Friday 8 November 2013

'Cutting Tradition,' BBC Radio 3

Recorded at BBC Radio 3’s Free Thinking Festival of Ideas at the Sage in Gateshead, 27 October 2013, and broadcast on BBC Radio 3, 7 November 2013. Listen here:

For those of you who are squeamish, please don’t worry, I’m not going to share with you the graphic details of what I saw as an 11 year-old girl when I snuck into our family living room and peered from behind the couch as my eight day old brother was circumcised. So rest easy. Instead, I am going to talk about the political storm brewing around religious circumcision. Less than a month ago, the Parliamentary Assembly of the Council of Europe passed a motion that declared the circumcision of young boys for religious reasons “a violation of the physical integrity of children.” Although the motion is non-binding, some charged the Council of Europe with Islamophobia and anti-Semitism. Others stressed the importance of protecting children from bodily violations justified in the name of religion. One said, “If a group demanded that infants must have a finger removed to comply with its belief structure, every civilised society would rightly outlaw the practice. Why is removal of part of the external genitalia any different?”

This debate is not a marginal issue affecting a small number of men: approximately 30% of males aged 15 years or older are circumcised around the world. Two thirds are Muslims living mainly in Asia, the Middle East and North Africa, 0.8% are Jewish. In the United States, the circumcision rate is now around 33%, whereas in the United Kingdom the vast majority of men remain intact with less than 5% circumcised. The age at which circumcision is undertaken varies depending on cultural and religious traditions, occurring from immediately after birth to the early twenties. The reasons for circumcising also vary: for Muslims it’s sunnah, meaning a practice instituted by the Prophet Muhammad, while for Jews brit milah of boys on their eighth day is a sign of God’s covenant with Abraham. For many it marks their entrance into manhood, while the procedure is also performed because of its perceived social or health advantages.

The history of circumcision is ancient. The oldest account is an image in an Egyptian tomb built sometime around 2400BC, which depicts temple priests cutting the genitals of two young noblemen. “Hold him and do not allow him to faint,” reads one inscription, leading to speculation that the ritual was an opportunity for a youth on the threshold of manhood to demonstrate mastery over bodily pain. Ancient Israel inherited circumcision from Egypt and attempts to limit circumcision were sometimes part of broader efforts to suppress Jewish practice. Antiochus Epiphanes, the draconian ruler of Judea in the second century BC, imposed severe penalties for circumcision as part of his assault on Judaism, as did the Roman Emperor Hadrian as part of his discrimination against all Judeo-Christian sects.

In the 19th Century, circumcision became popular when the nerve theory of the body suggested cutting the genitals could cure a number of ills, including paralysis, epilepsy, and mental illness, as claimed by a prominent New York doctor, Lewis Sayre. Later, germ theory contributed to the idea that the circumcised penis was cleaner and more hygienic. There has also been a persistent belief that circumcision could reduce masturbation, first pronounced by the great Jewish sage Maimonides who advocated circumcision to reduce excessive lust. This belief became prevalent during the Victorian era, and by the 1930s 35% of newborns were circumcised in the UK.

Two things changed in the 20th Century that led to a decline in the rate of circumcision. First, many of the original claims of health benefits were gradually discredited, leading medical organisations to change their positions. Today, leading European health organizations now advise against circumcision, although – interestingly – the American Academy of Pediatrics takes a more positive position, perhaps reflecting different cultural norms between the US and Europe.

Second, the fiendish human experiments conducted by German medical scientists during the Second World War left a legacy on both discussion of human rights and medical ethics. During the Nuremberg war crimes trials, it became evident that no clear standard of ethical conduct existed for medicine and medical research. As a result, the 1947 Nuremberg Code said “the voluntary consent of the subject is essential,” and Germany enshrined “human dignity” in its Basic Law of 1949 as an inviolable first principle. The United Nations made increasingly explicit rights declarations, culminating in the Convention on the Rights of the Child in 1989, which bound nations to “protect the child from all forms of physical or mental violence, injury or abuse.” That same year, activists gathered in the US for the First International Symposium on Circumcision.

Alongside this, the international community began to condemn female genital cutting, including the UK, which outlawed the practice in 1985. Those in the West have considered female genital cutting harmful and a violation of a woman’s rights, even in its least invasive form, whereas male circumcision has been generally accepted. That led some to ask why the two should be judged differently, and whether the distinction amounted to a double standard.

It is in this context of swirling concerns about human rights, physical integrity and sexism that a German regional court in Cologne ruled in 2012 that the medically unnecessary circumcision of boys should be treated as a criminal act in the area under its jurisdiction. The ruling elicited outrage and generated news headlines around the world. A leading European rabbi described it as “the worst attack on Jewish life since the Holocaust”. But another reading is that the court’s ruling makes sense in the context of Germany’s post-Holocaust emphasis on individual rights and physical integrity. But the pressure of accusations of anti-Semitism was too great: six months after the Cologne ruling, the German Bundestag passed a law explicitly protecting religious circumcision.

And this brings me back to the debate in Europe today. There are three main issues at stake, I think: First, where are the limits on parents’ religious rights? Second, what are the best interests and rights of the child? And third, is the contrast in attitudes towards male and female genital cutting justified? 

