by leaving the options open for him to make his own autonomous choice in the future.” International instruments are also relevant. Article 8 of the UNESCO Declaration on Human Rights and Bioethics (2005) states that “In applying and advancing scientific knowledge, medical practice and associated technologies, human vulnerability should be taken into account. Individuals and groups of special vulnerability should be protected and the personal integrity of such individuals respected.” Children certainly fall into this category. Given the government’s commitment to enhancing Australia’s commitment to individual human rights, it is highly anomalous that it allows Medicare to subsidise and thus encourage a disfiguring operation that denies them to so many children. 4. Gender equity Australia’s obligations under the Sex Discrimination Act 1984 and as a signatory to the United Nations Convention on the Rights of the Child require the national and State governments to treat males and females equally and without discrimination on the basis of sex, and to take action to eradicate traditional practices harmful to children. Article 24 (3) of the Convention requires parties to take “all effective and appropriate measures with a view to abolishing traditional practices prejudicial to the health of children.” In pursuance of this development several States passed laws to prohibit any form of female circumcision, and in 1995 the Commonwealth specifically excluded such procedures from the Medical Benefits Schedule. Although there was nothing in the wording of the Convention to suggest that it did not include male children, no action has yet been taken to protect boys. This failure is increasingly recognized, in Ranipal Narulla’s words, as “a hidden human rights violation”. The Commonwealth Sex Discrimination Act, Section 3 (b), states that the Act applies to the administration of Commonwealth laws and programs, while Section 22 (b) makes it illegal to discriminate on the basis of sex in the provision of goods, services and facilities. It could be argued that the exclusion of female circumcision from the MBS is a breach of this provision, since it denies to women a benefit given to men; whether or not circumcision is regarded as a benefit or a deprivation, it is certainly anomalous and inconsistent that the MBS specifically denies coverage for cutting procedures on the female genitals while providing a no-questions-asked rebate for comparable procedures on the genitals of boys. The situation is doubly discriminatory in that girls are denied a "benefit" that is given to boys, while boys are denied a protection from harm that is enjoyed by girls. The simplest way to remove such discrimination and restore the principle of equal treatment is to limit coverage of male circumcision to cases of proven medical necessity. 5. Economy and financial prudence All government welfare programs should be targeted at genuine need and be administered with prudence and economy. An open-slather approach to funding a medically unnecessary procedure is wasteful and invites over-servicing. It also acts as a signal that circumcision is a socially acceptable and even medically recommended operation, thus encouraging more parents to seek to have it done. Assuming 15,000 unnecessary circumcision procedures per year at a cost of between $100 and $1600 each, Katrina Spilsbury and colleagues have estimated that the removal of medically unnecessary circumcision from the MBS would save between $1.5 million and $24 million per year. They state that “the potential savings to the public purse would be considerable if elective and discretionary circumcision was removed from the Medicare schedule in line with other cosmetic surgeries, leaving rebates for the genuine medically indicated circumcision.” According to figures available on the Medicare website, the total cost of the rebate for all circumcision procedures in FY 2010-11 was $1,577,754, nearly half of which went to subsidise operations on infants less than 6 months old, almost none of whom could have had a genuine medical indication. This is not a large sum in the overall budget context, but the real cost to the government will be considerably higher, given that this figure does not include the cost of treating complications and long-term adverse effects, which may not become apparent until adolescence. A cost-utility analysis of neonatal circumcision by American researcher Robert Van Howe found that even if the extreme claims of circumcision advocates were true, the associated complications and adverse outcomes would cancel out and exceed the benefit to health by a considerable margin. On top of this there may be losses to revenue arising from tax rebates that parents are able to claim under the Medicare safety net for expenses related to child-bearing. These are not substantial sums in the context of today’s billion-dollar budgets, but when every effort is being made to rein in public expenditure, especially the ever-expanding health budget, every million saved can help to make a difference. Not only this: given the irresponsible media commentary on the role of circumcision in HIV control and the efforts of scaremongering evangelists and entrepreneurial circumcision practitioners to generate a mood of panic, the demand for circumcision could increase if parents are misled by their propaganda and become fearful of the alleged risks of not getting it done. It is thus possible that the cost of the circumcision subsidy will increase unless entitlement is restricted. Removal of non-therapeutic circumcision from the MBS will send a clear signal to Australian parents that routine circumcision is not a medically recommended procedure and is not necessary for the health and well-being of their child. Parental right to circumcise for religious reasons not affected The main argument for dropping non-therapeutic circumcision from the MBS is not the cost-saving, but the principles of prudent and targeted assistance to those in need; of adherence to stated entitlement guidelines and lawful program administration; of respecting current expert medical advice; of observing accepted principles of ethics and human rights; and of avoiding discrimination on the basis of sex. Allowing Medicare to provide a rebate for non-therapeutic circumcision sends the wrong signals to parents, suggesting that it is a socially and medically approved procedure, and thereby encouraging the practice. There is nothing in this proposal that will limit the right of parents to circumcise their children if they feel they have a compelling cultural or religious reason, merely that they will not receive a public subsidy for doing so. There is no intent to restrict the right of Jewish, Aboriginal or Muslim parents to circumcise their children in accordance with their respective traditions; but equally there is no reason why such rites and practices should be funded by the Australian taxpayer through the health budget. <h3>The Hawke government’s thwarted attempt to drop circumcision from the MBS in 1985</h3> It is true that when the Hawke government dropped circumcision from the MBS in 1985 it faced protests from Jewish community leaders and soon backed down, leading to the development of the myth that there was a “community backlash” and discouraging further attempts. This myth has been disproved in a detailed study of the incident by Dr Robert Darby, published in Hygiea, an international journal for the history of public health. His conclusions are that the decision was justified on medical and public policy grounds; that there was no wide public outcry and, indeed, that the decision was widely approved; and that the rapid reversal of the decision was the result of inept implementation, failure to consult, and a fortuitous combination of subsequent factors, including, vigorous lobbying by the groups who felt most deeply affected. The main objection of Jewish community leaders was not to the dropping of the rebate in itself, but the fact that it was dropped only from the code for circumcision of boys under 6 months, leaving the rebate in place for operations at later ages. Since Jewish people traditionally circumcise at 8 days, they justifiably felt that this was unreasonable discrimination. It is not clear why the government, rather than abjectly restoring the rebate, did not resolve the problem by requiring a medical indication at all ages, as would have been the simplest, most economical and most equitable course of action. The government now has the opportunity to rectify this mistake. If a proven medical requirement is attached to each of the codes for circumcision, there is no reason why the sensibilities of the Moslem and Jewish communities should be affronted, since the new rules would apply to everybody in the community, without discrimination. <h3>Conclusion</h3> There is no reason why Medicare, and thus the Australian taxpayer, should continue to fund operations that medical authorities have defined as unnecessary and potentially harmful, and which many people regard as an violation of the rights of the child, or even genital mutilation. The government must face up to its responsibilities, bite the bullet, rectify the mistakes it made in 1985, and delete non-therapeutic circumcision from the Medical Benefits Schedule. <h3>Appendix: Relevant MBS codes and payments (as at 1 January 2012)</h3> 30653: Circumcision of a male under 6 months of age Scheduled fee: $45.65; Benefit: $34.25 (75%); $38.85 (85%) 30656: Circumcision of a male under 10 years of age but not less than 6 months of age Scheduled fee: $106.15; Benefit: $79.65 (75%); $90.25 (85%) 30659: Circumcision of a male 10 years of age or over by a GP Scheduled fee: $146.95; Benefit $110.25 (75%); $124.95 (85%) 30660: Circumcision of a male 10 years of age or over by a specialist Scheduled fee: $182.15; Benefit $136.65 (75%); $154.85 (85%) 30663: Haemorrhage, arrest of, following circumcision requiring general anaesthesia Scheduled fee: $141.65; Benefit $106.25 (75%); $120.45 (85%) Until 1995 these codes were unisex and read “circumcision of a person”, thus authorising a benefit for circumcision of females as well as of males. In order to protect girls from genital mutilation as part of the general development of laws and policies against FGM that followed the passage of the UN Convention on the Rights of the Child, “person” was changed to “male”, thus introducing two elements of discrimination: females were denied a service that remained available to males; but males were denied the protection that was accorded to females. The deletion of non-therapeutic circumcision from the schedule can be effected by simply by adding the phrase “where medically indicated” to each of the codes above. “Medically indicated” means a case where (1) there is a medical problem that has not responded to conservative (non-surgical) treatment after reasonable efforts; and (2) this is certified by two qualified medical practitioners, one of whom must be an appropriate specialist, and neither of whom may be the surgeon or other operator who is to perform the surgery. <h3>Selected references</h3> Adler, Peter. “Is it lawful to use Medicaid to pay for circumcision?” Journal of Law and Medicine, Vol. 19, December 2011: 335-353. Australian Safety and Efficacy Registry of New Interventional Procedures – Surgical. Report No. 65: Male non-therapeutic circumcision. Adelaide: Royal Australasian College of Surgeons, 2008. Australian Federation of AIDS Organisations. Male circumcision has no role in the Australian HIV epidemic. Briefing paper, 23 July 2007. Beauchamp TL, Childress JF. Principles of Biomedical Ethics (6th edn). Oxford University Press: 2009. British Medical Association, The Law and Ethics of Male Circumcision: Guidance for Doctors (November 2007). Available at http://www.bma.org.uk/ethics/consent_and_capacity/malecircumcision2006.jsp Darby, Robert. “Infant circumcision in Australia: