German court: circumcising a child is bodily harm

LarryC wrote:

I still say that we ought to leave it to its devices and let its practitioners as they will. Those babies are theirs, not ours; it's infringing on the family unit to interfere.

It's infringing on the child to allow it to continue. At that point, we must decide which is more important, the family unit or the individual. Over here in the western world, we side with the individual.

I get that you're hesitant to tell call a cultural practice wrong due to your culture's history, but lets be clear about what's going on. The child's rights are being ignored in favor of the parent's right.

LarryC wrote:

What we're talking about here is the family unit and the differential powers and responsibilities accruing to each part, within the culture in question. In general, there's no call to interfere in non-lethal inter-family interactions; and there's call to interfere on the government level insomuch as that family has a responsibility to contribute socially (and it can't do that with no members).

On that note, we radically disagree. You might think it's fine to abuse your children as long as they survive the ordeal. Me? Not so much.

Clearly, we're drawing a line in *very* different places.

LarryC wrote:

Within that limitation, asking the government to interfere weakens the family unit on both responsibility and power sides. A father/mother pairing who doesn't have as much power over their family by dint of government oversight has reasonable recourse to appealing to said government for responsibilities they ought to be seeing to themselves.

We see this phenomenon occurring when parents shirk their responsibilities as the primary educators of their children, often leaving vital instruction to the hands of teachers and schools, or churches.

It's not a matter of parents owning their children, but a family functioning as a self-sufficient and powerful unit.

That's all well and good, until the famliy in question in comprised of assholes. Maybe it's my inner Westerner shining through, but I believe that the government's responsibility should be to protect those who cannot protect themselves, and that includes protecting children from their own families if necessary, regardless of how self-sufficient that family is, or should be.

LarryC wrote:
Those babies are theirs, not ours; it's infringing on the family unit to interfere.

There's that "property" argument/idiom again

I bolded the reason why that idiom comes up again, because it's exactly what your words suggest.

Jonman:

Indeed they do. However, as they say over here, "your freedom to swing your arms around ends where my nose begins."

I'm all for adults consenting to dangerous things FOR THEMSELVES. Hell, I do it myself all the time.

I am an enormous proponent of self-determination. Your religion thinks it's best for you to go without a foreskin? Awesome, when you're old enough to consent to it, you go right ahead and get your foreskin removed.

Not all of those festivals are for adults. I happen to think that the Western Halloween candyfest is fantastically damaging to the youth of that cultural sphere en masse, but I'm not about to go over there and tell you all it's a crime to celebrate it.

We're not even going into the crazier Japanese festivals where people hold flaming barrels of gunpowder.

So babies are property, and there is no place for a society to limit what one can do with/to their own children? By this logic, child prostitution is just dandy as long as it's the family that's pimping them out?

But seriously, don't defend that point - I know from your previous postings that that's not your position, I'm just spit-balling to show the holes in that line of reasoning.

There's that "property" argument/idiom again. It's really prevalent in your culture, and I don't think it meaningfully summarizes my position here. It's a tragic cultural tradition that I'm glad I wasn't around to personally experience, from either side.

By the by, treating people as "property" is only really cruel and inhumane in that you guys tend to be cruel and inhumane to your property in general. "Chattel slavery" is the tradition that's made the mark, and it's unfortunately made its mark on "slavery" as well.

What we're talking about here is the family unit and the differential powers and responsibilities accruing to each part, within the culture in question. In general, there's no call to interfere in non-lethal inter-family interactions; and there's call to interfere on the government level insomuch as that family has a responsibility to contribute socially (and it can't do that with no members).

Within that limitation, asking the government to interfere weakens the family unit on both responsibility and power sides. A father/mother pairing who doesn't have as much power over their family by dint of government oversight has reasonable recourse to appealing to said government for responsibilities they ought to be seeing to themselves.

We see this phenomenon occurring when parents shirk their responsibilities as the primary educators of their children, often leaving vital instruction to the hands of teachers and schools, or churches.

It's not a matter of parents owning their children, but a family functioning as a self-sufficient and powerful unit.

On the grounds of government responsibilities, I sometimes find it hard to condemn local parents who prostitute their children, because I do not know the circumstances under which they do so. It is altogether tragically too likely that the options are prostituting some of their children, or watching them all slowly starve to death one by one. It is a deplorable state of affairs.