Turning to the first question: when and under what circumstances should parents’ religious rights be limited?

Defenders of circumcision often point to Article 9 of the European Convention on Human Rights, which guarantees the “right to freedom of thought, conscience and religion,” and includes the “freedom to manifest one’s religion or beliefs.” This right is then linked with the undoubtedly profound meaning Jews and Muslims attach to genital cutting, and the significant leeway given to parents to bring up their children as they see fit.   

But opponents of circumcision point out that the right to manifest one’s religion is not absolute and is limited by the harm caused to others. It does not justify exposing a child to disease, injury or death. In 2011, in Birmingham Children’s Hospital, 11 boys under the age of one were treated for life threatening haemorrhage, shock or sepsis relating to circumcision. This raises the question of whether religion per se can justify the procedure. Critics also counter that neither the longevity nor meaning of a particular practice are usually accepted as sufficient moral justification to override individual rights. Some even question how essential circumcision is, since there is no specific mention of it in the Qur’an and nor does it confer Jewish status, which exists independently of the practice. Still, there is no doubt that circumcision is currently perceived as definitional by many Jews, even as a growing number publicly question the practice or express private doubts.

Moving onto the second question, how should children’s rights and best interests be understood?

Defenders of circumcision claim that the child is better off circumcised, since his wellbeing and development depend on his belonging to a community. That community should therefore be allowed to apply to him some practices whose main justification is that they are constitutive of membership in that community. Because children in these communities are likely to choose to be circumcised as adults, defenders of the practice say it reduces the violation of their self-determination, and increases their interest in avoiding the additional costs of adult circumcision. The alleged health benefits are also said to be in the best interests of the child, protecting him from urinary tract infections and sexually transmitted diseases.

Conversely, those concerned with children’s rights argue that circumcision violates the child’s right to bodily integrity, which is a cornerstone of human rights law. They also view it as undermining the child’s right to an open future, particularly because a significant number of children go on to reject the religion of their parents. This means that circumcision does undermine their self-determination, especially since an uncircumcised man can get himself circumcised, whereas a boy who has been circumcised does not have this option and must live forever with his parents’ choice. Critics also question the claimed health benefits, as we have already heard, and say evidence showing reduced HIV transmission among adults in Africa does not apply to children or in other contexts. They also argue that circumcision can cause physical, psychological and sexual harm.

My third question is whether the different attitudes to male and female genital cutting are justified?

Some reject the comparison on the basis that the two are incomparable: they say female genital cutting is a form of oppression aimed at restricting sexual pleasure whereas male circumcision is neither. But the situation may be more complex. Both female and male genital cutting violate children’s physical integrity in order to make their bodies conform to certain social ideals or their parents’ cultural beliefs. Female genital cutting takes many different forms, some of which are extremely invasive and detrimental to both health and sexual pleasure, but others less so. Indeed there has been resistance from some circumcised women to the pejorative term female “genital mutilation,” leading some scholars to adopt the more neutral term “genital cutting.” Male circumcision may also not be as innocuous as its advocates claim. It too can cause health problems and reduce sexual pleasure. One of the rationales for the practice was reducing lust, as I mentioned earlier. In this sense, like female genital cutting, male circumcision can be seen as being rooted in the desire to both shape male bodies and control male sexuality. Arguably, therefore, the same ethical considerations and legal restrictions could apply.

Given these debates about the rights of parents, the rights of children and the overlaps between male and female genital cutting, what, if anything, can be done to resolve these tensions? I want to end by briefly looking at three possible approaches: the first is accepting that personal freedom is the price of societal diversity – an approach rooted in a respect for pluralism and multiculturalism. To preserve the community, one sacrifices some individual rights, in this case those of the individual child. The problem is that sacrificing basic concepts like individual rights and bodily integrity to a particular worldview focused on community could be a slippery slope.

The second approach is more purist and more rights based. It would involve banning ritual infant circumcision outright in order to safeguard the rights of the child. There are problems here too though. Prohibition could have troubling side effects, such as a black market for the banned practice involving ‘back-alley’ circumcisions performed by incompetent individuals.

A third approach is to reduce the harm caused to children by constraining the practice in ways that minimally infringe on religious rights, such as prohibiting circumcision without anaesthesia, insisting that it only be performed by a properly qualified paediatric surgeon in a hospital, and outlawing certain religious practices such as sucking blood from the wound. The challenge to this approach is that while it alleviates actual harm, it fails to overcome the fundamental issues of the lack of consent to an irreversible procedure, and the undermining of the child’s right to bodily integrity.

None of these approaches is likely to resolve the problem to everyone’s satisfaction because the argument about circumcision is part of a much wider battle between religious subcultures seeking to demarcate and inculcate norms for their members, and liberal societies committed to protecting individual rights and equality. Critiquing a religious practice such as circumcision from the perspective of modern medical ethics is controversial and accusations of religious prejudice can follow quickly. So one needs a thick skin to enter this fray. But wrestling with these subjects, with the weight of God, history and human rights hanging in the balance, is the challenge of every new generation. Little did I know that I would rise to this challenge and enter this fray when I hid behind the sofa in my parents’ living room on the day my baby brother was circumcised.