A preliminary estimate, 2000-2010”. Australian and New Zealand Journal of Public Health, Vol. 35, August 2011 Darby, Robert and Robert Van Howe. “Not a surgical vaccine: There is no case for boosting infant male circumcision to combat heterosexual transmission of HIV in Australia.” Australian And New Zealand Journal of Public Health, Vol. 35, October 2011: 459-465. Available at http://onlinelibrary.wiley.com/doi/10.1111/j.1753-6405.2011.00761.x/full Darby, Robert. “Scientific advice, traditional practices and the politics of health-care: The Australian debate over public funding of non-therapeutic circumcision, 1985.” Hygiea Internationalis: An Interdisciplinary Journal for the History of Public Health, Vol. 10, December 2011. Available at http://www.ep.liu.se/ej/hygiea/ Forbes, David. “No evidence to support routine circumcision.” Sydney Morning Herald, 12 September 2009. On-line at: http://www.smh.com.au/national/letters/no-evidence-to-support-routine-circumcision-20090911-fkna.html Malone, Padraig and Henrik Steinbrecher. “Medical aspects of male circumcision.” British Medical Journal 335 (8 December 2007): 1206-1209. Narulla, Ranipal. “Circumscribing circumcision: Traversing the moral and legal ground around a hidden human rights violation”. Australian Journal of Human Rights, Vol. 12, 2007, 89-118 Royal Australasian College of Physicians. Circumcision of Infant Males [Policy statement]. Sydney: October 2010. Available at http://www.racp.edu.au/page/policy-and-advocacy/paediatrics-and-child-health Royal Dutch Medical Association. Non-therapeutic Circumcision of Male Minors (May 2010). Available at http://knmg.artsennet.nl/Diensten/knmgpublicaties/KNMGpublicatie/Nontherapeutic-circumcision-of-male-minors-2010.htm Spilsbury K, Semmons JB, Wisniewski ZS, Holman CD. “Routine circumcision practice in Western Australia 1981–1999”. ANZ Journal of Surgery 2003;73(8):610-4. Available at http://www.cirp.org/library/procedure/spilsbury1/ Svoboda JS, Van Howe RS, Dwyer JG. “Informed consent for neonatal circumcision: An ethical and legal conundrum.” Journal of Contemporary Health Law and Policy 2000;17:61-133. Available at http://www.cirp.org/library/legal/conundrum/ Van Howe RS. “A cost-utility analysis of neonatal circumcision.” Medical Decision Making 2004;24:584-601. Available at http://www.cirp.org/library/procedure/vanhowe2004/ <h2> <a id="colorado" name="colorado"></a>A comparable case in Colorado</h2> In the United States of America, where even the most minor local issues tends to be politicised, insurance coverage of non-therapeutic circumcision tends to become a political football. Last year Colorado dropped payments for circumcision from Medicaid (the USA equivalent of Medicare), but this year politicians in the state legislature who had been misled by the usual scaremongering propaganda put out by the usual suspects tried to restore it. Their arguments - for example, that the foreskin caused spina bifida, or that circumcision was good because it deadened the penis and discouraged teenage sexual activity - demonstrate why politicians should not get involved in these questions unless they have done some research.** Colorado drops circumcision from Medicaid A bill that would have restored Medicaid funding for circumcisions in Colorado died Friday. The measure squeaked through a hearing in the House Health and Environment Committee on Thursday, then died in Appropriations Friday morning. Opponents, who included health professionals, budget hawks and anti-circumcision activists told health committee members on Thursday that circumcision is cosmetic and potentially harmful, and taxpayers should not fund it. Proponents for the bill argued that funding for circumcision for babies on Medicaid is a social justice issue. In general, insurance companies pay for the procedure for insured Colorado babies even though the American Academy of Pediatrics does not deem circumcisions to be “medically necessary.” Meanwhile, low-income parents who want their babies circumcised are being put on waiting lists for the procedure until parents can prove they’ve paid in advance. Sen. Irene Aguilar, D-Denver, an internal medicine doctor for Denver Health, testified on behalf of restoring public funding for circumcision. Last year, Colorado lawmakers decided to save money and cut funding for Medicaid circumcisions. They were following the lead of 17 other states. Proponents wanted taxpayers to once again pay for the procedures for parents who choose to have their infants circumcised. Fiscal analysts estimated that covering the procedures again would cost the state about $195,000 next year and $230,000 the year after that. “As a physician, I don’t try to influence parents one way or the other,” Aguilar said. “People make this decision based on religious and cultural reasons.” She said that there is some evidence that infant boys who don’t get circumcised have higher rates of urinary tract infections and that adult men who are uncircumcised and live in poverty tend to have increased rates of HPV, which can lead to higher rates of cervical cancer in female partners. [What business does a medical doctor have performing unnecessary surgery based on religious or cultural reasons?] Only one other doctor testified on behalf of circumcision. The rest of the witnesses opposed public funding for the procedure for a variety of reasons. They included Dr. Jennifer Johnson, a family physician who works with Medicaid and uninsured patients at Clinica Family Health Services. “I’ve done at least 100 circumcisions and just recently decided to stop,” Johnson testified. She said she and her husband, who is Jewish, decided not to circumcise their own son, who is now 4. She said she was concerned when she researched the issue and found that removing the foreskin from a boy’s penis damages numerous nerve endings. While circumcision is traditional in the Jewish community, Johnson said her husband was open to new research about the potential harms from circumcision. If boys or men decide to remove the foreskin as adults, then they can make that decision, Johnson said. But she decided that as a physician, she should no longer do a procedure that is potentially harmful. “This is not a necessary procedure,” Johnson said. “It’s a healthy, normal body part. There are a lot of medical needs in our population. We have no business using limited health care dollars on a medically unnecessary cosmetic procedure.” One lawmaker, Rep. Sue Schafer, D-Wheat Ridge, elicited laughter in the hearing room when she asked Dr. Johnson if circumcision might help reduce teen pregnancy rates and teen sexual activity by reducing nerve sensation in boys’ penises. “I’m wondering if there’s a risk of more sexual activity, more male irresponsibility” for uncircumcised boys, Schafer asked. Johnson answered that teen pregnancy is certainly a problem, but said circumcision won’t halt teen sexual activity. “Circumcision is not a cure for behavior. That’s about education,” she said. While circumcision is an ancient tradition in some religions, circumcision opponents said it became popular in the U.S. as a method to prevent masturbation among boys. Later, fathers wanted their sons to look like them. “Frankly that’s cosmetic surgery…and I strongly urge you to vote against it,” said Dr. Matt Mason, a physician from Telluride. He was skeptical about cost estimates and said circumcision is now rare in Western Europe, Canada and New Zealand. [He might have added Australia; circumcision has always been rare to vanishing point in all Europe, not just the west.] Source: Katie Kerwin McCrimmon, <a href="http://www.healthpolicysolutions.org/?s=circumcision+colorado&x=0&y=0">Circumcision bill dies in Colorado House, Health Policy Solutions</a>, 5 May 2012 ** Take the example of a local senator, who claimed in an email to constituents that “Reliable studies prove that male circumcision reduces instances of infectious disease, some congenital obstructive urinary tract anomalies, neurogenic bladder, spina bifida and urinary tract infections.” He continued to dispense this fiction despite having been challenged previously by a competent physician, Dr. Mat Masem, who stated, “There are rare therapeutic indications for male circumcision, which generally relate to pathologic conditions of the foreskin. However, a number of the conditions you mentioned as being positively affected by circumcision have absolutely nothing to do with the foreskin. Spina bifida is an anomaly of the spine; congenital obstructive urinary tract anomalies are related to urethral strictures or other abnormalities of the urinary tract; and neurogenic bladder is a neurological condition. ” Source: Jere DeBacker, <a href="http://www.healthpolicysolutions.org/2012/05/01/opinion-lawmakers-clueless-about-circumcision-research">Opinion: Lawmakers clueless about circumcision research</a>, Health Policy Solutions, 1 May 2012. Social disadvantage vs anatomical/physiological disadvantage As for the argument that Medicaid/Medicare should cover circumcision because otherwise poor people cannot afford it (“Circumcision a health right of the poor”, as Brian Morris and Jake Waskett have claimed) - surely it’s bad enough to be poor. Why should poor people be deprived of their foreskins as well? That is merely adding injury to insult. <h2> <a id="hawke" name="hawke"></a>4. The Hawke government's unsuccessful attempt to drop circumcision from the MBS</h2> Robert Darby, Scientific Advice, Traditional Practices and the Politics of Health-Care: The Australian Debate over Public Funding of Non-Therapeutic Circumcision, 1985. <a href="http://www.ep.liu.se/ej/hygiea/" rel="noopener" target="_blank">Hygiea Internationalis: An Interdisciplinary Journal for the History of Public Health</a>, Vol. 10, December 2011. ABSTRACT In 1985 the Australian Government sought to delete circumcision of infants from the benefits payable under its newly established universal health scheme, Medicare. Although the decision had been recommended by the government’s health advisers and was welcomed by medical authorities, it was soon reversed after protests from Jewish community leaders. I present a detailed narrative of this affair and explain why a decision based on sound medical knowledge advice was rescinded after quite mild objections. The answer is found to lie partly in contingent factors, such as the details of the policy change, the personalities of the government figures involved, and problems with implementation and communication; and partly in the sensibilities of the ethnic/religious communities most directly affected. I dispel the misconception that the original decision aroused widespread opposition and show, on the contrary, that it was based on good advice, represented sound public policy, and was widely supported. I conclude that the episode may have useful lessons for other governments seeking to implement or resist policy changes that affect the sensitivities of cultural minorities. <a href="https://independent.academia.edu/RobertDarby" rel="noopener" target="_blank">Available at Robert Darby's Academia.edu page</a> <h2> <a id="smh" name="smh"></a>5. Sydney Morning Herald, The Question - Should elective circumcision continue to be covered by Medicare?</h2> <h3>Medicare should not cover non-therapeutic circumcision</h3> (a) Medical historian, Dr Robert Darby The Australian government is under pressure to balance budgets, give more recognition to individual human rights, promote gender equity and protect children from harm. One simple way to make progress on all these fronts is to drop non-therapeutic circumcision from the Medical Benefits Schedule. Medicare currently provides a no-questions-asked rebate for circumcision, despite the fact that most of these operations have no medical indication, and in defiance of Medicare’s own guidelines. These state that benefits are not payable for “medical services which are not clinically necessary”, nor “surgery for cosmetic reasons”. A medical procedure is clinically necessary only if it is essential to correct a diagnosed disease, injury, deformity or other pathological condition. Surgery for cultural or social reasons is essentially cosmetic surgery, intended to alter the appearance of the body. According to the Royal Australasian College of Surgeons, “male non-therapeutic circumcision is not clinically necessary as it does not treat an underlying pathological process.” Medicare should not, therefore, cover such procedures. There are five further reasons. 