Male Genital Mutilation

[ProfessorDavey]

BMA

"Many aspects of good practice – including careful assessment of best interests, balancing conflicting rights and consulting with patients and their families – have taken on added importance as a result of the Human Rights Act, which makes them a required part of the decision making process. As yet, the full impact of the Act on medical decision making is not known, and the rights in the Act are used by commentators to both support and reject non- therapeutic circumcision. One reason why it is not clear where the balance of rights lies is that the medical evidence is equivocal. Some argue that circumcision is a relatively neutral procedure, that, competently performed, carries little risk but can confer important psychosocial benefits. Others argue that circumcision has, or can have, profound and long-lasting adverse effects on the person who has been circumcised. If it was shown that circumcision where there is no clinical need is prejudicial to a child’s health and wellbeing, it is likely that a legal challenge on human rights grounds would be successful. Indeed, if damage to health were proven, there may be obligations on the state to proscribe it. The UN Convention on the Rights of the Child, which has been ratified by the UK, requires ratifying states to “take all effective and appropriate measures with a view to abolishing traditional practices prejudicial to the health ofchildren”.14 Atpresent,however,themedicalevidenceis inconclusive."


The evidence is " inconclusive "

Hence ATM its legal!

Nope - it's legality has not been tested or proved, hence 'assumed to be lawful'.

There is a difference - the lawfulness of infant circumcision remains unclear, and will do so until there is a definitive test case in the courts, or a clear view from Parliament.

[ProfessorDavey]

Only Robinson seems to have bothered to read them.

Not true - I have read them (any plenty of others besides) - I would have thought that was obvious from my posts.

[ProfessorDavey]

If the BMA say harm is not conclusive if circumcision is done in good hygienic conditions, then that is what they say. They are far more medically qualified than people here.

But that isn't true - again from the BMA guidance:

'The medical benefits previously claimed, however, have not been convincingly proven, and it is now widely accepted, including by the BMA, that this surgical procedure has medical and psychological risks'

[The Accountant, OBE, KC]

By working out the annual rate of infection of heterosexual men, combined with annual numbers of new circumcised boys (based on birth rate and assuming all are circumcised) and assuming a 50% reduction in infection if circumcised rather than uncircumcised.

Worth noting that pretty well all the HIV infections for heterosexual men are a result of unprotected sex.

Ok - but no one is advocating all babies be circumcised - the discussion was about whether parents in the UK should be legally prevented from having babies circumcised if both parents agree, especially if they see circumcision as one measure to reduce the risk of certain STDs and HIV infection along with condom use.

By the way, where are you getting the UK death rates from circumcision? If death rates are higher in the UK than the WHO have indicated in their report and parents are educated about the risks of death it should not be too difficult to persuade them to not circumcise their children if there is more chance of dying from circumcision than HIV, and to let the children decide for themselves when they can give informed consent.

[The Accountant, OBE, KC]

Not yet, not on this they haven't. Too busy having a go at me.

Gabriella picks the things she challenges you all on, so she keeps control of the discussion.

I don't doubt if she didn't keep her dignified self control, you would all start on her too.

Just spotted this - I don't have time to be on here much, that's probably why. I haven't had a chance to read all the posts but why haven't I been bullied about my point about consideration being given by the BMA to the emotional and social best interests of the child in being brought up in their parents' culture? Or have I been bullied and I missed it?

[Robbie]

Don't think so Gabriella, you're one who presents things clearly & well researched.

Sorry to see Rose go, she was so balanced and another one whose posts were clear. It was good to have someone not nit picky, able to see that not every issue is black or white.
I often though she'd have been a fair moderator.

Life goes on as they say.

[The Accountant, OBE, KC]

Don't think so Gabriella, you're one who presents things clearly & well researched.

Sorry to see Rose go, she was so balanced and another one whose posts were clear. It was good to have someone not nit picky, able to see that not every issue is black or white.
I often though she'd have been a fair moderator.

Life goes on as they say.

Well I feel a bit left out not being bullied. I could do with a laugh - if only I had more time to come on here to be called an apologist for mutilation of boys by Shaker or Gordon, it would really make my day. Ok tbh it probably wouldn't make my day exactly - Shaker and Gordon are fun but not that fun - but it's always good to come on here and put the other POV across and be called barbaric and lacking humanity by people whose opinions are not really worth very much at all.