I'll accept that we can say as a government that it's unacceptable to prostitute children on the condition that we make sure that it never becomes necessary to do so in order to keep on living. There must not be one instance where people died because of our infringement on the family unit.

On the same note, I will accept that the government can outlaw infant circumcision on the condition that it can go back in time and allow the infant to be retroactively circumcised, should the adult want to have been circumcised as a child. Barring that, we have to rely on the parent's best judgement.

Stengah:

It's infringing on the child to allow it to continue. At that point, we must decide which is more important, the family unit or the individual. Over here in the western world, we side with the individual.

I get that you're hesitant to tell call a cultural practice wrong due to your culture's history, but lets be clear about what's going on. The child's rights are being ignored in favor of the parent's right.

Actually, CheezePavilion clarifies this well. It is not that the child doesn't have rights or that it's being ignored. It's that it's been transferred to the parents as his or her legal executor, since he or she is incapable of making the decision.

I do not view the individual and the family as fundamentally separate entities. That makes as much sense to me as the mind/body dichotomy (which is also a Western concept). The family makes the individual, and families are made up of individuals.

Super-boring tangent on family:

Spoiler:

It occurs to me that a lot of this family/individual dichotomy and pull could be due to the disintegration of the unit we could call as "household." Robear shares that this social unit was common in the West up to the Industrial Revolution, but was shelved in favor of the "Nuclear Family" concept of one man, one woman, and their children.

I use "family" and "household" interchangeably because that's how it is in my culture. "Family" means the dad, the mom, their children, some of the closer neighbors, the household help, a few of the neighborhood kids, and an uncle or so. If that uncle happens to have a closer than normal relationship with the dad and they happen not to be blood relations, well, we don't look too closely; that's their affair.

It's obvious here that to some extent, you "choose your family," as "family" could very well be a bunch of unmarried males living in the same household as bachelors. Finding a room mate isn't just a matter of finding someone who'll foot the bill. That person could be your health advocate, dinner buddy, friend, or aggravating younger "brother."

In this sense, a man (or woman) cannot be without a family, and is much weaker and more vulnerable without one. He can't purchase necessities en masse. He has more difficulty in communication, cooking, transportation - all activities of life up to and including friendly company. Introverts go in as well. We respect their need to just sit and say nothing.

In the sense that each man (or woman) finds and lives within a "household," each family is made of individuals. In the sense that each household has its own personality and affects group dynamic, each family makes the individual.

We have people who live alone, though. It is difficult to care for them; they're generally lonelier and easier to fall through the cracks.

LarryC wrote:

It is not that the child doesn't have rights or that it's being ignored. It's that it's been transferred to the parents as his or her legal executor, since he or she is incapable of making the decision.

I'm okay with that right being transferred to the parent, but they should be preserving the option until the child is capable of making the decision for themselves*, not making it for them

*In this particular instance. There are other decisions that they should be able to make for their children, I just do not think that irreversible cosmetic body modification should be one of them.

Jonman:

See above tangent about family. I find it hard to express myself in English this way because English terms of endearment are so rife with innuendos about ownership and power. If "those babies are theirs" implies that babies are property, is every married couple property as well? It's a strange idiomatic landscape.

What I mean is that those babies are theirs to care for and raise. How they do so is their affair, not ours.

On that note, we radically disagree. You might think it's fine to abuse your children as long as they survive the ordeal. Me? Not so much.

Clearly, we're drawing a line in *very* different places.

I think you're mischaracterizing what I said there. I don't think it's fine to abuse my children at all; but I don't know that it's okay to interfere with other people's manner of raising their children if I happen to disagree with their manner of managing their family, to the point where I would personally call it "abuse."

I expect a similar courtesy, you see. If someone thinks that my taking my child out from her favorite ride because she's crying is abuse, I'll thank them very well for keeping that firmly to themselves. I want no censure by word, look, implication, or action.

Given that you espouse interference in parenting from the government or even other parents, can I assume that you will welcome other people undermining your parental authority in front of your children?