1. No health case for routine circumcision. All the medical authorities that have issued policies on routine circumcision have rejected the operation as unwarranted and potentially harmful, most recently the Royal Australasian College of Physicians in a lengthy statement of October 2010. 2. Consistency with international practice. Australia is the only country in the world that provides an automatic rebate for medically unnecessary circumcision. Even in the United States, 18 states have dropped circumcision from the list of benefits, and more are considering the question. 3. Ethics and human rights. The vast majority of circumcision procedures funded by Medicare are on infants and other minors, few of whom present any pathology requiring surgery. Since minors cannot give consent and may prefer to keep their foreskins, payments for such operations are questionable from a bioethical and human rights perspective, and may even be unlawful. 4. Avoiding sex discrimination. Girls are legally protected from any mutilation of their genitals; the least we can do for boys is not provide a public subsidy for needlessly modifying theirs. 5. Economy and financial prudence. Government welfare programs should be targeted at genuine need and be administered with prudence and economy. An open-slather approach to funding a medically unnecessary procedure is wasteful and invites over-servicing. For reasons of consistent public policy, financial prudence and respect for established principles of bioethics and gender equity, the rebate for circumcision should be abolished except for cases of proven medical need. NOTE: This is the original text of Robert Darby’s contribution to the <a href="http://www.smh.com.au/opinion/the-question/should-elective-circumcision-continue-to-be-covered-by-medicare-20120511-1yhqb.html">Question of the Week, Sydney Morning Herald, Saturday 12 May 2012</a>. The text as published was slightly edited. Dr Darby is an independent scholar who has written extensively on the history and ethics of male and female circumcision. His publications include A Surgical Temptation: The Demonization of the Foreskin and the Rise of Circumcision in Britain (University of Chicago Press, 2005) and, most recently, “Scientific advice, traditional practices and the politics of health-care: The Australian debate over public funding of non-therapeutic circumcision, 1985.” Hygiea Internationalis: An Interdisciplinary Journal for the History of Public Health, Vol. 10, December 2011. Available at http://www.ep.liu.se/ej/hygiea/ (b) Urologist Dr Stan Wisniewski Male circumcision is performed for religious, medical and social reasons. Religious circumcision is performed outside the ambit of the public health purse and is cost neutral, as long as no complications occur. Advocates of universal circumcision in newborn infants believe the procedure is a prophylaxis against future disease and that the phallus looks better and somehow functions better. Circumcision for infection, poor skin retraction or neoplastic changes is required in 5 to 10 per cent of males in the West. This means more than 90 per cent would not need the procedure in their lifetime. Infections in the foreskin or urinary tract are rare in infancy. The foreskin becomes retractile between 5-10 years of age and teaching hygiene should be intrinsic to healthcare. Contraction and transmission of sexually contracted diseases cannot be prevented by circumcision. The argument that AIDS is not transmitted by circumcised males is not factual. Penile skin cancer is rare and seen in situations of neglect and poor hygiene. One would need to perform 100,000 circumcisions to prevent one case of penile cancer. The idea that circumcision improves virility or sexual prowess is not scientifically validated. The foreskin has many sensory receptors important for sensual pleasure, and the mechanics of intercourse change when foreskin mobility is removed. The reason for performing surgery on neonates is a matter of expediency rather than scientific dictum. The operation is often performed without appropriate analgesia and screams and wriggling are ignored. Studies show many boys carry psychological scars afterwards, leaving them agitated and irritable for long periods, sometimes into adulthood. Physical consequences such as excessive skin removal, penile shortening, disfigurement and complications with bleeding and death are all reported. Many circumcised men express anger at parents for their decisions which they now regret, to the point of parents being sued. This is not a benign procedure free of problems. Rates of neonatal circumcision in educated, sophisticated societies continue to fall. A Medicare rebate for prophylactic neonatal circumcision would allow crusaders to continue to perpetuate a practice that is not substantiated. Nature, honed by millennia of evolution, decrees the foreskin is part of the perfection of humans. Until the time that other changes transmute, why do we think we can do better? Dr Stan Wisniewski is past president of the Urological Society of Australia & New Zealand. Source: <a href="http://www.smh.com.au/opinion/the-question/should-elective-circumcision-continue-to-be-covered-by-medicare-20120511-1yhqb.html">Should elective circumcision continue to be covered by Medicare</a>, Sydney Morning Herald, 12 May 2012 <h2> <a id="anu" name="anu"></a>6. ANU law student writes on why Medicare should not continue to pay for non-therapeutic circumcision</h2> The following paper was written in 2009 by a third year Law student at the Australian National University, as an assignment for a medical law and ethics unit. The author wishes to remain anonymous. It’s time for Medicare Australia to stop providing rebates for infant male circumcision ABSTRACT Infant male circumcision is a controversial procedure that has been debated for years. The overwhelming body of Australian medical opinion is firmly against the procedure and clearly classes it as non-therapeutic, yet the procedure is still covered by Medicare, despite their own guidelines stating they do not cover non-therapeutic procedures. This means the Australian government is indirectly authorising a non-recommended procedure. With the medical opinion firm, and in light of recent debates about the ethics and legality of male circumcision, now is the time for Medicare to stop covering this procedure. * * * * * * For years the potential benefits, disadvantages and ethical issues surrounding male infant circumcision have been debated in Australia and overseas. While male infant circumcision used to be common, even routine, in Western nations including Australia, it has dropped significantly in popularity as doctors and parents have become aware that it is not medically necessary or even recommended. Currently, it is estimated that around 10% of newborn baby boys are circumcised in Australia each year, at parental choice. As Medicare provides a rebate for circumcision of a boy under 6 months old, this unnecessary procedure costs Medicare, and therefore the Australian taxpayers, roughly $2 million each year. This is despite Medicare’s own statements that they do not provide rebates for clinically unnecessary procedures. Recent policies, reviews and cases relating to the medical, ethical and legal aspects of infant circumcision – such as the Tasmanian Law Reform Institute review, the Royal Australian College of Physicians new policy statement, and a case from the Oregon Supreme Court – highlight the importance of there being a swift policy change in Australia so that Medicare and the Australian Government come in line with current medical opinion and no longer indirectly endorse a non-therapeutic, non-recommended procedure fraught with legal and ethical uncertainties. <a href="https://www.circinfo.org/documents/Natasha-Medicare.pdf">To read full text, download document as PDF here</a> <h1>Lack of progress on Medicare reform attracts criticism</h1> Despite a series of reviews over the past few years aimed at containing costs and simplifying the system, there have been no significant changes to Medicare coverage of circumcision. The only changes have been to reduce the number codes (from four to two) and to make them unisex. This had had the unfortunate effect of making it impossible to calculate the number of circumcision procedures by age (thus obscuring the fact that the vast majority are of infants and young boys) and allowing circumcision of girls, as <a href="https://www.circinfo.org/Medicare_Coverage_Female_Circumcision.html" rel="noopener" target="_blank">previously documented on this site</a>. The latest report from one of the working groups, the Urology Clinical Committee, has proposed no changes to the circumcision codes at all, except for the requirement for analgesia (pain control). This is a desirable reform, but a less important issue than the fact that Medicare will continue to fund non-therapeutic (medically unnecessary) circumcision, including circumcision desired for religious, cultural and other social/cosmetic reasons. This is contrary to the provisions of the Health Insurance Act and the Medicare guidelines, which state clearly that benefits are payable only for “clinically relevant” services – i.e. procedures for which there is a demonstrated medical need. <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/mbs-review-2018-taskforce-reports-cp/%24File/v2%20-%20Urology%20Clinical%20Committee%20-%20Report.pdf" rel="noopener" target="_blank">The Committee report is available here</a>; the section relating to circumcision are on pages 68-70. <h2>Medicare should not pay for non-therapeutic circumcision</h2> For some years the Commonwealth Government has been concerned at the ever-rising costs of the ever-expanding health budget, particularly the cost of Medicare. In 2015 it resolved to establish a reform process, the aim of which was to simplify the system and reduce costs by eliminating services of low medical value. Non-therapeutic circumcision was identified as an example of such a low-value service, giving rise to the expectation that it would be dropped from the Medicare Benefits Schedule. This has not happened. In the first round of reforms all that happened is that the codes for circumcision were reduce from four (distinguished by age) to two (distinguished by type of anaesthesia) – thus making it impossible to determine how many infants and boys were being circumcised. In addition, the codes were made gender-neutral, allowing them to be used for circumcision of females – as is apparently happening. In a further round of reforms the <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/MBSR-consult-2018-taskforce-reports" rel="noopener" target="_blank">Urology Clinical Committee</a> tackled the circumcision codes and managed to produce a very small mouse. Of nearly 6000 items on the MBS, it managed to eliminate 18, of which circumcision was not one. The Committee’s sole recommendation was to require analgesia (pain control) for circumcision procedures, “thus ensuring patient wellbeing.” This is certainly a welcome move in the right direction, but it is not the main issue. More significantly, the Committee made no attempt to limit the availability of the circumcision rebate; on the contrary, it accepted the prevailing situation in which it is readily available for procedures carried out for religious or cultural reasons: