Monday, December 14, 2015

Intactivism and Feminism

by David Balashinsky

Like all social reform movements, intactivism follows logically from certain universal principles. That is one of the reasons why intactivists find it mind-boggling that our position is not shared universally. After all, how can anyone possibly disagree with the proposition that no one should have his or her genitals altered without his or her consent? Our adversaries look upon us as though we are crazy while we view them as morally inconsistent and perversely blind to their own moral inconsistency. This can only be explained by a cultural schism between the two sides in this debate. When intactivists look at male genital mutilation, we view it within a certain philosophical and moral framework that requires us to condemn it because the act itself is morally incompatible with the underlying (or overarching) moral framework. When proponents (or those who simply have never questioned whether male genital mutilation is consistent with the moral framework to which they probably already subscribe) look at genital mutilation of boys, it is not that they are not seeing what we are seeing but that they have placed forced infant male circumcision conceptually outside of the moral framework that governs most other aspects of their beliefs and conduct. It is as though male genital mutilation exists for them in another dimension beyond the purview of the principles of bodily integrity and basic human rights. Thus, intactivism has much in common with the abolitionist- and civil -rights movements. Jefferson and many other champions of "the rights of man," after all, saw no contradiction between their belief in basic human rights and slavery because enslaved Africans existed for them conceptually outside of the moral framework of those rights. Similarly, advocates and acceptors of MGM place male genital mutilation conceptually beyond the scope of rights and principles that they take for granted in all other respects.

That is why, when the abolitionist movement was gathering steam in the U.S. during the nineteenth century, the notion of human rights was not new but it took a cultural shift to expand the definition of "human" to include enslaved African Americans. The fact that the U.S. constitution was written by freedom-loving men, many of whom, like Jefferson, were at the same time slave-owners, represents a moral inconsistency in the foundation of our republic that could not even begin to be rectified until the issuing of the Emancipation Proclamation and the passage of the XIVth amendment. (Indeed, the legacy of this moral inconsistency - our nation's history of structural racism - to this day has not been adequately confronted.) The concept of basic human rights was not new: both the French and American revolutions were based on the Enlightenment ideas of universal human rights. What the abolitionist movement and its heir, the civil rights movement, did was merely to apply the same principles universally so as to include African Americans. These movements did not invent a new concept of rights but merely demanded that diaspora African Americans be brought within the fold of humanity and within the ambit of those rights so that those rights might at last be applied universally to all humans and not just to white property-owning men.

The suffragist-feminist movement had similar origins and has had a similar history. When the revolutionary minds of the European Enlightenment and behind the French and American revolutions conceived of the inalienable "rights of man," what they really meant was the rights of white, property-owning men. And just as the abolitionist- and civil-rights movements expanded the compass of "human rights" to include humans who were not white, so the suffragist-feminist movement expanded the compass of human rights to include humans who are not male.

Intactivism owes much to the civil rights movement and to feminism. It is their natural heir and ally. The concept of bodily integrity and autonomy - the right not to have one's genitals altered without one's consent - is not a new idea. But, like our civil-rights- and feminist predecessors, it is our job to bring infant male and intersex genital integrity within the ambit of rights that are already accepted by most people as axiomatic.

The question arises from time to time to what extent feminism and intactivism share a common moral foundation and to what extent they are in conflict with one another. This question arises mainly, and regrettably, because there is a strand of anti-feminist thought and polemics that runs through the larger tapestry of the intactivist movement. I believe, however, that the anti-feminist-pro-genital-autonomy philosophy is based not only on a misunderstanding of feminism but on a failure to recognize the fundamentally sexist and patriarchal origins of circumcision itself.

Writing as a victim of MGM, as a male feminist and as an intactivist, it is my conviction that feminism and intactivism both stand upon a single philosophical and moral foundation. Feminists and intactivists should therefore be natural allies. After all, the principles of bodily integrity and autonomy, which are at the core of the intactivist movement, are also at the core of feminism. The feminist claims on behalf of women's rights, including the right to safe and legal abortion, the right to contraception, and many other specific rights that are important to feminism, follow inevitably from the principles of bodily integrity and autonomy. Likewise, the principle of genital integrity for members of both sexes follows from these same principles.

A critical feature of feminism that is often overlooked by its critics and detractors is that feminism has always been a movement intended to liberate both sexes from their rigidly prescribed (and largely constructed) gender roles. Although patriarchal and sexist culture harms girls and women differently than it does boys and men, it harms boys and men, too, and the ways in which it does have been explicated and argued by feminist theoreticians more than by anyone else. The very concept that men should be liberated from their traditionally constructed gender roles - as breadwinner, as stoic, competitive, aggressive, violent, and unflinching in the face of pain - are feminist ideas. The claims on behalf of boys and men to be free to experience their full humanity and free to explore the full range of human emotion and experience are claims that were being made by feminist writers and theoreticians on behalf of boys and men decades ago. That, incidentally, is one of the reasons that the anti-feminist and MRA criticism of feminism as being somehow "anti-male" or pro-women's rights at the expense of men's right's is not only baseless but perversely and preposterously baseless.

Yet if intactivism is the natural heir of feminism (and of the civil rights movement more remotely), why has it not gained more traction with feminists? I think there are several possible answers to this question.

First, it must be acknowledge that some of the most eloquent champions of the cause of genital rights for males are in fact self-professed feminists, so it is not as though intactivism has escaped their notice. Their analyses of how intactivism fits within the broader philosophical framework of feminism are readily available on the internet and I would urge the reader to follow the links provided to these several good examples of feminist intactivist thought.

http://www.huffingtonpost.com/miriam-pollack/circumcision-identity-gen_b_1132896.html

http://barreloforanges.com/2013/03/06/circumcision-is-a-feminist-cause/


http://www.circinfo.org/Circumcision_and_women.html

But secondly, and to the extent that intactivism has failed to gain more traction with feminism than feminist-intactivists such as I might wish, I suspect it is probably due to the fact that power structures are adept at pitting against one another natural allies who, were they to make common cause, would make short work of their common enemy. Thus, the 1% adroitly makes blue-collar workers resent the poor, rather than the rich; it makes white-collar, middle-management and small business owners resent civil servants, rather than corporate CEOs with their bloated compensation packages. Poor whites are encouraged to resent blacks and immigrants.

So with women, men, feminism and intactivism. Patriarchal institutions adroitly foment male resentment against women for problems that affect men. And there certainly are kernels of truth within the MRA list of grievances. But the fact remains that the vast majority of these grievances reflect problems that have been created largely by men themselves. MRAs, for example, frequently complain about how our system of laws is tilted against men and in favor of women. Yet the U.S. has proportionally less women in government than almost half of all the other nations on Earth, so it is absurd to blame women and feminism for this state of affairs. The U.S. congress, after all, is not dominated by feminists. In fact, female representation - to say nothing of feminist representation - in congress is proportionally very low. As the Daily Kos reported back in 2012, out of the world's 195 nations, "the U.S. ranks 80th on the list of the percentage of women serving at the congressional level." This same source notes, incidentally, that even Afghanistan has proportionally more women in government than the United States has.

This is exactly the state of affairs with respect to circumcision. This ancient, Abrahamic practice derives from a fundamentally patriarchal religion. That a patriarchal religion should sprout from a patriarchal culture should surprise no one. Islam - adherents of which comprise the overwhelming number of males who are circumcised around the world, - likewise is a patriarchal religion and reflects the patriarchal culture in which it originated. Here in the United States, RIC was promoted during the 19th century by a medical profession that was dominated by men. Does anybody believe that the male Victorian physicians who advocated circumcision were feminists? And yet instead of looking to our patriarchal and sexist legacy as the obvious source of circumcision, MRA intactivists instead direct their wrath against feminists - the very people, in other words, who are working to dismantle the patriarchal culture that gave rise to circumcision in the first place.

Thus, feminists are not merely being kept busy fighting battles on behalf of girls and women but are contending at the same time with an unwarranted antipathy toward and a scapegoating of themselves by men which is fostered and facilitated by a pro-circumcision, anti-feminist power structure that is only too happy to see these natural allies turned into competitors and adversaries. I cannot speak as a feminist woman, of course, since I am a feminist man and my experience in the world is different, but I think I can imagine that the constant barrage of sexist attitudes and imagery - to say nothing of the anti-woman and anti-feminist invective being spewed daily by certain politicians and loudmouths in the media - might not leave women feminists particularly inspired to take up the cudgels on behalf of infant boys' genital integrity.