So, to be clear, from the perspective of an immigrant, I think community identity and culture are important and I think it is usually - but not always - in the best interests of children who are part of a minority culture to be brought up in that culture unless there is clear evidence of an unreasonable risk of harm. Of course there will be exceptions - children who will thrive better in a different culture to the one they are born into - but there are always exceptions.

For me to consider infant circumcision worth banning, as opposed to dying out naturally in the communities that practice it through persuasive argument, I would need to see medical professionals assess the risk of complications and death from circumcision as being unreasonably high. Medical professionals have done so in relation to FGM so clearly they have the appetite for opposing cultural practices where the level of harm warrants it. I accept the law against FGM is clearly not being enforced, given the lack of prosecutions, but I get the feeling that is changing and there is likely to be more robust prosecutions of parents and doctors who facilitate it in the UK if there is some way of getting the necessary evidence against an individual to get a successful prosecution.

I currently do not find the arguments from people on here who oppose the cultural practice of circumcision persuasive enough to legally ban it, though Prof Davey's stats could be if the rate of deaths and complications from non-therapeutic circumcision outweigh the benefits. In the meantime, while there is no consensus from the medical professionals in the UK that the medical benefits are too minimal to justify the risk of death or complications, or that the risk of harm is unacceptable enough to legally ban circumcision, I will continue to be an apologist for the barbaric, inhuman mutilation of boys by parents who are bringing them up with a particular culturally identity. I understand the argument that it is a pointless ritual - many rituals and cultural practices are pointless - and I therefore suspect that more and more people will abandon this part of their culture if the risk of complications and deaths seems too high. In countries where life is generally a lot less safe than in the UK, the risks from circumcision might seem acceptable, but in the context of the UK and its safety culture the risks will probably appear a lot more jarring to people who move here and absorb some of the cultural influences of their host country. 

I don't think that in relation to this particular issue, based on the current levels of harm being expressed by the majority of people who have been circumcisied and who do not have a problem with it, that it is in the best interests of children for their parents to be legally banned from having their children participate in that aspect of their cultural heritage. Of course I feel empathy for the people who do feel harmed by being circumcised when they would rather not be, and I would support them in educating parents about the risk of psychological trauma so that parents make a more informed decision.

Rose - hope you change your mind and stay - I think this forum needs an opposing POV rather than the same old boring voices and your posts are always welcome.

[ProfessorDavey]

Ok - but no one is advocating all babies be circumcised - the discussion was about whether parents in the UK should be legally prevented from having babies circumcised if both parents agree, especially if they see circumcision as one measure to reduce the risk of certain STDs and HIV infection along with condom use.

But you can only do that by quantifying the 'benefits' and also quantifying the 'harm' - My approach was to look at what would happen in terms of benefits and harm were all boys in the UK circumcised. But the effects are of course scalable.

By the way, where are you getting the UK death rates from circumcision? If death rates are higher in the UK than the WHO have indicated in their report and parents are educated about the risks of death it should not be too difficult to persuade them to not circumcise their children if there is more chance of dying from circumcision than HIV, and to let the children decide for themselves when they can give informed consent.

The death rates are based on a study in the USA (a comparable developed country) which I linked to earlier, which suggested one death per approx. 11,000 circumcisions.

Now as far as I am aware there hasn't been a recent UK study on this, but given there are about 11,000 circumcisions in the UK per year it is possible to work out whether the death rate is in the 'ball park' by looking for new reports of circumcision deaths in the UK of about one per year. And that's what you find.

I disagree that it should not be difficult to persuade parent not to circumcise their children as in the vast majority of cases this is religiously motivated and parents are under enormous pressure from their faith communities to do it, regardless of the risks. Indeed I suspect the risks are substantially downplayed within those communities.

[Aruntraveller]

I have felt hesitant to discuss this issue too much as I have been circumcised myself. This was as an adult and for medical reasons (a not uncommon problem for some men) and whilst my sex life (such as it is!) Is much better than it used to be, and I am going back over 30 years now, I still feel conflicted about it. A small sense of loss. Dont get me wrong  life is better since than before - but still when i think about it I feel some small sadness. I dont really understand the feeling and i certainly dont dwell on it. So there you have it. But to perform this procedure on children without any good reason  feels wrong to me.