The Committee noted that item 30654 should continue to include circumcisions conducted for religious and cultural reasons, reflecting both current practice and the need to ensure safe circumcisions. While this does not appear to be a formal recommendation, it presumably has the force of one. It is difficult to see how subsidising religious or cultural practices could be a legitimate use of the health budget, particularly as the Health Insurance Act and the Medicare guidelines state clearly that the rebate is available only for “clinically relevant” services – i.e. medical treatment that is actually needed for medical reasons. The policy is certainly in contradiction to the fundamental objective of the reform process: to rein in and control costs. The stated objectives of the reviews were to achieve: <ul> <li>Affordable and universal access</li> <li>Best-practice health service</li> <li>Value for the individual patient</li> <li>Value for the health system</li> </ul> An open-ended subsidy (essentially a blank cheque) for procedures of zero clinical relevance makes no contribution to achieving these objectives, and is in fact in complete contradiction to them, especially the last. Examining the <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/mbs-review-2018-taskforce-reports-cp/%24File/v2%20-%20Urology%20Clinical%20Committee%20-%20Report.pdf" rel="noopener" target="_blank">Urology Clinical Committee’s recommendations and observations on circumcision</a> in more detail, it is possible to raise six major objections to them, as set out below. Further information on this site <a href="https://www.circinfo.org/Medicare_circumcision_review.html" rel="noopener" target="_blank">Medicare Circumcision Review details</a> <a href="https://www.circinfo.org/Medicare_coverage_for_circumcision.html" rel="noopener" target="_blank">Medicare coverage of non-therapeutic circumcision criticised in submission</a> <a href="https://www.circinfo.org/Medicare_Coverage_Female_Circumcision.html" rel="noopener" target="_blank">Medicare coverage of female circumcision?</a> <h2>Medicare Benefits Schedule Review: Report of the Urology Clinical Committee</h2> <h3>A rational critique</h3> This response is directed at the recommendations relating to circumcision, at pages 68-70. 5.5.1 Recommendation 14 Amend the item descriptor to mandate the use of analgesia for this procedure. 5.5.2. Rationale for Recommendation 14 The item descriptor has been amended to mandate the use of analgesia, which ensures patient wellbeing. Comment While this is a progressive and desirable reform, it should be noted that analgesia does not necessarily “ensure patient wellbeing”, only that he is given a painless operation. The Committee noted that item 30654 should continue to include circumcisions conducted for religious and cultural reasons, reflecting both current practice and the need to ensure safe circumcisions. Comments 1. This proposal is regressive and inappropriate in that it is essentially offering a blank cheque to all parents who desire to have their boys circumcised, whatever their reason, as well as to those rare individuals who desire circumcision for themselves. The specification “religious and cultural” is meaningless and ineffective in the absence of a verification mechanism by which the religious/cultural credentials of the parents can be checked. Such a system is not proposed, and it would be complex to administer, and expensive even if the obvious difficulties could be overcome. In effect, the Committee has legitimised the existing open slather by which any individual who desires circumcision for himself or any parent who wishes to get a boy circumcised for any reason can require the public purse to meet part of the cost. Considering that the original objective of the various Medicare reviews was to rein in costs by eliminating procedures of low medical value, this seems highly counter-productive. 2. The argument about past practice is feeble and unacceptable. Merely because a certain policy has been followed in the past does not mean that it is desirable in or appropriate to current conditions; past practice is not best practice. The objective of reform exercises is to eliminate bad policies and replace them with good policies. Historical longevity is no basis for approving any practice in the contemporary world. As a matter of historical record, the government attempted to remove circumcision from the MBS in 1985, suggesting that in its original conception, Medicare was not intended to cover non-therapeutic circumcision at all. [1] 3. Related to (2), it is likely that payments for religious/cultural circumcision under Medicare are unlawful because the relevant act and associated guidelines provide that benefits are payable only for clinically needed procedures. As Michael Ryan, Assistant Secretary, MBS Policy and Specialist Services Branch, Department of Health, explains to Mr Peter Khalil MP (letter dated 6 November 2017, copy held by author): “The Medicare Benefits Schedule (MBS) provides benefits (or rebates) for a range of professional medical services, including circumcision. The Health Insurance Act 1973 stipulates that Medicare benefits are only payable for clinically relevant services provided by health practitioners. A clinically relevant service is one that is generally accepted by the relevant profession as necessary for the appropriate treatment of the patient. “On 1 November 2016 the MBS items for circumcision were restructured from four items to two items to separate them by the type of anaesthesia used, rather than by patient age. However, there have been no changes to the legal requirement that services must be clinically relevant, and there are no benefits available for non-therapeutic procedures.” In its current policy statement on circumcision the Royal Australasian College of Physicians concluded: “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.” That being the case, non-therapeutic circumcision (including circumcision procedures desired for religious/cultural reasons), must be regarded as clinically not-relevant, and hence ineligible for a Medicare rebate. 4. The argument about the need to avoid the risk of additional harms or complications that might arise if needy parents (those who claim to be unable to meet the full cost) would resort to less expensive unqualified operators (as in the backyard abortions and kitchen-table surgery of infamous memory) fails for 2 reasons. First, the argument about avoiding the risk of additional harm is not a reply to the proposal that parents etc should meet the full costs of medically unnecessary procedures, but to the proposition that such procedures should be legally prohibited. The Royal Dutch Medical Association, which would like to see non-therapeutic circumcision of minors banned, raised this point as the only consideration which deterred the from making such a recommendation in their 2010 circumcision policy statement. [2] But the current proposal is not that circumcision should be prohibited or restricted in any way at all, merely that individuals or parents who desire a medically unnecessary circumcision should meet the full costs. The mere fact that the procedure is covered by Medicare does not guarantee “safe circumcisions”. Complications and “botches” are still common in clinical settings, and at the hands of fully credentialed operators, often requiring expensive surgical repairs and sudden appearances in hospital emergency departments. [3] Ensuring patient safety is not the task of the MBS, but of the medical regulatory authorities. Further evidence for this point is provided by the two Medicare items for “arrest of haemorrhage following circumcision”, items 30649 and 30663; from a policy perspective the risks and complications of circumcision are real enough and recognised. There is thus a question as to whether these circumcision-related MBS benefits encourage unnecessary risk-taking behaviour on the part of parents and compliant practitioners. But what level of complications is acceptable in a clinically-unnecessary procedure? Second, the test of whether a person really values a good or service is how much he is willing to pay for it. Members of the religious/cultural groups that traditionally practise circumcision may be insistent that it is vitally necessary, but if they are not willing to put a price on it – if they do not wish to meet the actual costs involved – it suggests that they do not really regard it as necessary at all. To allow the rebate in this situation would be like allowing low-income families to drive a car without paying the full costs of vehicle registration because the expense is a strain on their resources. And here the full cost includes the insurance component, to cover the cost of accidents etc; the parallel with surgical complications of circumcision and the cost of repairing “botches” is quite exact. Most people regard the ability to drive as so vital that they are willing to meet whatever costs are involved. Moreover, some religious groups celebrate the circumcision with a lavish family party. If they are willing to pay for that, they should also be willing to meet the full costs of the surgery that is the occasion for the event. One assumes that they do not expect the taxpayer to subsidise the party. 5. Now that the Medicare circumcision codes have been made unisex or gender neutral, there is the danger that retaining coverage of religious/cultural circumcision will lead to Medicare providing a rebate for circumcision or other forms of genital cutting on girls. There is in fact evidence that this is already happening. [4] The religious/cultural groups that practise circumcision or other forms of genital cutting on girls regard the procedures as just as important and meaningful as circumcision of boys; if they see the rebate available for circumcision of the latter, they are likely to expect or even demand it for the former as well. And if cultural/religious affiliation is to be the deciding factor, how can their request be denied? [5] 6. While some defenders of circumcision have begun to advocate toleration of “mild” forms of female genital cutting, partly as a way of reducing the blatancy of the double standard (FGM legally prohibited, with heavy criminal penalties, circumcision of boys legal and generally unregulated), a stronger current of opinion stresses the importance of “genital autonomy” and the need to protect all children – male, female, intersex – from any form of non-therapeutic genital cutting. [6-10] It is puzzling and disappointing that the Committee displayed no awareness of these developments. References 1. Robert Darby. Scientific advice, traditional practices and the politics of health-care: The Australian debate over public funding of non-therapeutic circumcision, 1985. Hygiea Internationalis: An Interdisciplinary Journal for the History of Public Health, Vol. 10, December 2011. Available at https://www.academia.edu/7028494/Scientific_advice_traditional_practices_and_the_politics_of_health-care_The_Australian_debate_over_public_funding_of_non-therapeutic_circumcision_1985 2. Details at http://www.circinfo.org/Dutch_circumcision_policy.html 3. Gold, G. et al. Complications following circumcision: Presentations to the emergency department. Journal of Paediatrics and Child Health 51 (12) 2015: 1158-63; Jacques Gallant. Secrecy questioned about baby’s death after circumcision. The Star (Toronto), 26 October 2015. https://www.thestar.com/news/gta/2015/10/26/secrecy-questioned-about-babys-death-after-circumcision.html 4. See for example http://www.circinfo.org/Medicare_Coverage_Female_Circumcision.html 5. Brian Earp. Between moral relativism and moral hypocrisy: Reframing the debate on FGM. Kennedy Institute of Ethics Journal 26 (2) 2016: 105-144. Available at: https://www.academia.edu/10197867/Between_moral_relativism_and_moral_hypocrisy_reframing_the_debate_on_FGM_ 6. Brian Earp and Rebecca Steinfeld. Gender and genital cutting: A new paradigm. Euromind Global, 6 April 2017. Available at: http://euromind.global/en/brian-d-earp-and-rebecca-steinfeld/?lang=en 7. Robert Darby. The child’s right to an open future: Is the principle applicable to non-therapeutic circumcision?” Journal of Medical Ethics 39 (2013): 463-468. Available at: https://www.academia.edu/17264543/The_childs_right_to_an_open_future_Is_the_principle_applicable_to_non-therapeutic_circumcision 8. Eldar Sarajlic. Can Culture Justify Infant Circumcision? Res Publica 20 (4) 2014: 327-343. 