Another explanation for the failure of the intactivist movement to gain more traction among those who identify as feminists could be simply that the very word "feminism" has been skillfully vilified by reactionary anti-feminists. Thus, many people - of either sex - who, by inclination and principle might identify as feminists, are loathe to do so because of the success that anti-feminists have had in discrediting and misrepresenting feminism. For example, I have known not a few women who eschew the label of "feminist" and buy into the whole Rush Limbaugh feminist-bashing narrative and yet, if you ask them about particular matters of concern to them as women and as mothers, their concerns and principles for the most part reflect unabashedly feminist concerns and principles. This technique of prying women away from an organized feminist movement to which their social, legal, and economic interests should naturally make them gravitate has the effect of separating them from a philosophical organizing principle that would also be more likely to lead them to embrace intactivism. That probably holds for men, too. (Indeed, in my own case, my feminism preceded my intactivism and it was the former that prepared the ground, in my own philosophical development, for the latter.) Perhaps it is because women and men in our society are discouraged from looking at patriarchal power structures critically and deconstructing them through the feminist critique of power that an unquestioning acceptance of patriarchal authority and custom is fostered. But it is precisely this - an unquestioning acceptance of authority and custom - that has created a cultural environment in which routine infant male circumcision has thrived in the U.S. for over 150 years. Routine infant male circumcision, then, is an integral part - not an aberration - of the patriarchal power structure. We need more feminism, not less, in order to end both.

Still another explanation could be the phenomenon of attributing pro-male-genital mutilation attitudes to women who may - in contrast to women who shun the label "feminist" but in fact are - profess themselves feminists but in fact are not. After all, anybody can call herself anything she wants, but that does not make her what she professes to be.

On this head, I first need to question here, parenthetically, whether such a phenomenon is not merely an updated trope of the "castrating shrew." On numerous occasions now in online threads I have come across complaints by anti-feminist intactivists that feminists are indifferent to the plight of male victims of genital mutilation, and that this belies feminists' professions in support of bodily rights and equality. And yet, in my own experience and through my own observations, such a chimera is rarely to be found. On the contrary, as noted above, feminist women are in the vanguard of the intactivist movement.

But let us, in the interest of fairness and for the sake of being thorough, allow that there may be feminists who have not yet fully absorbed the fundamentally feminist principle of genital autonomy for all sexes, including intersex. For the most part, the major flaw of those feminists who are not animated on behalf of the cause of genital rights for all is merely that they labor under the same cultural prejudice in favor of circumcision in which its "benefits" are routinely touted and its harms as well as the human rights violation in which it consists are routinely minimized or discounted altogether. But this makes feminists who are indifferent to the wrongness of circumcision certainly no worse than anyone else who is equally indifferent to it. Of course, feminists, precisely because feminism strives for full equality among all sexes and genders, set themselves up to be held to a higher standard, and so it is fitting that they should be held to a higher standard. But holding feminists to a higher standard does not mean that they should be scapegoated and alienated from our cause. It is our job, as intactivists, to reach out to them and to win them over rather than to push them away. In the internet age, where invective and ad hominem attack have largely supplanted reasoned discussion, that will take enormous patience and self discipline.

At the same time, to the extent that there is a population of feminists which has not yet fully absorbed the fundamentally feminist principle of genital autonomy for all, of these I can only say that either they are not true feminists or they are not fully realized feminists. Male genital mutilation goes against absolutely everything that feminism stands for. A self-professed feminist who would exclude infant boys from her conception of universal human rights, including genital integrity, is analogous to a champion of "the rights of man," such as Thomas Jefferson - to return to that worthy - who is at the same time a holder of human chattel. The fallacy is not in the theoretical framework of the rights themselves but rather in their inconsistent application. Indeed, Jefferson's error was both a moral one and one of logic. His ultimate failing, though, was not that he was a champion of human rights but simply that he was an inconsistent one. The solution to Jefferson's inconsistency would simply have been a greater and more inclusive definition of humanity, hence, a more inclusive application of human rights. Similarly, a self-professed feminist who does not recognize both a moral and logical inconsistency inherent in a simultaneous belief in feminism and acceptance of male genital mutilation is laboring under the untenable burden of supporting a feminism that is not fully realized, and inconsistently applied. Thus, with respect to feminism and intactivism, when the former fails to embrace the latter, the problem is not with feminism itself but rather with its incomplete application to all humans. The solution is more feminism - not less. Intactivists, therefore, should criticize such incompletely realized feminists not for their feminism but for their want of it.

I began by observing that the divide between the intactivist community and those across the chasm is a cultural one. It is a difference in worldview. Routine infant male circumcision will only end when we have won enough hearts and minds to effect a cultural shift. The way to get there is not by alienating and scapegoating those who ought to be and probably are our natural allies. In this respect we need to take a page from the civil-rights, feminist-, and gay-rights playbooks. The successes that these movements have had thus far did not come about by their proponents' differentiating and segregating themselves from the rest of society but precisely the opposite - by demanding entry to the club: by demanding a consistent application to themselves of principles already embraced by society broadly. And just as the civil rights movement did not seek to create something novel but merely the application of universal human rights to blacks, and just as the feminist movement has not sought to create something novel but merely the equal application of universal human rights to females and males, so the intactivist movement should endeavor to call society to a better version of itself in which the principle of genital integrity is finally applied universally, protecting boys and intersex children as well as girls. In other words, we need to make unambiguously clear to those who have yet to join us that it is our side that is in possession of moral consistency and legitimacy. We need to do this, partly, because it is the right thing to do. But, more importantly, because our movement will remain consigned to the fringes if we don't.

Sunday, October 18, 2015

Some Reflections on "With a Spate of New Laws, California May Be the Most Progressive State in the Nation," by Sonali Kolhatkar in Truthdig

by David Balashinsky

From Truthdig (Oct. 15, 2015) comes this interesting review of recently enacted legislation in the state of California.

http://www.truthdig.com/report/item/with_a_spate_of_new_laws_california_may_be_the_most_20151015