I am, of course, referring to interference that runs counter to your cultural norms or very valued beliefs. It goes without saying that you will likely exercise those practices which are congenial to you, so "not abusing" your kids would be no problem at all. You're a fitness guy. How about someone coming over to stop your kid from cycling, on the premise that he thinks it's child abuse?

That's all well and good, until the famliy in question in comprised of assholes. Maybe it's my inner Westerner shining through, but I believe that the government's responsibility should be to protect those who cannot protect themselves, and that includes protecting children from their own families if necessary, regardless of how self-sufficient that family is, or should be.

It's my inner Pinoy that's leaking through then, since I don't trust any government to discharge that responsibility dispassionately. There's always an angle; there's always an agenda. How many times have you heard "Think of the children!" used as a rallying cry for some position or other?

But when it comes to brass tacks? Nothing. You gotta look out for number one, 'cause no one else is going to do that for you.

If there are families who are all assholes, I expect the kid to run away and never come back; presumably to stay with people who are not assholes. I'm reading that there is a dearth of that in your culture?

Stengah:

I refer you to the 2005 Taskforce report that Rezzy was kind enough to refer to upthread. Let's first establish that while the benefits and risks of circumcision were judged a wash by the AAP, at no point did cosmetic considerations weigh heavily on their evaluation.

LarryC wrote:

Stengah:

I refer you to the 2005 Taskforce report that Rezzy was kind enough to refer to upthread. Let's first establish that while the benefits and risks of circumcision were judged a wash by the AAP, at no point did cosmetic considerations weigh heavily on their evaluation.

Actually what the 2005 Taskforce determined was that there is no medical reason to routinely circumcise infant boys, so physicians should discuss the cultural and traditional considerations with the parents.

Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In the case of circumcision, in which there are potential benefits and risks, yet the procedure is not essential to the child's current well-being, parents should determine what is in the best interest of the child. To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision. It is legitimate for parents to take into account cultural, religious, and ethnic traditions, in addition to the medical factors, when making this decision. Analgesia is safe and effective in reducing the procedural pain associated with circumcision; therefore, if a decision for circumcision is made, procedural analgesia should be provided. If circumcision is performed in the newborn period, it should only be done on infants who are stable and healthy.

In other words, distancing the 'official' medical community from the decision to perform an unnecessary surgery on an infant since it doesn't benefit the patient in any meaningful way.

LarryC wrote:

Stengah:

I refer you to the 2005 Taskforce report that Rezzy was kind enough to refer to upthread. Let's first establish that while the benefits and risks of circumcision were judged a wash by the AAP, at no point did cosmetic considerations weigh heavily on their evaluation.

Why would you refer me to that? It's cosmetic surgery by the virtue of it altering the appearance of the individual. I'm not concerned with whether it looks better or not, I'm concerned that it can't be undone, and is being practiced on people who are unable to consent.

Rezzy:

You're reading that wrong.

Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision.

What this means is that there is a measurable benefit to the procedure, but the benefits were non-essential (the kid isn't going to die) and the benefits, while significant, were small. Ergo, no to routine procedures. That's not just fancy wording, and it's not to cover their legal concerns. That wording is used to characterize epidemiological recommendations.

Long story short; it's not cosmetic. Right?

Stengah:

Why would you refer me to that? It's cosmetic surgery by the virtue of it altering the appearance of the individual. I'm not concerned with whether it looks better or not, I'm concerned that it can't be undone, and is being practiced on people who are unable to consent.

By that measure, all surgery is cosmetic, since they all alter the appearance of the individual in some way or other. Ban all surgeries on minors?

I'm interested to hear your take on something that IS purely cosmetic, and doesn't have religious overtones: ear piercings for earrings.

Should the government outlaw putting earrings on young girls?

Actually you're reading that wrong. Potential medical benefits. If I circumcise 100 infants, then potentially one of them will not suffer from a urinary tract infection. Statistically speaking. That was the biggest medical benefit relevant to infants. A reduction from 1 in 100 Urinary tract infections to 1 in a thousand potential urinary tract infections.

Here is the section under 'Ethical Issues' of that report.