9. Steven Munzer. Examining non-therapeutic circumcision. Health-Matrix: The Journal of Law Medicine 28 (2018). Available at: https://scholarlycommons.law.case.edu/healthmatrix/vol28/iss1/5/ 10. Kai Möller. Ritual male circumcision and parental authority. Jurisprudence 8 (3) 2017: 461–79. </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Medicare should not pay for medically unnecessary circumcision darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h3>Introduction</h3> The modern concept of human rights emerged in the eighteenth century as part of the European Enlightenment, expressed most vividly in the Declaration of the Rights of Man, but the modern concept of an individual right derives from John Locke’s arguments against the divine right of kings in his Treatise on Government, where he wrote that “every Man has a Property in his own Person. This no Body but himself has any Right to but himself. The Labour of his Body, and the work of his Hands, we may say, are properly his.” These ideas were developed by the natural law philosophers of the eighteenth century, who introduced the principles that individuals had inherent natural rights by virtue of their birth as human beings; that these rights were universal, in that they applied to all people, no matter what societies and cultures they were born into; and that depriving a person of these rights was a violation of the ethical - and to many writers, the divine - order. One such thinker was Francis Hutcheson, a liberal Christian thinker and significant influence on other eighteenth century philosophers, such as Adam Smith and David Hume, on which account he is often referred to as the "father of the Scottish Enlightenment". In his Short Introduction to Moral Philosophy (1747) he listed a number of natural rights. The first and second of these were "1. A right to life, and to retain their bodies unmaimed. 2. A right to preserve their chastity." A fourth right was "A right of liberty, or of acting according to one's own judgement and inclination within the bounds of the law of nature." [1] From these ideas arose the principle that a person's body was inviolable, that any touching without consent constituted assault, and hence the contention by the great English jurist William Blackstone that every man’s person was sacred and Justice Brennan’s reference to this principle (in his judgement in Marion's case) in affirming that “each person has a unique dignity which the law respects and which it will protect.” [2] The key points about human rights are that they pertain to individuals, not to groups or collectivities, and that their purpose is to protect the dignity of the individual and the integrity of his or her body and personhood. Thus, to take one example, the Australian Capital Territory Human Rights Act (2004) states that "Human rights are necessary for individuals to live lives of dignity and value" and that "Human rights are set out in this Act so that individuals know what their rights are". One purpose of the act is to "encourage individuals to see themselves, and each other, as the holders of rights, and as responsible for holding the human rights of others." (Preamble) Part 2 (6) of the Act states clearly "Only individuals have human rights." Section 10, "Protection from torture and cruel, inhuman or degrading treatment" states (Para. 2) that "No-one may be subjected to medical or scientific experimentation or treatment without his or her free consent." Section 11 (2) states that "Every child has the right to the protection needed by the child because of being a child, without distinction or discrimination of any kind". It is thus clear that Australian law recognises that human rights apply to individuals (not to societies or cultures or belief systems); that every individual has the same human rights; that children, without regard to the culture into which they happened to be born (i.e. the culture of their parents), are entitled by law to have their human rights protected and defended; and that experimental medical therapies may not be imposed on individuals without their free (meaning fully informed) consent. An important implication of this perspective is that a right is an assertion against power, something conferred by law or custom that those without power can deploy in their defence against those that do have power. In the relations between children and adults, it is the children who are powerless and the adults who hold the power, and it follows that the children are the party in need of the rights. It makes no sense to say that parents have the right to circumcise their children because parents already have vast power over them and can, in practice, do anything they like to them. Law, custom and (in recent times) human rights instruments attempt to even up this disparity in power by setting limits on what parents may do to their children. Several of these instruments make direct or implied reference to circumcision. <h2> <a id="declaration" name="declaration"></a>Universal Declaration of Human Rights</h2> Composed in the shadow of the Second World War, the Universal Declaration of Human Rights has nothing direct or indirect to say about genital or other bodily mutilations, but it is interesting to recall that the initial seed idea for a declaration of rights emerged from attempts by the Engish writer H.G. Wells to formulate some war aims in 1939, and that his first draft included a prohibition on bodily mutilation. The draft was included in a letter to the Times, Article 9 of which included the following words: “That no man shall be subjected to any sort of mutilation or sterilization except with his own deliberate consent, freely given, nor to bodily assault, except in restraint of his own violence, nor to torture, beating or any other bodily punishment.” [3] No statement as explicit as this was included in the declaration that emerged after the war, but some authorities have seen an implied criticism of mutilations in its provisions on self-determination, physical and moral integrity, and protection of children. [4] While most of the provisions of the UDHR relate to civil rights and assume (with the example of Nazi Germany in mind) that the principal enemy of human rights will be the state, it does include provisions that recognise individual rights as inherent, universal and unalienable, and that they may be threatened by other individuals and non-state entities. To take these one by one: <ul> <li>The Preamble recognises "the inherent dignity and of the equal and inalienable rights of all members of the human family."</li> <li>Article 1 states that "All human beings are born free and equal in dignity and rights."</li> <li>Article 2 states that "Everyone is entitled to all the rights and freedoms set forth in this Declaration, without distinction of any kind, such as race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status."</li> </ul> These provisions make clear that rights are not culture or gender-specific, nor generated by laws or custom, but pertain to all human beings everywhere by virtue of their humanity, irrespective of gender or the culture into which they happened to be born. Boys and girls therefore have the same rights. <ul> <li>Article 18, on freedom of religions, states that "Everyone has the right to freedom of thought, conscience and religion" and adds (in a clause that is often forgotten) that "this right includes freedom to change his religion or belief." The implication is that the freedom of, say Muslims, to follow their religion does not entitle them to kill apostates. A less obvious implication is that parents should not do anything to their children that will make it difficult or embarrassing for them to change their religion at later stage.</li> <li>Article 29 establishes that these rights are not absolute, but are subject to respect for the rights of other individuals and adherence to accepted ethical principles. It reads: "In the exercise of his rights and freedoms, everyone shall be subject only to such limitations as are determined by law solely for the purpose of securing due recognition and respect for the rights and freedoms of others and of meeting the just requirements of morality, public order and the general welfare in a democratic society." A phrase such as "just requirements of morality" will be a red flag to cultural relativists, but Johannes Morsink* has argued that what the drafters had in mind were the universalist principles developed by the natural law philosophers of the eighteenth century, culminating in the American Declaration of Independence ("Life, liberty and the pursuit of happiness") and the French Revolution's Declaration of the Rights of Man and Citizen, and, further, that in the late twentieth century these manifestoes have been provided the language for all nations and groups struggling against any form of oppression.</li> <li>Article 30 reinforces the point that in the exercise of their human rights, individuals must not infringe the rights of others: "Nothing in this Declaration may be interpreted as implying for any State, group or person any right to engage in any activity or to perform any act aimed at the destruction of any of the rights and freedoms set forth herein." Note the reference here to non-state entities (groups, other individuals), which are recognised as having the same potential to violate human rights as the state itself.</li> </ul> * Johannes Morsink, Inherent Human Rights: Philosophical Roots of the Universal Declaration (University of Pennsylvania Press, 2009) <a href="http://www1.umn.edu/humanrts/instree/b1udhr.htm" rel="noopener" target="_blank">Full text of Universal Declaration of Human Rights</a> <h2> <a id="child" name="child"></a>United Nations Convention on the Rights of the Child, 1989</h2> This contains two provisions relevant to circumcision, including one that has been interpreted as a specific prohibition of genital mutilation. Article 19 (1): States Parties shall take all appropriate legislative, administrative, social and educational measures to protect the child from all forms of physical or mental violence, injury or abuse, neglect or negligent treatment, maltreatment or exploitation, including sexual abuse, while in the care of parent(s), legal guardian(s) or any other person who has the care of the child. Article 24 (3): States Parties shall take all effective and appropriate measures with a view to abolishing traditional practices prejudicial to the health of children. It is hard to know what Article 24 (3) could refer to unless it was genital mutilation of children, and it has generally been interpreted as having this intent. The algebraic quality of the phrase has, however, allowed the emergence of interpretations that restrict the application of the article to women only. The reasons why the wording of the Convention on the Rights of the Child was so vague may be guessed, but that it was originally intended to refer to both male and female genital cutting was made clear in some of the subsequent consultations, such as in Lesotho, where a local committee reported: Culture is a component of education. Cultural activities like circumcision are not to be a hindrance to a child’s right to education. It is proposed that proper medication be administered at circumcision schools. Children should be allowed to decide at 21 years of age