These are all great. Unfortunately, California also leads the nation in reactionary and regressive legislation when it comes to human rights and genital autonomy. To my knowledge, California is the only state in the union with a state-wide ban (signed by Governor Brown in 2011) on local ordinances that would regulate, restrict, or ban male genital mutilation (non-therapeutic infant circumcision). That would be like New York City banning female genital mutilation (if it weren't already banned by a federal law in 1996) and the State of New York saying, "No, you may not ban that ritual."
Let us take a moment to compare the progressive laws enumerated in this article with California's position regarding the right of infants not to be subjected to a permanent amputation of part of their genitals.
1)Abortion and the state's crackdown on phony abortion clinics: The right to obtain a safe and legal abortion rests on precisely the same legal and ethical foundation as the right of the individual to decide for himself what parts of his body he gets to keep. If denying a woman the right to control her own body violates her right of bodily autonomy, how does denying a male or intersex infant the same right constitute any less a violation of his rights?
2)The Right to Die: This is closely related to abortion rights: in other words, the right of bodily autonomy. What is more central to that right than being protected from a harmful and potentially lethal genital surgery imposed upon one without his consent?
3)Equal pay: Excellent, progressive legislation that rests on the principle of treating both sexes equally. Female genital mutilation is illegal in California not only under federal law but also under California law whereas male genital mutilation is not. And, as noted above, California law goes even farther in facilitating the human rights violation of infant circumcision by specifically and explicitly preventing localities within the state from protecting male and intersex infants from cosmetic, ritual, and customary genital surgery.
4)Environmental regulations: The reason we have environmental regulations is because history as demonstrated that, without them, polluters pollute even more than they do with them, while the epidemiological research as also shown, unambiguously, that pollution of the air, soil, and water harms human health.  So environmental regulations exist ultimately in order to protect our health.  The focus of the recently enacted environmental regulations cited in this article is clean- and renewable energy, but the goal of renewable energy, too, is ultimately to keep our planet hospitable to human (and other) life which, on the most basic level, is a public-health policy concern.  And yet, amputating a functional, sensitive, normal, and healthy body part is manifestly harmful to the individual subjected to the amputation. The male prepuce - like its homologous counterpart in females, the clitoral hood - has evolved over millions of years precisely because it is functional and anatomically important. The male prepuce is the most sensitive, hence erogenous tissue of the penis and its amputation unquestionably adversely affects the male's ability to experience normal and natural sensation as an adult. In addition, the male prepuce has many other functions, including protecting the infant from infection during early childhood, throughout which the prepuce remains fused to the glans. Thus, its removal, besides being a human rights violation, is harmful - just like exposing someone to air pollution or water pollution is harmful.
5)The ban on the routine use of antibiotics in animals: the rationale behind this important and overdue legislation is that the indiscriminate and routine use of antibiotics has led to the evolution of drug-resistant microorganisms which, in turn, has harmed human health. Non-therapeutic infant circumcision and "corrective" genital surgery on intersex infants also harms human health and far more seriously than drug-resistant strains of staph- or enterococcus do.
6)Legislation making undocumented children eligible for state-subsidized health insurance: This legislation is pro-child and pro-health. No child should be denied adequate health care simply because of the immigration status of her or his parents. This legislation, then, incorporates the principle that access to healthcare should not be denied on the basis of a child's legal status. But the very first principle of medicine is "Primum non nocere" - "First, do no harm." Thus, before California subsidizes healthcare for minors, ought it not to insure that the healthcare that they receive is in accordance with medical best practices and medical ethics? Routine infant circumcision - male genital cutting in the absence of a disease or other medical reason for it - violates the most basic principles of healthcare. Hence, it is not merely morally inconsistent but preposterous for the state of California to take steps promoting childhood wellness while simultaneously facilitating medical malpractice on 50% of its infant and child population.
7)Voting rights: the new motor voter law advances the laudable objective of increasing citizens' participation in government and thus aims to facilitate the actual practice of democracy. And what, after all, is more democratic - indeed, what is more directly democratic - than ballot initiatives and citizen-driven referenda? And yet California has explicitly banned such referenda when it comes to protecting infant boys and intersex infants from genital cutting. Hence, this legislation, which appears to be progressive and pro-democratic on its face, amounts to the state legislature saying to the residents of California: "You may participate in the democratic process but only up to a point - we will determine beforehand what laws we think you should have."  That's not democracy - that's sham democracy.
8)Gun control. This is simply another public health matter. Gun violence is epidemic in the U.S. and California is right to take this modest step toward curbing it. But genital mutilation is also a form of violence and it is also an epidemic, since more than one million infants are subjected to it annually in the United States (I was unable to locate statistics on the current rate of forced genital cutting on male and intersex infants in California). Why does the California state legislature regard the right not to be shot as somehow fundamentally different from the right not to have part of one's penis lopped off for reasons of custom? Both rights are, fundamentally, the same right: to be secure in one's person and free from harm and violence.
9)Ban on the offensive term "Redskins." Bravo! But what is the term "redskins" but a reflection of a type of bigotry based on ethnicity or "race"? And what is the practice of male genital mutilation and the state of California's statue forestalling citizen referenda to prevent it but a reflection of a form of cultural bias against male genitalia? - A bias that defines the natural penis as something innately disgusting, disease-prone, ugly, offensive, and urgently in need of surgical modification at birth.
10)Medical Marijuana regulation: The author of this article construes this legislation as being significant largely insofar as it may be a precursor to the eventual decriminalization of marijuana. To the extent that it is, it advances two important principles: the ability of citizens to have access to a valid pharmacological agent in order to alleviate suffering and the more basic right of citizens to be free to use psychoactive substances recreationally without an unwarranted governmental proscription against their doing so. The relevant principles behind these laudable objectives are that health, wellness, and freedom from needless suffering are positive goods to which people have an innate right and that people should be autonomous and retain absolute ownership of their bodies, including what they do to their own bodies and what substances they put into their own bodies. But routine infant circumcision violates both of these principles. It harms the individual and stands in opposition to medical ethics and best practices on the one hand while violating the principle of bodily autonomy on the other. Hence, while the California legislature is forward-looking when it comes to marijuana, it is backward-looking when it comes to routine infant circumcision and the more basic principle of the right of genital integrity.
That may be said of every one of the new statutes discussed in this article: they reveal a glaring moral inconsistency on the part of California's legislature. One can only hope that as the state government moves ever closer toward incorporating the principles of beneficence, democracy, and respect for human rights, the moral gravitational pull of such legislation will awaken in the hearts and minds of California's legislators the recognition that non-consensual genital surgery represents the moral antithesis of those principles and thus, like female genital mutilation, should be banned.

Sunday, September 20, 2015

On The Decision by the New York City Board of Health to Repeal the Metzitzah B'Peh Consent-Form Regulation, On Same-Sex Marriage, and On the Question of Anti-Semitism

On the Decision by the New York City Board of Health to Repeal the Metzitzah B’Peh Consent-Form Regulation, On Same-sex Marriage, and On the Question of Anti-Semitism
By David Balashinsky


Just over a week ago the New York City Board of Health shirked its responsibility to protect public health and the health of New York's neonates within the relatively small community of Ultra-Orthodox Jews by repealing a Bloomberg-era rule that imposed only the most modest regulations on the ritual of metzitzah b'peh.  Metzitzah b'peh, or "oral suction circumcision" as it is sometimes called in English, is a circumcision ceremony in which a mohel amputates an infant's foreskin, then sucks the infant's penis in order to remove the blood.   As the New York Times reported back in 2012, "Between 2004 and 2011, the city learned of eleven herpes infections it said were most likely caused by the practice.  Two of those babies died; at least two others suffered  brain damage."  In response, the Board of Health in 2012, instead of banning this practice outright as it ought to have done, merely issued several impotent regulations.  The Times reported on these regulations (Sept 13, 2012) as follows: "In an effort to educate parents, the city will now require ritual circumcisers to inform parents in writing if they will use direct oral contact during the circumcision, and must receive their written consent. The consent form states that the health department advises against the procedure because of the possibility of herpes transmission, which may cause brain damage or death.  The mohelim must keep that permission document for one year. Failure to comply may result in warning letters or fines to the mohelim. Enforcement, though, will be based on investigation of specific complaints and herpes cases, not spot checks or raids, and there are no mandatory punishments. . . "

For the record, "oral suction circumcision," as occurs in the "metzitzah b’peh," is practiced primarily (and probably exclusively) by adherents of Haredi Judaism (such as Hasidic Jews and the Satmars) who are a small fraction of Orthodox Jews.  Orthodox Jews themselves are a fraction of religious Jews.  Religious Jews (of all stripes) are themselves a sizable fraction but a fraction, nonetheless, of those who identify ethnically and culturally as Jewish.  And Jews, broadly, comprise a mere 1.4% of the population of the U.S.  In other words, oral suction circumcision is an exceedingly rare practice.  Yet, lest anyone think that I am offering an excuse or rationalization for the legality of this practice on the grounds that it is limited to a minority of a minority of a minority, I am not.

Writing as someone who is at least part Jewish (depending upon how one defines "Jewishness") but who nevertheless identifies as  Jewish, I find the practice of "oral suction circumcision" revolting and and even barbaric. It is manifestly unsanitary and should absolutely be abolished - if not by religious Jews themselves, then by the New York City Board of Health.  If not by the New York City Board of Health, then by the New York State Department of Health.

The regulation requiring the signing of a consent form that had been issued in 2012 by the city's Board of Health was, as the Times subsequently reported earlier this year (2015), routinely ignored.  Then, in 2014, there was a significant spike in the number of herpes infections that are believed to have been caused by this practice.  As the Times noted, "City health officials have advised that the ritual should never be performed, but the growing ultra-Orthodix Jewish community that cherishes it represents a crucial political constituency for Mr. de Blasio. So he pledged during his campaign to rescind the consent requirement on 'Day 1' of his administration and find a solution that would be more acceptable to Orthodox leaders, while still protecting children's health." That "solution," was proposed by the de Blasio administration  in February of 2015. "Administration officials," the Times continued, "announced a [proposed] new policy that they described as a compromise between reducing health risks for infants and protecting the religious freedoms of those who cherish the ritual. . . ."  That compromise did away with the signed consent form and instead mandated a series of diagnostic tests in cases in which a mohel was suspected to have transmitted herpes to infants during this ritual.  In the case of a DNA match (confirming the source of the transmission), the mohel would be banned for life  from performing oral suction circumcision.   However, under the proposed regulations, "a mohel who [was] found to have herpes would still be allowed to perform the ritual if a DNA test does not match his virus with the strain present in the infant." This, despite the fact that "It can sometime require multiple DNA tests  to establish a match."  This wholly inadequate regulation, until about a week ago, still needed to be approved by the New York City Board of Health.  It was not. Instead,  the health department, it has now been announced, will merely "ask hospitals to distribute a brochure to Orthodox families that warns of the risks of the ritual," thus doing away not only with the mandatory testing in cases of suspected herpes transmissions but even with the consent-form requirement.

