Male circumcision is an ancient practice, closely connected with religious beliefs and ethnic background. However, these days, it is also performed under the influence of medical reasons, primarily related to hygiene. More recently, this practice has been the subject of growing criticism. Although in some countries circumcision is a part of historical, cultural, and religious traditions fixed with the centuries-old practice, there are numerous concerns about the ethical and medical expediency of the conduction of this surgery with non-therapeutic purposes.
Debates on the Admissibility of Circumcision
Male circumcision involves the surgical removal of the foreskin, which often occurs in infancy. Nearly one-sixth of the male population of the Earth has undergone the procedure of circumcision. Avraham Faust states that “circumcision has received a great deal of scholarly attention”. Experts still cannot come to a consensus about the use and safety of this procedure.
While male circumcision is often associated with Judaism and Islam, this procedure is also widespread among other populations due to a number of religious, cultural, or rarely medical reasons. The Jews children are circumcised on the 8th day after birth, the Muslims – on the 13th year of life. According to the World Health Organization (WHO), male circumcision for cultural reasons is found among people of sub-Saharan Africa, Australian Aborigines, Aztec, Maya, individual ethnic groups in the Philippines, and inhabitants of the Pacific Islands. Thus, in these areas, male circumcision is an acceptable and encouraged procedure approved from a religious point of view, which is often equated to standard pediatric procedures. It is conducted in public and private health facilities and medical and ethical aspects of this ritual do not evoke any questions.
Nevertheless, in most countries, the debates on this issue do not stop. This fact puts Muslims and other religious and ethnic groups that practice male circumcision in a difficult situation requiring from them other arguments to justify the procedure. The issue of circumcision of male infants with therapeutic purposes has caused numerous debates in many developed countries. Moreover, the debates became acuter after a series of severe complications of circumcision. “The negative medical evaluations of circumcision come to color its legal reception in Europe”. In June 2012, the subsequent decision of the German court ruled that male circumcision inflicts serious damage to health.
Risks and Benefits from a Medical Point of View
In general, the whole argument involves four key principles of biomedical ethics, namely autonomy, benefit, safety, and justice, which define the responsibilities of the physician regarding the patient. These concepts are the basis of the entire legal framework regulating the provision and financing of health services. These principles are mostly considered separately from religious values and within the framework of a secular system of professional ethics. Nevertheless, according to some scholars, they are clearly traced in Islamic teachings. First, the practice of male circumcision in infancy is disputed on the basis of the ethical considerations related to the protection of the child’s right to physical integrity and self-determination. In addition, the disputes also concern the health risks of the procedure.
The main group of critics of circumcision includes physicians and scientists in the field of medicine. “Health is the primary focus in debates over circumcision”. Based on their clinical experience and research, physicians argue that circumcision is associated with an increased risk of adverse health effects, including bleeding, infection, and erectile dysfunction. Opponents point out the ethical principles of safety and benefits. They stress that the main principle of the doctor is not to harm patients and take care of the preservation of their health and well-being. Conclusiveness is one of the central pillars of the modern view on the medical intervention. Therefore, opponents of circumcision argue that there is a need to reflect the evidence of the prevalence of risk over the benefit in medical practice and health policy. Circumcision can be conducted not only by doctors but also by nurses. After the procedure of circumcision, the role of nurses is extremely significant. They look after the patient as the care for circumcised penis is important and help prevent postoperative complications.
A number of medical associations, including the British Medical Association and the Royal Dutch Medical Association, adhere to the line of criticism. They are involved in the critical discussion about the medical aspects of male circumcision in infancy in non-therapeutic purposes and the revision of standards in this area. In several European countries, a result of this criticism was a campaign in support of the legal prohibition of this type of circumcision. In parallel, in many US states, there were calls to cancel the insurance coverage of the male circumcision operation.
Some medical experts agree that the evaluation and application of new scientific evidence in policy and practice of public health have a fundamental importance. However, at the present time, there are significant differences in regard to the quality and objectivity of the available scientific evidence on the health risks and benefits of male circumcision. Discrepancies of the scientific basis of male circumcision in infancy are reflected in a sharp debate in reputable medical journals and accusations of medical associations being prejudiced in the assessment of the medical scientific basis of this procedure.
Different views on these data are also reflected in the attitudes of influential international and national human rights and professional organizations, such as the WHO and the American Academy of Pediatrics. They claim that male circumcision has a preventive benefit and positive impact on the health of the population. They also affirm that this medical procedure reduces the risk of HIV infection sexually transmitted. Muslim organizations, clinicians, and scientists adhere to the same line of reasoning in favor of male circumcision, although the benefits in terms of hygiene and health effects have always been a secondary argument in support of this procedure. In addition, there are attempts to challenge the completeness of the existing scientific evidence on male circumcision in infancy. There are suggestions not to restrict the arguments in favor of circumcision to such areas as physiology, disease prevention, and sexual life but to extend the list of arguments supporting this procedure in psychological and social aspects. Many religious people affirm that at an early age, circumcision has a positive effect on the identification process and the formation of a sense of belonging to a religious community. However, the debate on male circumcision in terms of a purely medical science really advances arguments that are difficult to challenge.
Respect for Religious Diversity and Human Rights
The second line of criticism focuses on the child’s right to physical integrity and self-determination, which is reduced to the biomedical principle of autonomy. This category of opponents of male circumcision claims that this procedure violates many international declarations and agreements, including the Universal Declaration of Human Rights, the Convention on the Rights of the Child, the International Covenant on Civil and Political Rights, and the Convention against Torture.
In response to this group of arguments and largely based on the principles of human rights related to religious and cultural diversity, Muslims and other people point out the obligation to respect individual’s values, autonomy, and religious freedom. From this perspective, the prohibition of male circumcision in infancy violates the UN Convention on the Rights of the Child, which assigns parents the right to make a choice for the child. The European Convention on Human Rights also speaks about respect of family, private life, freedom of thought, conscience, and religion. Jewish communities have joined these arguments expressing concerns about the violation of the right to freedom of religion. However, opponents of this argument state that this procedure is a violation of human freedoms. If children support the same religious beliefs as parents, they can have this procedure conducted in adulthood at their request.
Legal Aspects and Risk Reduction Strategies
Finally, the last group of arguments lies in the legal plane and touches upon possible consequences of a ban of procedures of male circumcision at an early age. Undoubtedly, the resumption of debates on male circumcision in many countries can have implications for the millions of believers if the ban on circumcision is adopted at the legislative level. It is quite possible judging from the emotional disputes in some countries and steadfast attention of the public, doctors, and politicians who strongly wish ban male circumcision in infancy in non-therapeutic purposes. These disputes are reduced to the probability that the prohibition of practices based on deep religious convictions will result in the conduction of circumcision in bad conditions. Consequently, it will contribute to the risk of adverse effects on children’s health.
Circumcision is an operation aimed at the removal or excision of the prepuce of the penis in men. This procedure can be done according to the medical or hygienic reasons. Circumcision in infants without medical indications has some disadvantages. The main statement against this operation lies in the fact that human rights activists argue that the removal of any part of the human body is not permitted without the consent of a person. Since circumcision is mostly performed in infancy, the procedure is considered antihuman.