whether or not they want to be circumcised. [5] The reference here is to children’s right to decide, meaning both boys and girls. In Guinea-Bissau another report made clear that “traditional practices” were those affecting all children, not just girls: The report states that traditional practices and customs are causing serious problems for children and women. The circumcision of boys aged 9 to 13 years and female genital mutilation in girls aged between 7 and 12 years among the Fula and Mandinga ethnic groups are the most cruel and harmful practices. There are no effective measures at the national level to eliminate them. [6] Despite the reference to children, however, the rest of the report forgot about boys and went on to talk about the need for campaigns against female genital mutilation, and made no further mention of circumcision of males. This tendency for “traditional practices prejudicial to … children” to be increasingly interpreted as applying to girls only was deplored in a report to the United Nations by the National Organization of Circumcision Information Resource Centers, which pointed out: That international humanitarian law, insofar as it provides protection against rape and other sexual assaults, is applicable to men as well as women is beyond any doubt as the international human right not to be discriminated against (in this case on the basis of sex) does not allow derogation. Males may not be discriminated against in the application of human rights principles. United Nations experts have acknowledged that at least under certain circumstances male circumcision constitutes a human rights violation. [7] The reference in the last sentence is to a UN report on the civil war in Yugoslavia, which states that as well as women suffering rape and other forms of sexual violence, “Men are also subject to sexual assault. … They have also been subjected to castration, circumcision or other sexual mutilation.” [8] <h2> <a id="American" name="American"></a>American Convention on Human Rights</h2> The American Convention on Human Rights is an international human rights agreement adopted by the countries of the Americas in 1969. It came into force in 1978 after ratification by all the countries of Central and South America, with the exception of a couple in the Caribbean. The United States was an original signatory to the treaty, but did not proceed with ratification. Two provisions of the treaty embody an implied or explicit guarantee of physical integrity. Article 4, Para 1: Every person has the right to have his life respected This right shall be protected by law and, in general, from the moment of conception. No one shall be arbitrarily deprived of his life. Article 5, Para 1: Every person has the right to have his physical, mental, and moral integrity respected. Article 4 (1) has generally been interpreted as directed against abortion, which is the reason Canada decided not to adopt the treaty. Nonetheless, with its reference to respect for a person’s life, the provision could easily be interpreted as condemning any form of bodily mutilation, if the will and interest were there. Article 5 (1) is an explicit guarantee of physical integrity, and as such represents a clear prohibition of any bodily mutilation, including circumcision. <a href="https://en.wikipedia.org/wiki/American_Convention_on_Human_Rights" rel="noopener" target="_blank">Further details and full text of convention</a> <h2> <a id="African" name="African"></a>African Charter on Human Rights</h2> The African Charter on Human and Peoples’ Rights (also known as the Banjul Charter) is an international human rights instrument that is intended to promote and protect human rights and basic freedoms in the African continent. It emerged under the aegis of the Organisation of African Unity (since replaced by the African Union) which, at its 1979 Assembly of Heads of State and Government, adopted a resolution calling for the creation of a committee of experts to draft a continent-wide human rights instrument, similar to those that already existed in Europe (European Convention on Human Rights) and the Americas (American Convention on Human Rights). This committee was duly set up, and it produced a draft that was unanimously approved by the OAU in 1981. Part I (Rights and duties), Chapter 1 (Human and people’s rights) contain several articles which would appear to protect individuals from unwanted violations of their bodily integrity, such as circumcision. Article 2: Every individual shall be entitled to the enjoyment of the rights and freedoms recognized and guaranteed in the present Charter without distinction of any kind such as race, ethnic group, color, sex, language, religion, political or any other opinion, national and social origin, fortune, birth or other status. Article 4: Human beings are inviolable. Every human being shall be entitled to respect for his life and the integrity of his person. No one may be arbitrarily deprived of this right. Article 5: Every individual shall have the right to the respect of the dignity inherent in a human being and to the recognition of his legal status. All forms of exploitation and degradation of man particularly slavery, slave trade, torture, cruel, inhuman or degrading punishment and treatment shall be prohibited. Article 6: Every individual shall have the right to liberty and to the security of his person. <h3>Comment</h3> On the face of it, these articles represent the most explicit protection of individual bodily integrity to be found in any human rights instrument. Article 4 is especially direct, stating clearly that “Human beings are inviolable” and that "Every human being shall be entitled to respect for his life and the integrity of his person.” If this does not mean that he or she is protected from physical assaults such as circumcision, it is hard to see what could. It is significant that all these articles refer to individuals and stress that “every individual” has these rights as autonomous human beings. There is nothing here to suggest that an individual may be subject to the authority of religious or tribal elders, or that these rights may be exercised only as subject to traditional religious or tribal law and custom. The charter recognises only individuals and, on the face of it, asserts their rights as individuals against any collective entity or group claim. The whole point about rights is that they are an assertion against power and are meaningful only insofar as those without power can deploy them against those who do have the power – for example, wives against husbands, students against teachers, children against parents etc. To recognise individual rights is to accept that it is not only the state that may be a source of injustice. Presumably, the term “every individual” means males as well as females, children as well as adults, and boys as well as girls. Considering the extent of political violence in both Africa and South America, and the appalling incidence of forced circumcision in many African countries, it is sadly obvious that many of these treaties are not taken very seriously by the governments that have so optimistically put their signatures to them. <a href="https://en.wikipedia.org/wiki/African_Charter_on_Human_and_Peoples'_Rights" rel="noopener" target="_blank">Further information about charter</a> <a href="http://www1.umn.edu/humanrts/instree/z1afchar.htm" rel="noopener" target="_blank">Full text of charter</a> <h2>Other treaties: bioethics</h2> There are several further international conventions in the bioethics field that explicitly give children protection against unwanted or unnecessary medical and quasi medical-procedures. These are the Council of Europe’s Convention on Human Rights and Biomedicine 1997, and the UNESCO Universal Declaration on Bioethics and Human Rights 2005. <h3> <a id="biology" name="biology"></a>1. Convention for the Protection of Human Rights and Dignity of the Human Being with regard to the Application of Biology and Medicine</h3> Chapter II (Consent), Article 5, states as a general rule that "An intervention in the health field may only be carried out after the person concerned has given free and informed consent to it. This person shall beforehand be given appropriate information as to the purpose and nature of the intervention as well as on its consequences and risks. The person concerned may freely withdraw consent at any time." Article 6, Protection of persons not able to consent, states that “an intervention may only be carried out on a person who does not have the capacity to consent, for his or her direct benefit.” [9] Here the term “person” clearly refers to both males and females, both adults and children, and requires fully informed consent for any medical intervention. The provision amounts to an acknowledgement that people of any age or sex have the right to refuse unwanted medical or surgical interventions and to be protected from interventions they do not understand. <h3> <a id="bioethics" name="bioethics"></a>2. UNESCO, Universal Declaration on Bioethics and Human Rights</h3> This includes a number of clauses that appear to protect individuals from unwanted medical interventions. These are quoted in full: Article 3 – Human dignity and human rights 1. Human dignity, human rights and fundamental freedoms are to be fully respected. 2. The interests and welfare of the individual should have priority over the sole interest of science or society. Article 6 – Consent 1. Any preventive, diagnostic and therapeutic medical intervention is only to be carried out with the prior, free and informed consent of the person concerned, based on adequate information. The consent should, where appropriate, be express and may be withdrawn by the person concerned at any time and for any reason without disadvantage or prejudice. Article 7 – Persons without the capacity to consent In accordance with domestic law, special protection is to be given to persons who do not have the capacity to consent. Article 8 – Respect for human vulnerability and personal integrity In applying and advancing scientific knowledge, medical practice and associated technologies, human vulnerability should be taken into account. Individuals and groups of special vulnerability should be protected and the personal integrity of such individuals respected. [10] <h3>Comment</h3> It is readily apparent that circumcision of a non-consenting minor, unless essential to correct a deformity, malfunction, injury or disease that has not responded to conservative treatment after a fair trial, would breach every one of these provisions. In Article 3 (2), “interest” should be interpreted in a wide sense as including all the individual’s interests apart from “welfare”. These might include self-esteem, body image, aesthetic preferences, cultural allegiances, erotic practices and self-identification, all of which might be seriously affected by the presence or absence of the foreskin. Article 8 gives special protection to the personal integrity of those unable to protect themselves, that is, to infants and children. These treaties and conventions do not have the force of law in Australia, but they nonetheless represent an aspirational ideal to which the Australian community has declared its commitment. It is quite possible for a practice to be unethical and wrong but still legal, or at least tolerated by the law; but the aim should be to reform the law to bring it into closer alignment with what is ethically desirable. It becomes embarrassing if human rights and law drift too far apart. <h2> <a id="refs" name="refs"></a>References</h2> <ol> <li>John Locke, An Essay Concerning the True, Original Extent and End of Civil Government (Second Treatise on Government), Book II, Chapter V; Francis Hutcheson, A Short Introduction to Moral Philosophy, ed. Luigi Turco (Indianapolis: Liberty Fund, 2007), 129</li> <li>Department of Health & Community Services v JWB & SMB (" Marion's Case ") [1992] HCA 15; (1992) 175 CLR 218 (6 May 1992); discussed in Gregory J. Boyle, J. Steven Svoboda, Christopher P. Price, J. Neville Turner, <a href="http://www.cirp.org/library/legal/boyle1/">Circumcision of healthy boys: Criminal assault?