This is not a compromise but a capitulation.  It is a naked and craven act of political expediency by de Blasio himself and, at the same time, and perhaps worse, a wholesale abandonment by the Department of Health of its stated mission "to protect and promote the health of all New Yorkers." It is incomprehensible that, to date, the New York State Department of Health has not simply banned this practice, superseding the city's accommodation of it.  After all, if the New York State Department of Health can require me, as a healthcare worker, either to get the annual flu vaccine or wear a mask all winter, I do not see why it cannot protect infant Jewish boys from this manifestly unsanitary and dangerous practice.

The claim that banning oral suction circumcision in particular and ritual circumcision in general  constitutes an infringement on religious liberty is frequently made.   And this claim is not only made by some religious Jews themselves.  No less august a defender of civil liberties, the ACLU of Northern California, incomprehensibly and to its shame, opposed - precisely on the grounds that it constituted an infringement of religious liberty - the proposed ballot initiative in San Francisco in 2011 which, had the voters been permitted to vote on it and if passed, would have outlawed non-therapeutic circumcision in most cases.  The ACLUNC issued a press statement in which its managing attorney, Jory Steele, is quoted as follows: "Conducting a popular vote on whether to criminalize a minority religious practice fosters sectarian strife. This initiative would have undermined the right to religious liberty that we cherish in a pluralistic society."

The claim of "religious liberty" as a carte blanche to violate the rights of others has, of course, been much in the news of late in the context of same-sex marriage.  To its credit, the ACLU has condemned Kim Davis's actions, writing in a blog on its official website, "Davis's duty as a public official is to enforce civil law, not her own personal religious views." Hear, hear to that!  Yet in an act of stunning hypocrisy and moral inconsistency, the Northern California ACLU affiliate has taken a position supporting the right of parents to inflict genital cutting on their children on religious grounds (and to my knowledge it has not altered its stance) while the ACLU itself rightly condemns a government official for interfering with the right of same-sex couples to marry on religious grounds. Individual government officials and agencies have both a legal and an ethical duty to carry out their duties and mandates in accordance with the law, with public policy, and on the basis of rational objectives that further the interest of the public good.  This is no less true with respect to ritual circumcision than it is with respect to same-sex marriage.  Thus, the New York City Board of Health, as a secular governmental agency, has a duty to protect public health, and no less so when public health policies conflict with manifestly unhealthy religious practices.  Invoking religious liberty as a justification for discriminating against other citizens who are attempting to exercise their civil right to marry is wrong.   Invoking religious liberty as a justification for performing genital mutilation on infants and then ritually "cleansing" their bleeding penises in one's mouth is equally wrong.

The parallel between the claim of religious liberty on behalf of the right to discriminate against LGBTs and the claim of religious liberty on behalf of the right to perform an inherently dangerous and potentially deadly ritual on an infant is inescapable.  Religious liberty ends where another person's rights begin.  The First Amendment guarantees each American the freedom to practice her or his religion.  It does not guarantee each American the right to impose her or his religious beliefs on another person.  That is especially the case when doing so carries the risk of brain injury and death. Indeed, this principle - that one's zone of freedom to act is delimited by every other person's zone of freedom not to be harmed by one's actions - is no doubt what guided Congress when it did not allow for a religious exemption to the national ban on female genital mutilation back in 1996. Exactly by this reasoning, the right of infants not to be harmed by the ritual of metzitzhah b'peh - or, for that matter, by any non-therapeutic circumcision, whether performed for religious, cultural, or cosmetic reasons - supersedes the right of their parents to subject them to it.

Religious freedom as articulated in the First Amendment does not extend outward from the believer to include the bodies of others.  Otherwise, slavery could have found a safe haven within the ambit of the First Amendment since the Bible itself countenances slavery (there were many denominations before the "Great Schism" and before the Emancipation Proclamation that used the Bible as a justification for slavery).  By the twisted logic of those who claim the right, on the basis of "religious freedom," to mutilate the genitalia of infant boys (and infect them with herpes, into the bargain) a man could simply claim that his religion requires him to have carnal knowledge of his daughter in order to get away with the crime of incest.  Anyone could claim the right to commit any act of assault, battery, or violence of every conceivable description on the basis of religious freedom, according to that logic. What about those religious sects that once practiced ritual human sacrifice and would still were it not outlawed?  Should an exemption to laws against homicide be made in order to accommodate human sacrifice?  A closer parallel exists in the U.S. federal law banning female genital mutilation.  The Congressional Findings that are an adjunct to the text of that legislation state, in part, "The Congress finds that - the practice of female genital mutilation is carried out by certain cultural and religious groups within the United States" and that "the practice of female genital mutation can be prohibited without abridging the exercise of any rights guaranteed under the first amendment to the Constitution or under any other law. . . ."

Fortunately, not only do the vast majority of Jews not subject their infant boys to the inherently dangerous practice of oral suction circumcision but, encouragingly, there is a growing number of Jews who are rejecting infant male circumcision altogether.  That makes sense. After all, having had one's penis mutilated is not where Jewish identity comes from. It comes from one's upbringing, one's values, one's cultural and ethnic heritage and, in the case of Judaism, it comes from one's religious beliefs.  If infant male circumcision were sufficient alone to confer "Jewishness" on those who have been subjected to it, the millions of non-Jewish American men who have been subjected to forced infant male circumcision would in fact have become Jewish as a result.  Conversely, were infant male circumcision necessary to confer "Jewishness" on all of its victims, there would be no Jewish women since Jewish women are never circumcised. Even some Talmudic scholars and rabbis have rejected the claim of the necessity of infant male circumcision (as the Jewish Circumcision Resource Center notes, "Maimonides, the renowned physician, philosopher, and rabbi, wrote, 'Circumcision weakens the power of sexual excitement, and sometimes lessens the natural enjoyment.'") Thus there is a growing number of secular and religious Jews who oppose infant male circumcision (MGM), for example, "Beyond the Bris," whose efforts have been endorsed by several rabbis.

Yet, because of the historical importance and even centrality of the rite of circumcision to Jewish identity and religious practice, the question as to whether the campaign (which I enthusiastically support) to end routine infant male circumcision is itself somehow antisemitic frequently and inevitably arises. Because it does, I think it important to address it head on, whenever it does.

I have no doubt that there are some antisemites in the intactivist community, just as I am sure that there are antisemites involved in many other worthwhile causes, their antisemitism notwithstanding.  Indeed, I have tangled with a few of them myself in online forums several times when this subject has come up previously. Often their position amounts to something like this: "The reason infant male circumcision hasn't been banned is because the Jews defend it and they have so much power that it will never get banned." That's an almost-verbatim quote from someone posting in an online thread.  And it's always the collective "the Jews," isn't it?   That's usually a reliable way to spot an antisemite - as though all Jews are in cahoots with one another and all think the same and act in concert as befits our secret cabal.  And I have no doubt that there are antisemitic intactivists who are only too happy to have, in their capacity as antisemites, another club, in the form of Jewish defense of circumcision, with which to beat up on Jews.  But to those Jews who claim that the intactivist movement embodies, at its core, Jewish hatred, I would counter that - and I say this as a Jew - forced infant male circumcision constitutes the ultimate act of Jewish self-hatred. I would also ask, if you believe in a god who presumably loves us (I don't, but that's beside the point), why would he want us to maim our children's genitals?  Further, it could be argued that antisemites should, in theory at least, be only too happy to see male Jewish infants sexually maimed. Why on Earth would an antisemite really care about harm being inflicted on Jewish infants?