I ,like Gabby, hope that Rose reconsiders.  Diversity should be a strength.

[The Accountant, OBE, KC]

Nope - it's legality has not been tested or proved, hence 'assumed to be lawful'.

There is a difference - the lawfulness of infant circumcision remains unclear, and will do so until there is a definitive test case in the courts, or a clear view from Parliament.

No doubt when the medical evidence is unequivocal that circumcision carries a risk that outweighs the psycho-social benefits and conclusively proves damage to health, there will be a test case on the lawfulness of infant circumcision. As the BMA guidance says "If it was shown that circumcision where there is no clinical need is prejudicial to a child’s health and wellbeing, it is likely that a legal challenge on human rights grounds would be successful."

[The Accountant, OBE, KC]

But you can only do that by quantifying the 'benefits' and also quantifying the 'harm' - My approach was to look at what would happen in terms of benefits and harm were all boys in the UK circumcised. But the effects are of course scalable.
The death rates are based on a study in the USA (a comparable developed country) which I linked to earlier, which suggested one death per approx. 11,000 circumcisions.

Now as far as I am aware there hasn't been a recent UK study on this, but given there are about 11,000 circumcisions in the UK per year it is possible to work out whether the death rate is in the 'ball park' by looking for new reports of circumcision deaths in the UK of about one per year. And that's what you find.

I disagree that it should not be difficult to persuade parent not to circumcise their children as in the vast majority of cases this is religiously motivated and parents are under enormous pressure from their faith communities to do it, regardless of the risks. Indeed I suspect the risks are substantially downplayed within those communities.

I think it depends on the community and their level of education in understanding the stats. I have no experience within the Jewish community but my experience of educated Muslims is that they would not put their child at risk if they were aware that the risks were not small. I already know people within my community who waited until their child was older and able to express an opinion about cultural ties,and being part of a tradition, and to consent to the circumcision. If the stats are available and back up the position that the risk is not small then that should be highlighted in GP surgeries and hospitals, and through public campaigns etc with a link to the stats.

[ProfessorDavey]

No doubt when the medical evidence is unequivocal that circumcision carries a risk that outweighs the psycho-social benefits and conclusively proves damage to health, there will be a test case on the lawfulness of infant circumcision. As the BMA guidance says "If it was shown that circumcision where there is no clinical need is prejudicial to a child’s health and wellbeing, it is likely that a legal challenge on human rights grounds would be successful."

I'm not sure it is that simple - legislators are terrified of upsetting the religious.

Look at what happened in Germany - a court did exactly that - it weighed the harm and purported benefits and concluded that infant circumcision (i.e. without the consent of the baby) cannot be in the best interests and outlawed it. The government received a huge backlash from religious lobbies and caved in reversing the decision - not on evidential grounds but because of political expediency.

If non therapeutic infant circumcision was not associated with religious traditions and the decision was being made on the evidence base it would be declared unlawful in an instance.

[Rhiannon]

I think that community and identity are incredibly important - contrary to Rose's accusations of antisemitism my family have had a lifelong close relationship with Jewish friends - and so I think I understand how rich their traditions are. I'm less familiar with Islam but I'm assuming the same there. I'm aware that within Judaism there are movements to change the practice of infant circumcision, backed up by Jewish teachings, and that some families do take the step of refusing it, but if there are still communities that regard it as essential in order for their child to be welcomed then that is sad. Do they feel that their child is outside that community and is therefore rejected in some way? How many families can stand up to family, cultural and religious pressure?

https://www.theguardian.com/lifeandstyle/2007/feb/03/familyandrelationships.family

When I was a kid most of us were 'christened' as babies, sometimes due to family pressure but often because it was just what people did and there was an excuse for a party. It is supposed to be a welcoming into the church but actually it's pretty meaningless because the child hasn't chosen that faith. Now many Christian parents are opting against infant baptism in favour of naming ceremonies in church, and of course the Baptist church itself doesn't conduct infant baptism at all. Opting to be baptised as an adult is a big message about faith and belief. I know that adult circumcision is a bigger deal than for infants but men still opt for it for a whole range of reasons; opting for it as a matter of faith sends a big message and has such a depth of meaning, surely?