</a> Journal of Law and Medicine, Vol. 7, 2000</li> <li>H.G. Wells, “The rights of man”, letter to Times, 25 October 1939, 6A; reprinted in The Rights of Man; or What Are We Fighting For? (Harmondsworth: Penguin Special, n.d. [1940])</li> <li>For example, the United States group, <a href="http://www.arclaw.org/arc_human_rights_table">Attorneys for the Rights of the Child</a>.</li> <li>Committee on the Rights of the Child, Initial reports of States parties due in 1994: Lesotho. 20/07/98. CRC/C/11/Add.20. (State Party Report).<a href="http://www.unhchr.ch/tbs/doc.nsf/(Symbol)/739266a4d55f1969802566e2003f7b92?Opendocument"> Full text available here</a>.</li> <li>Committee on the Rights of the Child Considers Initial Report of Guinea-Bissau, United Nations Press Release, 22 May 200.<a href="http://www.unhchr.ch/huricane/huricane.nsf/view01/39E976491EF5DD8DC1256BC20029E249?opendocument"> Full text available here</a>.</li> <li>Submission by Nocirc to the U.N. Sub-Commission on the Promotion and Protection of Human Rights, 23 March 2002, Document E/CN.4/Sub.2/2002/NGO/1.<a href="http://www.cirp.org/library/ethics/"> Full text available here</a>. </li> <li>United Nations Security Council,<a href="http://www.his.com/~twarrick/commxyu1.htm"> Commission of Experts’ Final Report [on the former Yugoslavia]</a>, 27 May 1994, document S/1994/674, part IV, section F.</li> <li>Council of Europe, Convention for the Protection of Human Rights and Dignity of the Human Being with regard to the Application of Biology and Medicine.<a href="http://conventions.coe.int/Treaty/en/Treaties/Html/164.htm"> Full text available here</a>.</li> <li>UNESCO,<a href="http://portal.unesco.org/en/ev.php-URL_ID=31058&URL_DO=DO_TOPIC&URL_SECTION=201.html"> Universal Declaration on Bioethics and Human Rights</a>, 2005.</li> </ol> </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource International human rights treaties darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> With the proclamation of the South African Children’s Act in April 2010, South African boys now have a significant level of legal protection against unwanted circumcision. The act gives children the right not to be subjected to social, cultural and religious practices detrimental to their well-being, and prohibits circumcision of male children under the age of sixteen except in cases where there is a valid religious reason, or if the operation is medically necessary for therapeutic purposes. Although these are significant loopholes, the act still gives South African boys considerably greater legal protection than is enjoyed by boys in Australia or most other countries. The relevant sections of the act are printed below. <h2>Republic of South Africa, Children’s Act 2005 (No. 38 of 2005)</h2> <h3>Chapter 2, General Principles</h3> Best interests of child standard 7. (1) Whenever a provision of this Act requires the best interests of the child standard to be applied, the following factors must be taken into consideration where relevant, namely – … (l) the need to protect the child from any physical or psychological harm that may be caused by (i) subjecting the child to maltreatment, abuse, neglect, exploitation* or degradation or exposing the child to violence or exploitation or other harmful behaviour; or (ii) exposing the child to maltreatment, abuse, degradation, ill-treatment, violence or harmful behaviour towards another person. Best interests of child paramount 9. In all matters concerning the care, protection and well-being of a child the standard that the child’s best interest is of paramount importance, must be applied. Social, cultural and religious practices 12. (1) Every child has the right not to be subjected to social, cultural and religious practices which are detrimental to his or her well-being. (8) Circumcision of male children under the age of 16 is prohibited, except when – (a) circumcision is performed for religious purposes in accordance with the practices of the religion concerned and in the manner prescribed; or (b) circumcision is performed for medical reasons on the recommendation of a medical practitioner. (9) Circumcision of male children older than 16 may only be performed – (a) if the child has given consent to the circumcision in the prescribed manner; (b) after proper counselling of the child; and (c) in the manner prescribed. (10) Taking into consideration the child’s age, maturity and stage of development, every male child has the right to refuse circumcision. * NOTE: The Act defines “exploitation”, in relation to a child, as “all forms of slavery or practices similar to slavery, including debt bondage or forced marriage; sexual exploitation; servitude; forced labour or services; child labour prohibited in terms of section 141; and the removal of body parts." <h3>Comment</h3> As you can see, although this is a great step forward, it is not without problems. For a start there is gross gender discrimination, in that girls are given blanket protection against any kind of harm, but boys have to make do with qualified and limited protection. The exception for “religious purposes” allows practising Jewish and Muslim parents to circumcise without constraint, but the failure to specify the religions accorded the exemption provides a loophole for anybody who wants to invent his own religion – as occurred <a href="http://scienceblogs.com/pharyngula/2009/10/aaaah_horrible_wretched_wicked.php">in a recent Canadian case</a>, where the father decided that the religion he had just invented allowed him to circumcise his four-year-old. Even more seriously, the reference to “medical reasons” fails to define what they are. If what is meant is a situation where circumcision is necessary to treat an injury, deformity or disease that has failed to respond to conservative treatment after reasonable efforts, that is one thing, and the provision will provide a significant level of protection. If, on the other hand, what is meant is circumcision performed in the belief that it will reduce the risk of contracting diseases to which the child may be exposed at some later date (i.e. prophylactic or precautionary circumcision), that is quite another, and the provision will provide no protection at all against the circumcision promoters. Most non-religious circumcision is prophylactic circumcision, but it should not be confused with therapeutic circumcision (i.e. treatment for an existing problem). It is significant that in its paper on the legal status of circumcision of male minors the <a href="http://www.law.utas.edu.au/reform/">Tasmania Law Reform Institute</a> is careful to explain that prophylactic circumcision is not therapeutic. Still, South Africa is way ahead of Australia and most developed nations in making some attempt to crack this difficult nut. <h2>“Unethical and illegal”: South African Medical association rejects circumcision of infants</h2> In a letter dated 23 June 2011, the South African Medical Association has stated that it does not support the practice of circumcision of infants as a means of preventing HIv transmission and that it considers circumcision of infants to be both unethical and illegal. The letter was signed by Ms Ulundi Behrtel, Chairperson of the Human Rights, Law and Ethics Committee. The full text of the letter follows: 23 June 2011 Mr Dean Ferris, Co-Director National Organisation of Circumcision Information Resource Centres South Africa Dear Mr Ferris CIRCUMCISION OF BABIES FOR PROPOSED HIV PREVENTION We refer to the above matter and your email correspondence of 16 February 2011. The matter was discussed by the members of the Human Rights, Law & Ethics Committee at their previous meeting and they agreed with the content of the letter by NOCIRC SA. The Committee stated that it was unethical and illegal to perform circumcision on infant boys in this instance. In particular, the Committee expressed serious concern that not enough scientifically-based evidence was available to confirm that circumcisions prevented HIV contraction and that the public at large was influenced by incorrect and misrepresented information. The Committee reiterated its view that it did not support circumcision to prevent HIV transmission. We trust that you will find this in order. Yours faithfully Ms Ulundi Behrtel Head: Human Rights, Law & Ethics unit Obo Chairperson: Human Rights, Law & Ethics Committee SA Medical Association A pdf of the letter is available on request. <h2>South Africa Children’s Act fails to protect boys from circumcision</h2> A correspondent in South Africa has sent a long letter explaining that, despite its apparent prohibition of circumcision, the South African Children’s Act does not protect boys from circumcision, but actually makes it easier for parents and government authorities to get them circumcised. This is disturbing news, revealing that massive violations of human and child rights are occurring in South Africa, with the connivance of the United Nations and without any protests from international human rights bodies. The only groups that seem to be protesting are anti-circumcision organisations such as <a href="https://www.facebook.com/NocircSouthAfrica" rel="noopener" target="_blank">Nocirc South Africa</a>, and (surprisingly) the <a href="https://www.circinfo.org/africa.html">South African Medical Association</a>, which has consistently rejected schemes to promote circumcision as a response to South Africa’s high prevalence of HIV infection. The letter shows circumcision is now being promoted by an authoritarian government, with a high level of propaganda, bullying and other coercion. With regard to the information on your website about the South African Children’s Act, it is not accurate that South African law protects boys from unwanted circumcision, especially minor boys. I am a South African, and it is clear to me that parents take boys for circumcision up to the age of 16, whether they like it or not. Section 8 of the Children’s Act states that circumcision of male children under the age of 16 is prohibited, except when (a) circumcision is performed for religious purposes in accordance with the practices of the religion concerned and in the manner prescribed. But there is no regulation to determine how religious a parent is or which religions can legitimately circumcise. An atheist can say “I believe in Allah” and there is no contest: that is sufficient, as attendance at Mosque, church or any participation is not required for the circumcision to be categorised as religious. Any person can say they circumcise because they are Jewish, or like a friend who said she was Israeli, but a Christian rather than Jewish. The Zulu people used not to circumcise, but they have decided to start circumcising, and suddenly claim that it is their culture and 100% legal: all the Zulu king had to say is “I support Circumcision”, and now it is mandatory for all Zulus to be circumcised. Sub-section (b) allows an exception for circumcision to be performed for medical reasons on the recommendation of a medical practitioner. But this is not interpreted to mean that there is a medical condition requiring circumcision: HIV prevention is recognised as a medical reason, and there are no guidelines to limit which medical reasons may be appealed to. It is confirmed that HIV prevention is a valid reason. South African authorities accept that circumcision reduces the risk of HIV infection and therefore that it is “medical reason”. Furthermore any person who is registered under Health Professions Act 1974 (including dentists) is a medical practitioner by law. Even a dentist’s recommendation is valid under this law, which does not require a recommendation to come from the child’s GP. Another