All the way at the other end of the spectrum are those Jews who, without a shred of justification, denounce any and all efforts to ban non-therapeutic circumcision as antisemitic. I even saw a picture of a Satmar holding up a sign that read "Blood Libel" in protest of the effort merely to regulate and impose a modicum of medical common sense on the practice of oral-suction circumcision. (For those of you unacquainted with Medieval European Jewish history, the "blood libel" was the canard made by Christians against Jews that Jews secretly murdered Christian children and used their victims' blood in the manufacture of matzohs. On the basis of these accusations, many hundreds and probably thousands of Jews were rounded up, tortured, and burned alive from time to time during the Early and High Middle Ages.)  Opposing genital mutilation in general and oral suction circumcision in particular is not antisemitic and to claim that it is demeans Jews who have actually been the victims of antisemitism and antisemitic violence. To claim persecution in defense of the right to commit an act of violence and mutilation on another human being is contemptible and makes a mockery of the valid claims of actual Jewish persecution that are a part of Jews' collective history.


The effort to end male genital mutilation - whether as a fraudulent medical practice, as a cultural norm, or as a religious rite - is blind to race, religion, and ethnicity. (It is also blind to sex, inasmuch as intactivists oppose female genital mutilation just as vehemently as we oppose male genital mutilation. Sadly and inconsistently, the anti-FGM movement has not universally embraced our cause with the same ardor with which we have embraced theirs. That's a shame because these are fundamentally the same cause.) Not only is the intactivist movement not intrinsically antisemitic (and non-sexist) but it is the paradigmatic humanitarian and ethical social-reform movement.



Genital integrity is a human rights issue, and no one should understand the bedrock principles of human rights better than the Jewish people, precisely because of our history. Indeed, it is in no small part because of my own Jewish heritage that I feel a moral obligation to oppose and to fight male genital mutilation, whenever it occurs and for whatever reason it occurs.

Thursday, August 20, 2015

In the News

by David Balashinsky

  One of the dangers of fanaticism is that one's obsession with a cause can become a filter through which everything that enters one's ken is viewed only insofar as it does or does not relate to that cause.  As someone who has lately been preoccupied by the cause of genital autonomy (that is, the right not to be subjected to genital mutilation against one's will and the companion effort to end routine infant circumcision, or, male genital mutilation [RIC/MGM]) I worry at times that I may appear to have become monomaniacal or even obsessed with this subject.  Monomania seems to be a characteristic of "intactivists" in general and is both one of the movement's strengths and one of its liabilities.  As Mark Joseph Stern wrote in his frenzied, distortion-filled and factually-challenged attack-piece in Slate ("How Circumcision Broke the Internet," September 18, 2013 http://www.slate.com/articles/health_and _science/medical_examiner/2013/09/intactivists_online_a_fringe_group_turned_the_internet_against_circumcision.html), "Intactivists gain validity and a measure of mainstream acceptance through their sheer tenacity.  Their most successful strategy is pure ubiquity, causing a casual observer to assume their strange fixations are widely accepted. . . .  Intactivists . . . are winning the online battle.  Is it only a matter of time until they win the greater war?"  One can only hope, Mr. Stern, one can only hope.
     The point here, of course, is that while Stern concedes the efficacy of our efforts, he appears to hold our very commitment to this cause against us, as though struggling too energetically and too passionately to end a human rights violation is not only unseemly but, ultimately,  proof of the irrationality of those who struggle in behalf of that cause.   (This from a champion of gay rights, no less.)  This tactic is not new.  Abolitionists, suffragettes, civil-rights advocates, feminists, and, yes, gay-rights advocates:  all have had their characters, their motives, even their sanity questioned because it is so much easier to mount an ad hominem attack than to to dispute a moral position on the battlefield of morality when one has taken the immoral or at least amoral side in that battle, or to dispute a fact-based, scientifically valid position empirically when the science is not one's side, as Mr. Stern and other genital-mutilation advocates have done with respect to RIC.
     This tactic is especially effective also because it deprives the underdogs of the right to argue their case (and for all their passion and presence on the internet, intactivists remain the underdogs in the effort to end RIC/MGM in the United States).  Their very articulation of their position becomes, as construed by someone like Mr. Stern, yet more proof of their fanaticism.  It is like the classic predicament of a sane person locked up in an asylum, or an innocent person locked up in prison.  "You may not have privileges along with the other inmates until you concede the error of your delusional thinking."  "I'm not delusional!," the sane inmate protests.  "Well, I can see we have much more work to do.  Put her back in her cell."  Or in the case of a wrongfully convicted person before a parole board whose release is contingent upon her accepting "responsibility" for her "crime."  Her factual disputation of her guilt at this stage would be held against her so she must choose between maintaining her innocence and gaining her freedom.  But indispensable to the unevenness of the playing field in these cases is that one of the adversaries is essentially powerless while the other largely controls the rules of the contest.  The latter can be a person, such as a warden or a jailer, or it can be something more diffuse, such as society broadly, or it can be the status quo as maintained by a firmly entrenched power structure.  That is why the luxury of discrediting a rights advocate of any stripe in this particular way always falls exclusively to the one in power or someone who argues on behalf of power.  In the United States, although its incidence is declining,  male genital mutilation, especially as it exists within the realm of the practice of medicine and of medical orthodoxy, remains the status quo and enjoys the privilege of being supported by a powerful pro-circumcision lobby which is itself part of the medical establishment.  (There are, however, many committed and conscientious physicians here in the U.S.A. who oppose RIC.  See, as examples, Doctors Opposing Circumcision [http://www.doctors opposingcircumcision.org] and the blog of Adrienne Carmack, M.D. [ http://www.adriennecarmack.com].)   Against these forces, who, it is needless to a ask, is less powerful than a neonate strapped by all four limbs to a circumcision board?  Intactivists have considerably more power to articulate their objections on behalf of that neonate but these objections are routinely dismissed a priori and the intactivists themselves dismissed as crackpots or, as Mr. Stern writes,  "a vitriolic mob. . . . drowning out reasoned discourse. . . . comically bizarre, peddling fabricated facts, self-pity, and paranoia [who] . . .  obsess about sex to an alarming degree."   Explicit attempts to marginalize intactivists, such as Stern's, as well as the fact that they are still underdogs in the campaign to end RIC/MGM in the U.S., where it remains legal in all fifty states,  probably have the effect ultimately of making intactivists redouble their efforts even as their redoubled efforts make them appear fanatical to those who remain willfully ignorant and perversely dismissive of the moral and scientific bases for the principle of genital autonomy and the cause of ending male genital mutilation. 
  It is because I am mindful, therefore, of my position as an underdog in the crusade against male genital mutilation, and the special burden that that places on me of trying to end a firmly entrenched cultural practice while not alienating potential converts with my apparent fanaticism, that I am always on guard against exposing myself to the charge of fanaticism.  Yet while I concede that bodily rights, especially insofar as they pertain to human genitalia, have become something of a preoccupation of mine, neither do I believe that the amount of attention, time and energy that I have been devoting to this cause is in any way out of proportion to the urgency and the importance of it.  Rather, when I consider how outrageous and blatant a human-rights violation genital mutilation is, how frequently it is inflicted on its helpless victims, and how harmful it is, I feel ashamed that I am not doing much, much more to fight it.  (I should also mention, as an aside, that it might even be presumptuous of me to call myself an intactivist because my activism in this cause is generally limited to the written word.  I do not attend protests and I do not directly attempt to persuade friends and acquaintances not to subject their neonates to genital mutilation.)
  I mention this because it now seems to happen more frequently than it doesn't that I will come across an article or news story that, superficially, may have nothing whatever to do with circumcision and, yet, the way in which it relates to the subject of RIC/MGM inevitably suggests itself to me.  I do not even need to search for the connection.  That makes me wonder whether I have crossed over to fanaticism.  Perhaps I have, so consuming and intense is my opposition to RIC/MGM, for I seem to find myself viewing so many news stories through that filter.  But, at the same time, my very acknowledgment of this self-conscious anxiety also constitutes evidence of my being on guard against fanaticism.   And the reason that I am is because I believe that fanaticism, for all its merits, can ultimately result in one's efforts becoming counterproductive.  Besides this, there remain many important matters of public policy and human rights that occupy my thoughts and my convictions.  Yet few have inspired me to active involvement in the way that the cause of genital autonomy has.  Undoubtedly, the fact that I, myself, was victimized has a great deal to do with this.
  All of the foregoing may be taken as prefatory to a brief discussion of four such news items that have caught my attention during the past month or so.   Although all of these stories are connected in some way to healthcare, none relates directly to the question of RIC/MGM.  Yet, in each case, there is a conspicuous intersection between the ethical and philosophical questions raised by these stories and the right of genital  autonomy. 
  The first story concerns a notorious case in which a physician was recently convicted of falsely and fraudulently  providing healthy patients with a diagnosis of cancer or other condition in order to treat them with chemotherapy or other drug regimens.  (Here is a link to one of the stories about the physician: http://www.freep.com/story/news/local/michigan /oakland/2015/07/10/fata-sentence-handed-down/29952245/.)  The patients were subjected to painful, debilitating, harmful, and utterly unnecessary treatments for which the physician billed his victims and their insurance companies millions of dollars.   I first became aware of this when a friend posted a link to this story on Facebook along with the rhetorical question, "How could anyone be so evil?"
     This is a shocking case, not only in the extent of the harm, pain and suffering that this physician caused his patients (and their loved ones) but in the scope of his crimes (there were hundreds of victims of his fraud).  However, it is not to minimize the harm and depravity of this person's crimes to observe that, given that over one million infant boys in the U.S. are subjected to medically unnecessary genital surgery every year, that well over a hundred of them die every year from this surgery, and that more than half of all men living in the U.S. have had a normal, healthy, sensitive, and functionally important part of their penises surgically amputated without their consent,  this one case doesn't seem all that outlandish or even unusual.   Treating a patient in the absence of a disease is considered medical fraud, and prosecutors in this case had sought a 175-year sentence.  (For an excellent discussion of how RIC constitutes medical fraud, see Peter Adler's article in the Richmond Journal of Law and Public Interest, Vol. XVI:iii, 2013, "Is Circumcision Legal?" http://rjolpi.richmond.edu/ archive/Adler_ Formatted.pdf.)  The physician ultimately received a mere forty-five year sentence.  But this case also raises the important medical-ethical question: Why is treating a patient in the absence of a disease considered medical fraud in this case, but not in the case of routine infant circumcision? 
  The second item is an opinion piece from the New York Times in which Maxine Eichner calls attention to the latest child-abuse hysteria and (its concomitant abuse of the legal system) in which parents, guilty of nothing more than seeking appropriate medical care for their children, have been charged with what is now called  "medical child abuse" ("The New Child Abuse Panic," Maxine Eichner, Sunday Review, New York Times; July 11, 2015; http://www.nytimes.com/2015/07/12/opinion/sunday/the-new-child-abuse-panic.html).  Typically, these cases revolve around rare conditions or diseases about which different physicians are in disagreement regarding the appropriate course of treatment.  The charge of "medical child abuse" is based on the theory that the child's parents are exploiting - "abusing" - their child by seeking additional tests or medical treatment when none is needed.  Often, this charge has been based on nothing more substantial that the parents' having had the temerity to question a physician's opinion and wanting to obtain a second.  Citing several egregious cases of false accusations against the children's parents, Eichner describes how physicians referred these parents for investigation and even prosecution simply because they refused to accept these particular physicians' assessments.  In some of these cases, the parents lost custody while their children were denied the medical treatment that they, in fact, needed.
  The point of intersection between this story and the medically unnecessary - that is, non-therapeutic - circumcisions that are to this day routinely performed on male infants in the United States is that the medical profession itself is guilty of this very same form of child abuse when it takes a normal and healthy anatomical structure - the male prepuce - and defines it as a pathological organ warranting amputation.
     Eichner traces the history of the concept and diagnostic term of "medical child abuse" to the work of two American physicians (one a pediatrician and the other a psychiatrist - who are married to one another, incidentally).  According to Eichner, this couple argued that