[The Accountant, OBE, KC]

I'm not sure it is that simple - legislators are terrified of upsetting the religious.

Look at what happened in Germany - a court did exactly that - it weighed the harm and purported benefits and concluded that infant circumcision (i.e. without the consent of the baby) cannot be in the best interests and outlawed it. The government received a huge backlash from religious lobbies and caved in reversing the decision - not on evidential grounds but because of political expediency.

If non therapeutic infant circumcision was not associated with religious traditions and the decision was being made on the evidence base it would be declared unlawful in an instance.

I see that the court ruled that a mother's or father's right to freedom of religion as well as their right to determining how they raise their child would not be limited if they were forced to wait and allow their child to decide for himself if he wanted to be circumcised. The ruling states a child's right to self-determination should come first. I think it just requires a little momentum and public support for this to be adopted by other courts.

[ProfessorDavey]

I see that the court ruled that a mother's or father's right to freedom of religion as well as their right to determining how they raise their child would not be limited if they were forced to wait and allow their child to decide for himself if he wanted to be circumcised. The ruling states a child's right to self-determination should come first. I think it just requires a little momentum and public support for this to be adopted by other courts.

Although I would not wish it done myself, I have no issue with an adult consenting to circumcision, and therefore a requirement that circumcision can only be performed (unless there are medical indications) with the consent of the person being circumcised.

My issue is with circumcision on an infant or child who has not consented, and indeed is unable to consent.

[The Accountant, OBE, KC]

I think that community and identity are incredibly important - contrary to Rose's accusations of antisemitism my family have had a lifelong close relationship with Jewish friends - and so I think I understand how rich their traditions are. I'm less familiar with Islam but I'm assuming the same there. I'm aware that within Judaism there are movements to change the practice of infant circumcision, backed up by Jewish teachings, and that some families do take the step of refusing it, but if there are still communities that regard it as essential in order for their child to be welcomed then that is sad. Do they feel that their child is outside that community and is therefore rejected in some way? How many families can stand up to family, cultural and religious pressure?

https://www.theguardian.com/lifeandstyle/2007/feb/03/familyandrelationships.family

When I was a kid most of us were 'christened' as babies, sometimes due to family pressure but often because it was just what people did and there was an excuse for a party. It is supposed to be a welcoming into the church but actually it's pretty meaningless because the child hasn't chosen that faith. Now many Christian parents are opting against infant baptism in favour of naming ceremonies in church, and of course the Baptist church itself doesn't conduct infant baptism at all. Opting to be baptised as an adult is a big message about faith and belief. I know that adult circumcision is a bigger deal than for infants but men still opt for it for a whole range of reasons; opting for it as a matter of faith sends a big message and has such a depth of meaning, surely?

I didn't read Rose's comment as an accusation of anti-semitism. I thought it was pretty accurate - that some people who hold a different POV for cultural and religious reasons could feel bullied by some posters on here if their views are challenged using emotive  terms such as "inhuman", "barbaric" etc. Some people might quite rightly dismiss those kind of comments as playground tactics and find them unpersuasive, but some people might feel more hurt by their traditions being attacked in those terms - and that is what I understood Rose to mean in her posts.

I think she was quite right to point out that different POVs should be expressed on here and she is therefore far more useful to this forum than posters who all think the same or are not prepared to argue constructively.

Yes I agree that adult circumcision sends an important message about faith.

If there is majority public support that the right of a child to self-determination supercedes parental rights to decide what is in the best interests of the child, then there will be the political will to make the legislative changes. I suspect the problem is that society currently prefers parents to decide what is in the best interests of the child in this situation. 

[ProfessorDavey]

I think that community and identity are incredibly important - contrary to Rose's accusations of antisemitism my family have had a lifelong close relationship with Jewish friends - and so I think I understand how rich their traditions are. I'm less familiar with Islam but I'm assuming the same there. I'm aware that within Judaism there are movements to change the practice of infant circumcision, backed up by Jewish teachings, and that some families do take the step of refusing it, but if there are still communities that regard it as essential in order for their child to be welcomed then that is sad. Do they feel that their child is outside that community and is therefore rejected in some way? How many families can stand up to family, cultural and religious pressure?

https://www.theguardian.com/lifeandstyle/2007/feb/03/familyandrelationships.family

When I was a kid most of us were 'christened' as babies, sometimes due to family pressure but often because it was just what people did and there was an excuse for a party. It is supposed to be a welcoming into the church but actually it's pretty meaningless because the child hasn't chosen that faith. Now many Christian parents are opting against infant baptism in favour of naming ceremonies in church, and of course the Baptist church itself doesn't conduct infant baptism at all. Opting to be baptised as an adult is a big message about faith and belief. I know that adult circumcision is a bigger deal than for infants but men still opt for it for a whole range of reasons; opting for it as a matter of faith sends a big message and has such a depth of meaning, surely?