popular misconception is the meaning of Section 10: “Taking into consideration the child’s age, maturity and stage of development, every male child has the right to refuse circumcision.” This section requires the child to be of sufficient “age” and “maturity“ and “well developed” to be entitled to refuse. Because of the word AND, all those criteria must be met before his right to refuse is valid. There is no legal definition of maturity or stage of development, and on this point there are two schools of thought: some say the age of consent is 12 for medical procedures, meaning that the boy must be at least 12 to refuse or to be legally recognized in a medical procedure. Others reason that the law makes special provision for consent for circumcision at age 16 and older. The right to refuse means the right to withhold consent, which is applicable only when the boy turns 16. If a parent or guardian provides surrogate consent for a boy under 16, then the medical practitioner may circumcise him, and no consent from the boy himself is required. This makes it difficult to determine whether a boy under 16 can actually refuse to consent or whether his consent is required. It is likely that circumcising a boy under 16 against his expressed wishes will still be legal, while it is certainly legal to circumcise a boy under 12 against his will. To take an example, let say the boy is 13 and has still has a non-retractable foreskin. The doctor say he has incurable phimosis and must be circumcised or he will be at risk of cancer later. The boy refuses because he is scared and does not understand the seriousness of the problem. Would that mean the parents no longer have any say because he chooses to refuse? Of course not: in that case the parents can consent, and whether he likes it or not that phimotic foreskin must be removed. But the law does not make any distinction between a phimosis and HIV prevention. In terms of the circumcision law “medical reasons” mean that one is as valid as the other. Both are medical reason deemed beneficial to the child’s interest. Social pressure Another aspect is social pressure, with schools and the media promoting circumcision. When a parent wants a boy circumcised, he is already conditioned to think that its expected and it is the right thing to do, so he is unlikely to resist even if he does not like the idea. Parents tell boys that they must be circumcised because of the benefits (“It’s better, girls like it more” etc) and scare him with stories of what will happen if he doesn’t cooperate. That also causes boys not to resist and to believe they have to cooperate. Furthermore, boys generally lack knowledge and are easily intimidated by the authority of parents, thus leading them not to question or argue. For this reason a friend of mine who is a nurse says that minor boys are queued at hospitals for circumcision regardless of whether they like it or not. A boy who protests falls under the category of “All children are scared of medical procedures, even the dentist, so just try to keep him calm so that we can proceed”. For practical reasons Section 10 places no limits on parental power when boys are under 16. The only area where the laws on circumcision are often enforced is with illegal non-medical practices and forced circumcision of boys older than 16. But these legal actions are very few. There has never been a case where the law has been invoke to protect or avenge a boy under 16. It is a professional opinion of a legal practitioner that; prior to the new law there was no law protecting parents who circumcise boys or protection for practitioners or for government to promote circumcision in formal ways. Government cannot promote it and parents cannot insist on it if the legal position is uncertain. Under the new legal framework circumcision is now officially legal, there are less risk for both parents and practitioners to circumcise boys as long as it is within the law. This seems to increase the incidence of circumcisions rather than decrease it. Furthermore the age for consent for medical procedures is 12, but they made special exception with male circumcision to set it at 16. This will cause boys not to be able to consent when under 16. This was also done to upscale circumcision by allowing parents to circumcise boys up to older ages without their consent being required. Pressure from World Health Organisation and aid agencies The next consideration is that the Children’s Act was written in 2005 – before it became official policy that circumcision reduces the risk of HIV infection, and before the South African government committed itself to the United Nations’ requirement to circumcise 80% of men by 2015. The legal framework helps to mobilize government to encourage circumcision officially, as there is a legal position for it which gives legal and official sanction to mass circumcision programs, while schools and teachers preach the benefits of circumcision for school boys and girls. This sort of pressure leads boys to give in to circumcision more easily, and encourages girls to put pressure on boys to get circumcised in order to be cool or accepted as manly or sexy. While circumcision was always a 100% male thing as a native tradition, only 30% of men support it, compared with 80% of women. By having circumcision legal in terms of the law and to give parents right to consent on the boys’ behalf now gives mothers the legal right to decide on circumcision for their boys. With 90% of single parents being mothers they are in a stronger position to make that decision than men. Further, the rights of the biological mother applies also give her more decision making power. Only if a father can prove in court that circumcision is harmful for the boy would her ability to consent not apply anymore. While the law recognizes circumcision as legal and beneficial it is unlikely that any court would take away the mother’s right to consent. The law also requires all circumcision to be done medically and formally, which means that gender equality laws apply. This means that at least 50% of doctors and nurses who perform these circumcisions must be women. This helps to empower women and stop female exclusion from the practice. Professors at universities even speculate that the law may be amended to accommodate South Africa’s commitment to upscale circumcision, as the current law was drafted before the commitment to circumcise 80% of men. The only restrictions on circumcision being contemplated relate to the non-medical (bush) circumcisions performed by the Xhosa. While many used to escape circumcision on account of the high death rate, calling it unsafe and thus giving more voice for intactivists and other circumcision critics, the new law ensures that boys are circumcised by doctors or nurses in clinics or hospitals. This makes the operation safer and undermines the arguments of anti-circumcision critics. This also increases the incidence of circumcision. The circumcision rate in South Africa is growing rapidly, and the pressure on men and boys to be circumcised is greater than ever before. Organisations such as USAID, UNAIDS, UNICEF, MRC, WHO, CDC, Brothers for life, Engender Health, Section27, PEPFAR all sponsor and promote the upscaling of circumcision. Hundreds of millions of dollars are now invested in mass circumcision programs, and circumcision clinics are popping up like mushrooms. Circumcision is here to stay and will become the new norm. If anything the Children’s Act helped to upscale male circumcision and to turn it into a cultural norm more than anything else. The upscaling of circumcision is driven international aid agencies. WHO requires 14 African countries to upscale circumcision to 80% of men between ages 15 and 49, and many practices target boys around 14. The South African government is supporting it, and even TV and radio ads are aired all the time to encourage it, while big billboards encourage men to get circumcised and the benefits of circumcision is also tough at schools. This is South africa’s HIV prevention program. Similar policies are being urged or followed in Rwanda, Tanzania, Swaziland, Zimbabwe, Zambia, Uganda, Kenya, Botswana, Ethiopia, Malawi, Namibia, Lesotho, Mozambique. Basically, according to the WHO, all African countries who do not normally circumcise, have to start circumcising men now. Details at: http://www.who.int/hiv/topics/malecircumcision/male-circumcision-info-2014/en/ The Bill and Melinda Gates foundation and PEPFAR have been two major sponsors of circumcision in South Africa. For details see: http://www.bpmcc.co.za/research.htm http://southafrica.usembassy.gov/us-government-partners-with-higher-education-medical-male-circumcision-campaign2.html In South Africa, every province has created a number of circumcision clinics where men and boys can be circumcised for free. As mentioned, the Xhosa people in South Africa practice circumcision of late teenage boys as a rite of passage. The Zulu people did not, but in 2006 the king made it a compulsory part of their tradition. The government’s major concern is that about 100 boys die each year as a result of this practice. The main focus of the Children’s Act now is not to stop circumcision, but to make it safer and ensure that it is done medically. The reason so many boys die is because guys from the townships take boys into the bush and use pieces of glass or old blades to circumcise them. Often these guys are not even experienced, let alone qualified. The boys are initiated and have to live without food and water in the bush under harsh conditions. Many end up with dehydration that causes death, or infections or injuries that causes many to loose their genitals completely. Therefore, the first priority is to ensure that no boy goes into the bush and get circumcised with pieces of glass, but rather has it done by a doctor or nurse. If it is done medically in hygienic conditions the risk of complications is much lower. The law allows circumcision, but now makes it a criminal offence now for unqualified thugs to go around kidnapping boys and cutting them in dangerous ways. All boys must have it done in a medical setting. Further information http://www.news24.com/SouthAfrica/News/Botched-circumcision-death-toll-rises-20140704 New medical practices for mass circumcision program in Africa: (1) All bush circumcision becomes medicalised circumcision. (2) All-male practices becomes practices with both male and female medical practitioners. http://www.cdc.gov/globalhealth/countries/southafrica/partners/winnie.htm http://www.ubuzimabwacu.com/inama/4664/rwanda-bugesera-male-circumcision-encouraged-reduce-hivaids-stds-infections/ http://thepump.jsi.com/reducing-the-spread-of-hiv-through-voluntary-medical-male-circumcision-jsis-experience-in-east-central-uganda/ Bill boards like this pop up everywhere to promote circumcision http://www.aidscirc.org/2012/07/how-circumcision-solution-in-africa.html http://www.avert.org/voluntary-medical-male-circumcision-vmmc-hiv-prevention.htm http://www.eurojewcong.org/News%20and%20Views/10273-circumcision-as-defence-against-hiv.html http://blogs.scientificamerican.com/guest-blog/2011/04/04/whats-the-deal-with-male-circumcision-and-female-cervical-cancer/ Women are encouraged to encourage their partners and sons to get circumcised; some of the media looks like this: http://www.c-hubonline.org/sites/default/files/resources/main/SMC%20Stand%20Proud%20Get%20Circumcized_Billboard%201.jpg http://www.c-hubonline.org/sites/default/files/resources/main/SMC%20Stand%20Proud%20Get%20Circumcized_Billboard%202.jpg http://www.c-hubonline.org/sites/default/files/resources/main/SMC%20Stand%20Proud%20Get%20Circumcized_Disruptive%20Poster.jpg http://www.c-hubonline.org/sites/default/files/resources/main/SMC%20Stand%20Proud%20Get%20Circumcized_Rural%20Poster%201.jpg </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource South Africa passes law to restrict circumcision darby