Doctors . . . should simply determine whether the child had received unnecessary and hurtful, or potentially harmful, care at the behest of a parent.  They defined 'potentially harmful' to include any unnecessary medicine or diagnostic test that could have harmful side effects, even if the child wasn't actually harmed.  Such care, they argued, should be labeled medical child abuse, and treated like any other kind of child abuse [my emphasis].

     That definition, as it happens, perfectly describes routine infant circumcision when performed in accordance merely with the infant's parents' predilection for a surgically modified penis.  If a parent seeks genital surgery for her or his child in the absence of a medical problem with that child's genitals, that, it seems to me, would constitute a prima facie case of medical child abuse, in which case, the parents of the more than 66 million American men who have been subjected to medically unnecessary circumcisions are guilty.  A guilt, I hasten to add, for which credulous parents are entitled to a certain amount of absolution when one considers not only the social and cultural pressures to circumcise to which they are subject but especially when these parents have been pressured by pediatricians, obstetricians, or others in the medical profession into subjecting their neonates to circumcision.  A greater degree of guilt, I would argue, attaches to the medical profession in the United Sates, itself, which has been and continues to be not merely complicit in this abuse but is its primary promulgator and perpetrator - perhaps because RIC is anywhere from a $150 million to $400 million per year industry (these figures being the products of a "typical" physician's fee for a circumcision  -  $150 - $400 according to this site [http://health. costhelper.com/circumcision.html#comments] and one million - which is just under what is generally agreed to be the number of circumcisions performed annually in the U.S.; and these amounts represent only the fees paid to physicians for the surgery itself - they do not include the resale value of amputated foreskins  [see below]).  Of course, when the medical profession engages in medical child abuse, as in RIC, the abuse acquires a cachet of legitimacy. It then becomes codified as a standard protocol and, thus, normalized.  But it is still abuse.
     The third item is an essay in the Mayo Clinic Proceedings in which a group of physicians argues that cancer-fighting drugs have become so expensive that they are rapidly becoming unaffordable for those who need them  ("In Support of a Patient-Driven Initiative and Petition to Lower the High Price of Cancer Drugs," Mayo Clinic Proceedings, August 2015; http://www.mayoclinicproceedings. org/article/S0025-6196(15)00430-9/fulltext).  In some cases, the authors note, the cost of a year's regimen of cancer-fighting drugs can exceed the median annual income of an American household.  The authors cite several factors that have contributed to this problem - most notably, the fact that Medicare is now barred, by law, from negotiating prices with drug manufacturers - and propose a number of commonsense and reasonable solutions which may at least ameliorate if not solve it.  But without explicitly blaming Big Pharma's greed, the essay unambiguously lays at least part of the blame at Big Pharma's feet.  The authors write that whereas "Health care in most economically advanced nations is provided to all citizens with minimal personal economic burdens. . . .  in the U.S. [it] is delivered in a profit-driven marketplace that commands 18% of our gross domestic product, compared with 4% to 9% in other industrialized nations."  The essay further notes that, despite our prodigal spending of healthcare dollars, the U.S. is not first in

          [healthcare ] parameters compared with other industrialized nations that spend far less per capita.  Rather, the United States often ranks well below average in several comparative studies that assess a number of measures of health care quality.  Money diverted as profit does not necessarily contribute to better health outcomes or even to innovation and development of novel therapies.

