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'être.  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.