The notion of pressure to conform (whether from family or broader religious community) invalidates consent. One of the cornerstones for valid consent is that it is entirely voluntary, free from any coercion, pressure or duress to act in a particular way. I would strongly argue that parental consent for infant circumcision in many cases is not valid due to the pressures brought to bear on the parents to agree to circumcision.

[Shaker]

Yes I agree that adult circumcision sends an important message about faith.

Primarily that you can get away with carrying out the most disgusting shit on babies and children if you claim you're doing it in the name of some idiotic belief system.

[ProfessorDavey]

If there is majority public support that the right of a child to self-determination supercedes parental rights to decide what is in the best interests of the child, then there will be the political will to make the legislative changes.

But this is already enshrined in law, embedded in ethics declarations in the field of medicine already and has been for decades. What we have here is a bizarre anomaly - specifically because it abuts against religious convictions.

[The Accountant, OBE, KC]

Primarily that you can get away with carrying out the most disgusting shit on babies and children if you claim you're doing it in the name of some idiotic belief system.

Thanks for sharing your belief system on this issue. All diverse views are welcome.

[The Accountant, OBE, KC]

But this is already enshrined in law, embedded in ethics declarations in the field of medicine already and has been for decades. What we have here is a bizarre anomaly - specifically because it abuts against religious convictions.

Presumably because society currently believes there is a benefit and that it is in the child's socio-psychological best interests to participate in his parents' culture on this issue. There is no objective measure of the benefit so it remains for society and the courts to look at the ethical issues again and to change its mind on this and feel differently in order for there to be the political will to change the legislation.

[ProfessorDavey]

Presumably because society currently believes there is a benefit and that it is in the child's socio-psychological best interests to participate in his parents' culture on this issue. There is no objective measure of the benefit so it remains for society and the courts to look at the ethical issues again and to change its mind on this and feel differently in order for there to be the political will to change the legislation.

No it is because society does not want to offend religious sensibilities.

In other area of medical ethics there is no presumption of benefit - quite the reverse. The presumptions are usually as follows for treatment (and even more so for any intervention that is not medically indicated - the best example perhaps being non therapeutic research).

Intervention can only be permitted with parental consent where it cannot be delayed until the child themselves is old enough to be able to consent - i.e. necessity of immediacy (infant circumcision fails on that ground)

That the benefits very clearly outweigh the potential harm (again infant circumcision fails)

Where the intervention is not therapeutic (as is the case for ritual circumcision) that unless the circumstances are exceptional, it should pose no more than a minimal risk to the subject (again infant circumcision fails)

That parental consent should, as a starting point, be the presumed will of the child (again infant circumcision fails) and must be in the child's best interests

That the parent giving consent must have the capacity to consent (no reason to suspect not), be sufficiently informed (question marks here) and that the decision will be entirely voluntary, free from duress, coercion or pressure (infant circumcision fails).

[floo]

I would certainly challenge a Jewish poster about circumcision, just as I would challenge people of other faiths, like Catholics for instance, about the things their faith decrees, which I think are very wrong.

[Rhiannon]

I'll challenge anyone. That isn't the same thing as 'turning on' someone. Rose specifically said that people who disagree with infant circumcision would turn on a Jewish poster. She was accusing us of mob mentality with an undercurrent of antisemitism and I find that worrying.

[floo]

I'll challenge anyone. That isn't the same thing as 'turning on' someone. Rose specifically said that people who disagree with infant circumcision would turn on a Jewish poster. She was accusing us of mob mentality with an undercurrent of antisemitism and I find that worrying.

I think she was completely out of order, but now she is no longer with us, we can dismiss her opinions.