  While these physicians have a valid point, this strikes me as being at least in part yet another case (along with charges of "medical child abuse") of the pot calling the kettle black. I would like to see physicians put their own house in order first if only that they might have greater moral authority to criticize others.  OBGYNs, interns, and pediatricians (and to a lesser extent others)  perform over one million medically unnecessary infant circumcisions annually in the United States.  As noted previously, that is a $150-to-400 million per year industry which provides a hefty revenue stream for physicians.  The stolen foreskins are then sold to pharmaceutical- and cosmetics companies with nary a dime in compensation for - let alone consent from - the victims in this flesh trade (and see below).  Thus, even as non-therapeutic circumcision deprives the victim of a body part that is essential to normal sexual function and, worse, results in the needless deaths of over one hundred infants and the permanent disfigurement of countess more in the United States annually, it violates the Hippocratic Oath and is also a grave human rights violation.   Viewed against this background, the spectacle of physicians criticizing Big Pharma for its profiteering invites less of a comparison and more of a contrast.  That is because an act of commission that results in harm is more egregiously injurious  than an act of omission that merely results in a person's not having access to something potentially beneficial. 
  No one is born into this world with an innate right to cancer-fighting drugs.  Everyone, on the other hand - female, male, and intersex - is born into the world with an inalienable right not to have part or parts of his or her genitals needlessly amputated without his or her consent. The right to have one's body left intact is far more basic and essential to one's personhood and autonomy than the right to have access to drugs that we have done without for more than 99% of our existence as a species.  I would argue, therefore, that, although highly desirable - both from an ethical and a public-policy point of view - access to healthcare, let alone to specific drug regimens, is not a basic human right.  The right to be left alone physically - not to have part of one's body amputated without one's consent - is.  In fact, I would argue that this right is at the very core of the concept of human rights.  All other rights are somewhat peripheral and secondary to the right of of the individual to be physically secure in his person.  Thus, while the physicians in this essay are arguing for a positive good, they are not arguing on behalf of a basic human right nor against the violation of a basic human right.  By the same token, when drug manufacturers profit unconscionably or excessively at the expense of cancer patients, they may not be acting benevolently but neither are they affirmatively or positively violating anyone's rights.  In contrast, when a physician amputates part of a male neonate's penis in the absence of a disease or congenital deformity, that physician is violating the individual's basic human rights.  Hence, as long as physicians continue to profit from this medically inappropriate surgery and as long as their professional brethren remain silent about this unethical conduct, the medical profession in the United States lacks the moral authority to criticize others for less than sterling ethical behavior and especially for profiteering.  (Incidentally,  the tacit support that is given by physicians who do not perform genital cutting to those who do, by virtue of the silence of the former, itself constitutes unethical conduct inasmuch as physicians are obliged to report the unethical conduct of other physicians to professional licensing boards and other appropriate authorities [American Medical Association; https://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion9031.page?].)  When the AMA and the AAP unequivocally condemn and actively discourage routine infant circumcision, as many physicians and professional medical organizations throughout the rest of the developed world have now done, and when they cease violating their own professional oaths and the central tenet of medical ethics ("Primum non nocere" - "First, do no harm") by performing non-therapeutic infant circumcision, they will then acquire the moral authority to criticize the unethical conduct of drug manufacturers and others.
  The fourth and final story concerns the recent brouhaha concerning allegations that Planned Parenthood has been illegally selling body parts from aborted fetuses.  This has been all over the news as Republican politicians, seeking to curry favor with the anti-choice lobby, fulsomely profess their moral outrage, conduct congressional hearings, and propose legislation to defund Planned Parenthood, despite the facts that a mere three percent of Planned Parenthood's services actually involve abortions, Planned Parenthood's education- and contraceptive services actually result in the prevention of about a half million abortions annually, and, by law, not a dime of tax-payer money may be used to fund abortions except in the cases of rape, incest, or when the woman's life is threatened by the pregnancy (http://www.factcheck.org /2011/04/planned-parenthood/; http://plannedparenthood .org/about-us/who-we-are/planned-parenthood-at-a-glance).  It has also been pointed out that some of the same Republican legislators who now fulminate against the use of fetal tissue for research actually voted in favor of legislation permitting it (http://www.huffingtonpost .com/entry/mitch-mcconnell-fetal-tissue-donations-abortion_ 55b28329e4b0074ba5a479d1).  Another noisy hypocrite, Ben Carson, prior to making a campaign issue out of this, actually published a paper based upon fetal-tissue research in which he participated  (https://drjengunter.wordpress .com/2015/08/12/ben-carson-did-research-on-17-week-fetal-tissue/).  However, it was this opinion piece in the Times  by Ross Douthat ("Looking Away From Abortion," Sunday Review, New York Times, July 25, 2015; http://www.nytimes.com/2015/07/26/ opinion/sunday/ross-douthat-looking-away-from-abortion.html?smid=fb-nytopinion&smtyp=cur) that caught my eye.  
  Douthat's thesis seems to be that abortion is only made acceptable when we shield ourselves from its true horrors.  I'm not sure that a majority of abortion-rights advocates regard abortion as an unalloyed good (although there are those that do, and they have every right to do so unapologetically) or as the preferred method of birth control.  Indeed, it's not that the reality of abortion in and of itself isn't at least on some level and to many of us, tragic, disturbing or even revolting.   But the question for those, like me, who believe in a woman's right to choose to have an abortion, is not whether abortion is pretty but whether or not it should be safe and legal and whether women who terminate their pregnancies should be put in prison for asserting their (still) constitutional right to control their own bodies and make their own healthcare and reproductive decisions.   Mr. Douthat can behold the operating-room reality of abortion and be revolted by it but his revulsion in no way entitles him or anyone else to deny a woman her right to determine what happens to her body, even when the exercise of that right results in the death of a fetus.
  More relevant, however, is the charge made against Planned Parenthood that it is illegally selling the bodily remains of aborted fetuses.   While Douthat does not echo this particular assertion, he does criticize the crassness of Planned Parenthood personnel who were surreptitiously videotaped as they "cheerfully discuss the procedures for extracting those organs intact during an abortion and the prices they command."  In Douthat's formulation this does seem ghastly and it elicits an innate revulsion and loathing for such a callous commodification of human beings and their bodies.  It even raises the specter of stolen body parts being sold on the black market.   As bad as abortion must seem to those who oppose its remaining legal and safe, how much worse must it seem when the alleged merchants in death  - women's healthcare providers - profit by the sale of their gory handiwork?
  Of course, using fetal tissue for scientific research is not new.  And body parts are routinely harvested from cadavers when donations of those parts have been seen to by a thoughtful and generous donor prior to her or his death or by a generous next of kin when organ donation by the deceased hasn't been specified.  Fetal tissue research and organ donation have saved and improved thousands of lives and have the potential to save and improve countless more.  But the fact remains that, unless and until abortion, as described in Douthat's piece, is obviated through the development of and universal access to earlier-acting abortifacients or simply banned outright (in which case it will merely continue as it did pre-Roe, with wire coat hangers in cheap motels), abortion as we currently know it will continue.  Until then, should the remains simply be discarded?  Or is it preferable to at least try to turn abortion to good account in a way that may benefit humanity and even save more lives than those sacrificed in the abortion itself?  These are valid ethical questions with which society is still grappling.  It is not necessary, as Douthat argues, to "look away" from abortion in order to wrestle with this issue: it can be acknowledged and confronted in all its grim reality (if that is how one views it - not everyone does [http://www.salon.com/2015/04/24/ i_am_pro_abortion_not_just_pro_choice_10_reasons_why_we_must_ support_the_procedure_and_the_choice/]).  But the discussion is in no way advanced by the creation of deliberately incendiary, misleading and outright false anti-abortion propaganda.
  A real medical scandal - in contrast to this manufactured one - is that actual body parts are stolen and sold by hospitals.  I am referring to infant foreskins, which are routinely stolen from their owners - the neonates born with them - and sold by hospitals to pharmaceutical companies, bio-tech companies, and cosmetics manufacturers.   According to one website that I came across (http://www.acroposthion.com/ acroposthion_018.htm ), the financial gain from this flesh trade is 

       staggering, and this financial force is one which is providing the funds to continue the spread of medical propaganda advocating circumcision.  The resale value of neonate foreskins is astronomically dizzying in that from one boy's foreskin can be grown bio-engineered skin in a lab to the size of a football field.  That's 4 acres of new skin which . . . sells at $3,000 a square foot.  Considering that there are 1.25 million neonate foreskins circumcised each year in the U.S. alone this translates to one of the most lucrative trades, if not THE [sic] most lucrative trade in human body parts in the history of humanity.

