Male Circumcision and Self-Determination

12/13/2016 08:34 am ET

Every so often the practice of neonatal male circumcision becomes a news item, typically when some medical association issues a statement on the practice. Last week it was the turn of the Danish Medical Association, which recommended the practice be stopped. Prominent among the reasons cited for this conclusion was that the procedure permanently alters a child's body, something which should not be done, the Danish doctors argue, without the informed consent of the person whose body is affected.

The Danish doctors' recommendations are in line with most Europeans' thoughts on this issue. By contrast in 2012, the American Academy of Pediatrics emphasized that there were definite health benefits to male circumcision, a conclusion which the Centers for Disease Control seconded in draft guidelines in 2014. In particular, male circumcision reduces the risk of infant urinary tract infection and the risk of contracting STDs later in life. There is also a reduced risk of other health problems, such as penile cancer.

However, even those who maintain that circumcision has health benefits recognize that the most that can be said in favor of circumcision is that "the health benefits ... outweigh the risks [but] existing scientific evidence is not sufficient to recommend routine circumcision." Although circumcision reduces the risk of developing various medical problems, the overall risk of these medical problems is small, whether one is circumcised or not, especially if one is prudent in one's sexual practices (e.g., by wearing a condom).

For the most part, the empirical information relied upon by the dueling medical associations is the same -- but their interpretation of the data is different. The difference in views among the various medical associations, and other health groups, appears to be due, in part, to cultural factors. Most Europeans are not circumcised, whereas circumcision is not uncommon in the United States.

Given this background, one might conclude that circumcision should be largely a non-issue: it's a procedure that's medically justified, but not necessary. Whether the procedure should be performed on one's newborn is something that can be left to parental discretion.

That conclusion, however, would be fiercely resisted by many opponents of circumcision, some of whom are adamant in their rejection of the practice. For them, male circumcision is "genital mutilation." One critical principle animates this opposition and it is the one alluded to by the Danish Medical Association, namely that no permanent changes should be made to a person's body without their consent, which, of course cannot be obtained until that person is legally an adult.

This principle has strong intuitive appeal, at least in our contemporary world. Who could argue with self-determination? But upon reflection, the principle that no permanent changes should be made to somebody's body without their consent is impossible to comply with.

To put it mildly, the brain is an important part of a person's body. It's certainly more important than the foreskin of the penis. One's brain is inevitably shaped by the parents or guardians one has as a child. This is not some metaphorical allusion to the information that's put into one's brain nor am I referring to one's genetic inheritance -- no, the physical structures of one's brain are changed based upon one's training and education. For example, the brains of literate people differ from the brains of illiterates. Similarly, musical training affects the architecture of the brain.

Most developed countries do exercise some control over the training and education children receive, imposing various legal standards and restrictions, but even so, wide scope is given to parents in terms of how they raise their children. Homeschooling is permitted in the United States, for example, with minimal oversight in most states. (Interestingly, homeschooling is forbidden in some European countries, such as Germany--again a significant cultural difference.) With respect to training in music or sports, parents can subject their children to extensive training, just short of physical abuse. Hour after hour of piano practice or swimming lessons. When grown, these children might be grateful for their training, or they may resent the physical or psychic pain they had to endure while forced to pursue an activity which they never liked. On the other hand, some children will receive no training in music or sports, something which they may regard as a handicap in later life. Either way the bodies of these children will have been permanently altered by their parents.

We rightly value self-determination, but our ability to choose our own path and make our own decisions about our bodies begins after our bodies have already been shaped by our parents in ways we are powerless to change. In this light, agonizing over the loss of a foreskin is an unwarranted, excessive reaction.

Nothing in the foregoing analysis should be interpreted as saying we should allow parents to change their children's bodies in any way they regard as suitable just because their role in shaping these bodies is inevitable. Clearly, limits should be-- and are --imposed on what parents can do. Parents cannot inflict disabling injuries on their children. But, as indicated, the evidence regarding male circumcision is that it provides some small benefits. It cannot plausibly be characterized as medically necessary, but, with appropriate use of analgesia, it's not harmful. The energies that some devote to opposing male circumcision might be better spent lobbying for tighter regulation of homeschooling. The cerebral portion of young male bodies should receive as much attention as the genital portion.