Parents and physicians each have an ethical duty to the child to attempt to secure the child's best interest and well-being.119 However, it is often uncertain as to what is in the best interest of any individual patient. In cases such as the decision to perform a circumcision in the neonatal period when there are potential benefits and risks and the procedure is not essential to the child's current well-being, it should be the parents who determine what is in the best interest of the child. In the pluralistic society of the United States in which parents are afforded wide authority for determining what constitutes appropriate child-rearing and child welfare, it is legitimate for the parents to take into account cultural, religious, and ethnic traditions, in addition to medical factors, when making this choice.119

Physicians counseling families concerning this decision should assist the parents by explaining the potential benefits and risks and by ensuring that they understand that circumcision is an elective procedure. Parents should not be coerced by medical professionals to make this choice.

The 119 Footnotes point to:
Fleischman AR,
Nolan K,
Dubler NN,
et al.
(1994) Caring for gravely ill children. Pediatr. 94:433–439.

EDIT: My point is that the Taskforce takes pains to establish that in the USA parents have the prerogative to make elective surgery decisions on cultural, religious, and traditional considerations. Why should Germany be forced, at gunpoint, to deny protections from those considerations to their children?

LarryC wrote:

By that measure, all surgery is cosmetic, since they all alter the appearance of the individual in some way or other. Ban all surgeries on minors?

All surgery can have cosmetic components (scars and the like), but no, it's cosmetic because it's entire purpose is to alter the appearance.

I'm interested to hear your take on something that IS purely cosmetic, and doesn't have religious overtones: ear piercings for earrings.

Should the government outlaw putting earrings on young girls?

I think on infants, sure. If the girl is the one asking to get her ears pierced, it's no longer being done without her consent. A tiny hole in the earlobe is a bit different than cutting off foreskin though. A better comparison would be cutting off the earlobes entirely.

Rezzy:

Actually you're reading that wrong. Potential medical benefits. If I circumcise 100 infants, then potentially one of them will not suffer from a urinary tract infection. Statistically speaking. That was the biggest medical benefit relevant to infants. A reduction from 1 in 100 Urinary tract infections to 1 in a thousand potential urinary tract infections.

I don't see how I was reading it wrong, given that I bolded "potential" as well. All preventative procedures have a percentage chance of being beneficial vs. the cost and risk of the intervention. This is true of vaccination, too. It's just that in the study, the taskforce pointed out that the "Number Needed To Treat" was large for cost. That doesn't make the benefit nonexistent, and we still refer to it as "benefit" for short. Your relative risk or odds ratio still go down, albeit by a really small amount.

My point is that the Taskforce takes pains to establish that in the USA parents have the prerogative to make elective surgery decisions on cultural, religious, and traditional considerations. Why should Germany be forced, at gunpoint, to deny protections from those considerations to their children?

This question goes to parental prerogative now; and religious freedom. Germany isn't being forced to do anything at gunpoint. I'm pointing out that they're using force to stamp out a religious practice. You're using a rhetorical device here; I'm not. If you commit a crime in Germany, they will come for you and if you resist, they will actually, really, literally shoot you.

Stengah:

All surgery can have cosmetic components (scars and the like), but no, it's cosmetic because its entire purpose is to alter the appearance.

Referring to the taskforce report again. Rezzy was kind enough to post the relevant parts.

"In the pluralistic society of the United States in which parents are afforded wide authority for determining what constitutes appropriate child-rearing and child welfare, it is legitimate for the parents to take into account cultural, religious, and ethnic traditions, in addition to medical factors, when making this choice."

I don't see "cosmetic" in there.

It may that you consider the procedure cosmetic; that doesn't make it so. Technically, you might consider an appendectomy cosmetic as well, but that doesn't make it so.

I think on infants, sure. If the girl is the one asking to get her ears pierced, it's no longer being done without her consent. A tiny hole in the earlobe is a bit different than cutting off foreskin though. A better comparison would be cutting off the earlobes entirely.

It may be from your standpoint, but I was considering it from a risk/benefit analysis. An earlobe piercing still pierces the skin and also carries a risk of infection, and it's painful, too, given that it's not done under anesthesia as far as I know. There's also a continuing risk of trauma and/or infection, allergies, and the like.

It's also far more obvious. The entire point of the procedure is cosmetic; it has no known medical benefits, however small. I am not using cosmetic here relatively, nor from my viewpoint, nor to denigrate the benefit of piercings. To my knowledge, ear piercings have no known medical benefit whatsoever.