     I wonder if Mr. Douthat is as offended by this unethical and unsavory industry as he is by the alleged selling of organs that have been harvested from aborted fetuses. (There are many articles and blogs to be found on this topic.  Here is one from from Alternet from 2007: http://www.alternet .org/story/47421foreskin_face_cream_and_other_beauty_products _of_the_future.)
  There is a fundamental ethical difference between the use of fetal tissue obtained from abortion and the use of foreskins obtained from living  infants.  First, in the case of abortion, the fetus has no need of and will never "miss" the body part or organ that has been harvested.  That cannot be said of neonates whose prepuces have been removed without their consent.  (There are two dimension to this: unlike the foreskin in a living being, the organ harvested from the fetus serves no function since the life of the fetus is terminated so no harm befalls the fetus in consequence of the loss of that particular organ; in addition, the aborted fetus, not being sentient, is incapable of experiencing awareness of harm resulting from the loss of the body part as well as a sense of violation or loss, unlike the adult male who the circumcised neonate inevitably becomes - unless, of course, as happens now and then, he has the misfortune to die as a result of complications from the circumcision.)
  The second difference revolves around the philosophical question of personhood and the related question of bodily integrity.  As long as the fetus remains unviable (and right up until the time of its birth, some would argue), it does not enjoy the privilege of personhood and all of the rights that pertain thereto.  Once born, a human being - even one a few seconds old - in theory, if not in practice, enjoys all of the rights of full personhood.  "Ownership," of the organs of a fetus, therefore, resides with the woman carrying that fetus.  It is her decision, therefore, in what way the aborted fetus's organs may be used.  Conversely, once born, a male's prepuce is his and not only whether he retains it but to what profit-making purpose it may be put after its removal are both decisions that morally and legally (see again Adler, cited above) belong to the male person himself.
  Consequently, the use of foreskins obtained without the consent of their owners constitutes a far greater moral outrage than the use of fetal tissue obtained from elective abortions.  Where, one may wonder, is the moral outrage over this from Douthat and from others now demanding an end to tax-payer funding of Planned Parenthood?
  There is another interesting intersection: this one between Planned Parenthood itself and the practice of Routine Infant Circumcision which, although somewhat coincidental and tangential to this discussion, merits inclusion here.  Planned Parenthood had been criticized and even condemned in toto by some intactivists as a result of its stance on circumcision.  Although Planned Parenthood - at least its national organization - officially maintains a quasi-neutral policy regarding circumcision, its site does include, in answer to the question, "Should I get [my son] circumcised?," this statement from Vanessa Cullins, M.D. (Dr. Cullins is a board-certified OBGYN and is Planned Parenthood's vice president for external affairs): "We can't advise you what to do.  This is a very personal decision for parents to make."  I would dispute that, of course.  It is decidedly not the parents' decision to make, just as whether or not to excise part or parts of a girls genitalia or whether to tattoo an infant is not the parents' decision to make.  To Dr. Cullins's  (and Planned Parenthood's) credit, however, the answer provided by Dr. Cullins, continues, in part: "For many years in the U.S., it was considered important for good sexual hygiene.  Today, routine circumcision is considered elective surgery without medical benefits."   (http://plannedparenthood.org/learn/ask-dr-cullins/body-q-a/.)
  Local Planned Parenthood affiliates may not, however, necessarily be in line with the national organization's position.  At least one - Planned Parenthood of Northern New England - has adopted an affirmatively pro-male-genital-mutilation position (at least as reported by New Hampshire Public Radio [http://nhpr.org/post/house-committee-hears-circumcision-bill]) and, in so doing, echoes amply debunked myths about the alleged health benefits of circumcision.  (I was unable to find any position statement regarding circumcision on Planned Parenthood of Northern New England's website.)
  Planned Parenthood has also been criticized by some intactivists for its "Different is Normal" YouTube video (https://www.youtube.com/watch?v=t9tFk835vjo) which purports to represent a wholesome message of bodily self-acceptance and thus includes the statement about circumcised and intact penises alike that both "are normal."  One blogger has pointed out that Planned Parenthood, even as it is attempting to promote bodily acceptance and self-acceptance with this video is, nonetheless, helping to confer legitimacy on male genital mutilation by "normalizing" it (http://joseph4gi.blogspot.jp/2012/02/ planned-parenthood-mutilated-is-new.html).  Significantly, the very first image of a penis in this video is a circumcised penis.  This, obviously, "privileges" circumcised penises as being "more normal" than intact penises.  Through this pride of place, circumcised penises are implicitly granted a status of being first among equals.  Also significantly, not one among the numerous varieties of vulvas depicted in this video has been subjected to female genital mutilation.  Hence, Planned Parenthood's "Different is Normal" video not only privileges circumcised penises at the expense of intact ones but privileges  the right of genital integrity of girls and women over the right of genital integrity of boys and men.  These, I believe, are valid criticisms.
  Planned Parenthood's own website states "For nearly 100 years Planned Parenthood has promoted a commonsense approach to women's health and well-being based on a respect for each individual's right to make informed, independent decisions about health, sex, and family planning [my emphasis]." What about boys' and men's "right to make informed, independent decisions" about what happens to their foreskins?  To claim abortion rights for girls and women (which I happen to support, ardently), as Planned Parenthood does, while at the same time supporting forced genital mutilation of male neonates (by asserting that genital mutilation of boys remains the parents' prerogative and by normalizing MGM) is to maintain a morally inconsistent double-standard.
  Human rights must encompass infant's bodies and children's bodies, otherwise they are meaningless. Indeed, no group is more vulnerable, hence more deserving of protection from such violations as female genital mutilation and male genital mutilation, than infants and children.  I do not regard Planned Parenthood as the enemy, however, and I do not believe that this worthy and, in most respects, honorable organization should be abandoned by those, like me, who support both the right to safe and legal abortion and the right of genital autonomy.  After all, the right upon which access to abortion and contraceptives is based (and the right to love whom one will, Mr. Stern) is the even more basic right of the individual to control her or his own body.  These are all, fundamentally, the same right.  But Planned Parenthood needs to come out of the 19th century and recognize that the right of bodily integrity and genital integrity must include infant boys as well as girls (and intersex children).   Forced infant male circumcision is an affront to and a violation of this right.
  Leaving aside this digression into Planned Parenthood's position on circumcision,  although none of the stories that I have discussed above relates directly to RIC/MGM, what I have attempted to demonstrate here is the way in which the principle that lies at the heart of  each intersects with the principle on the basis of which routine infant circumcision is a violation of medical ethics.  If the different aspects of  medical practice (or malpractice) as they are illustrated by these stories may be conceived as spokes in a wheel which converge at the hub, that hub would be medical ethics, which is the very soul of healthcare.  What is healthcare, after all, but a scientifically-based physiological application of the principle of beneficence?  To do good by making people well or at least ameliorating their suffering from diseases or other medical conditions is medicine's raison d'ĂȘtre.  That is why the very first tenet of the practice of medicine is "Primum non nocere" - "First, do no harm."
  Each of these stories, in its own way, demonstrates a conflict between the ethical core of medicine and one or another of medicine's applications or practice.  At times, the practice of medicine itself can become corrupted, placing it in conflict with its ethical foundation, as in the case of the physician who deliberately misdiagnosed patients for profit, which is fundamentally the same as diagnosing a healthy foreskin as a pathological structure that needs to be amputated.  At other times, precisely because of the esteem in which they are held, the word of physicians can be taken as sacrosanct and used unethically as a cudgel against well-meaning parents, as in the case of a physician-asserted claim that procuring medical intervention on behalf of a child where no medical intervention is needed, constitutes medical child abuse, even as physicians themselves routinely engage in precisely this sort of behavior when recommending and performing non-therapeutic circumcisions.  In still other cases, well-meaning physicians may demonstrate moral inconsistency and be guilty of the very lapses in ethical conduct for which they criticize others, as demonstrated by physicians editorializing about profiteering at the expense of cancer patients even as they or their colleagues profit from the performance of non-therapeutic circumcisions.  And, finally, public policy debates concerning valid healthcare procedures and basic science such as abortion and fetal-tissue research, respectively, may be framed in a morally inconsistent way in service of the advancement of a religious belief or political doctrine, as in the false allegations that Planned Parenthood has profited illegally from the sale of aborted fetuses even as those who make these charges remain silent concerning the sale of stolen infant foreskins.
     Routine infant circumcision and the way in which it is in conflict with the ethical core of medicine, therefore, has something in common with every one of these stories.  That it does is probably due to the fact that routine infant circumcision represents the paradigm case of the negation of the ethical core of medicine: - not a passive but an overt repudiation of the dictum, Primum non nocere.   Thus, it is not my fanaticism but that the practice of routine infant circumcision inevitably suggests itself as a benchmark against which many - perhaps all - other breaches of medical ethics, such as those that emerge conspicuously in these stories, may be viewed.