A girl is no more considered legally competent than an infant. She can't give her consent for body piercings; we have to get the parents' signatures, not the child's. Ergo, it's still done without her consent.

Follow-up question. If you consider a young girl competent enough to give consent for an ear piercing (I don't), is a young body competent enough to give consent for a circumcision?

LarryC wrote:

This question goes to parental prerogative now; and religious freedom. Germany isn't being forced to do anything at gunpoint. I'm pointing out that they're using force to stamp out a religious practice. You're using a rhetorical device here; I'm not. If you commit a crime in Germany, they will come for you and if you resist, they will actually, really, literally shoot you.

I don't understand. How is the force of a law preventing a harm any less lethal than the force of a law compelling you to endure it?

Edit: Should Medical Staff, Police Officers, and Court Officials be compelled, by force of law, to ignore clearly injured children delivered to their care?

LarryC wrote:
I think on infants, sure. If the girl is the one asking to get her ears pierced, it's no longer being done without her consent. A tiny hole in the earlobe is a bit different than cutting off foreskin though. A better comparison would be cutting off the earlobes entirely.

[...]
A girl is no more considered legally competent than an infant. She can't give her consent for body piercings; we have to get the parents' signatures, not the child's. Ergo, it's still done without her consent.

[...]

Follow-up question. If you consider a young girl competent enough to give consent for an ear piercing (I don't), is a young body competent enough to give consent for a circumcision?

It's not about competences. It's about whether the child is capable of expressing what she wants or does not want to be done to his/her body.

LarryC wrote:

Follow-up question. If you consider a young girl competent enough to give consent for an ear piercing (I don't), is a young body competent enough to give consent for a circumcision?

Depends on how old the boy (assuming the "d" was a typo) is. I'd say for a procedure like that, maybe 12 or 13 would be old enough. I get that they're not legally competent, and a parent/guardian would have to sign for any procedures.

I don't see "cosmetic" in there.

It may that you consider the procedure cosmetic; that doesn't make it so. Technically, you might consider an appendectomy cosmetic as well, but that doesn't make it so.

It doesn't matter at all if the taskforce never mentioned the word "cosmetic" in their report. It is cosmetic because the sole intent of the procedure is to alter the appearance of the body. I sincerely hope you're just trolling me, because I would expect someone in the medical field like yourself to know what cosmetic surgery is.

It may be from your standpoint, but I was considering it from a risk/benefit analysis. An earlobe piercing still pierces the skin and also carries a risk of infection, and it's painful, too, given that it's not done under anesthesia as far as I know. There's also a continuing risk of trauma and/or infection, allergies, and the like.

It's also far more obvious. The entire point of the procedure is cosmetic; it has no known medical benefits, however small. I am not using cosmetic here relatively, nor from my viewpoint, nor to denigrate the benefit of piercings. To my knowledge, ear piercings have no known medical benefit whatsoever.

Cutting off the earlobe is a better comparison from the logical standpoint. If you want to compare piercing the ears to a procedure done to the penis, piercing the foreskin would be an apt comparison.

Rezzy:

I don't understand. How is the force of a law preventing a harm any less lethal than the force of a law compelling you to endure it?

Edit: Should Medical Staff, Police Officers, and Court Officials be compelled, by force of law, to ignore clearly injured children delivered to their care?

I'm not comprehending the question; the syntax and idiom is unclear. Could you restate that in plainer terms with a clear reference to what you're referring to?

As for the edit, I don't see how that's relevant to the topic. The AAP has already rendered the practice as medically neutral. Why are we comparing it to ignoring children who are injured? That's clearly medically irresponsible. If you want to go against the statements of the taskforce you yourself referred and recommended, then please do so more explicitly.

Grimmi Meloni:

It's not about competences. It's about whether the child is capable of expressing what she wants or does not want to be done to his/her body.

That's not a relevant issue. The ability to express desire does not lead to legal competency, especially with regard to consent and responsibilities. A child may not consent to life-saving surgery because she may not comprehend that the pain and the fear are temporary. She'll express extreme resistance, but we're going to hold her down and save her life anyway, if her parents consent.

Note: parents and people of legal competence can elect not to have life-saving surgery.

Stengah:

Depends on how old the boy (assuming the "d" was a typo) is. I'd say for a procedure like that, maybe 12 or 13 would be old enough. I get that they're not legally competent, and a parent/guardian would have to sign for any procedures.

Well, now you're playing to my biases, aren't you! I'm inclined to agree since that's the age where its common for the local boys to get circumcised, but I'm suspicious of my own biases. I don't know that our mutual agreement on this age limit is any objective or reasonable measure. I think it's reasonable, but that's me.

It doesn't matter at all if the taskforce never mentioned the word "cosmetic" in their report. It is cosmetic because the sole intent of the procedure is to alter the appearance of the body. I sincerely hope you're just trolling me, because I would expect someone in the medical field like yourself to know what cosmetic surgery is.

I do. I'm telling you that the procedure isn't cosmetic. I'm not trolling you. Consider this FYI. The sole intent in your locality may be to change the appearance, but that may be just you. Reasons given in the report are not cosmetic. Reasons given in the case are religious - not to change appearance but to adhere to religious mores and rituals. None of these reasons are cosmetic.

Cutting off the earlobe is a better comparison from the logical standpoint. If you want to compare piercing the ears to a procedure done to the penis, piercing the foreskin would be an apt comparison.

I'm afraid I don't get the logic of that comparison. Cutting off the earlobes is considered disfiguring in all cultures I know of, and in none are they religiously significant. Moreover, it's considerably riskier and more prone to medical problems immediately and later down the line. I cannot see where it's comparable except that you think it's all of these things that's applicable to earlobe removal, even though those same things are not applicable to circumcision.

In fact, piercing the foreskin with the intent of attaching a decorative implement would be most like both ear piercing and earlobe removal, in all the senses I enumerated.

LarryC wrote:
It's not about competences. It's about whether the child is capable of expressing what she wants or does not want to be done to his/her body.

That's not a relevant issue. The ability to express desire does not lead to legal competency, especially with regard to consent and responsibilities. A child may not consent to life-saving surgery because she may not comprehend that the pain and the fear are temporary. She'll express extreme resistance, but we're going to hold her down and save her life anyway, if her parents consent.

And this is where the vast majority of the disagreement will arise. There is simply too much of a disconnect culturally, I believe, for you and just about everyone else here, to agree on this point.

Since the child is unable to express a desire to be circumcised or not, the child's right to remain intact and not receive elective surgery (and let's be clear, circumcision is 100% elective surgery until real medical COMPLICATIONS arise. Preventive measures do not apply) should be protected above all else.

Your comparison is also fundamentally flawed when you compare circumcision to a life-saving surgical procedure. Preventive circumcision never saved a life, and has, in fact, taken quite a few.

NSMike:

The Taskforce report disagrees. The benefits of cicumcision vis a vis penile cancer and urinary tract infection, rated in the population at large, offsets the possible death from complicaitons, both (benefits and risks) of which have been studied and found to be low. In other words, it saves about as many lives as complications end. Digitalis is the same way; evidence suggests.

That's not a cultural disagreement. This is a medical taskforce report and recommendation. I'll refer everyone to the AAP report that Rezzy was good enough to mention. Let's please all read that.

LarryC wrote:

Let's please all read that.

Can we avoid condescension, please?

I did read it. Regardless, I don't know of any cases where medical concerns, especially elective, preventive procedures, trump human rights.

Also, let's not forget that the AAP is low-balling that report because they don't want to alienate doctors who have performed, and want to continue to perform, the procedure. There's politics there.

The report basically says there are measurable preventive benefits to circumcision. There would be measurable preventive benefits to performing mastectomies on pubescent girls as well. It's still not a good idea.

NSMike:

It was not meant to be condescending, but polite. Should I have said RTFM? I'm not sure how to phrase that.

I did read it. Regardless, I don't know of any cases where medical concerns, especially elective, preventive procedures, trump human rights.

You were making a case for it being medically unsound. I was refuting that. If you want to make it about rights, then it devolves to parental prerogative, since child rights are exercised by the parent until age of majority. I was not implying that medical concerns trump human rights. If anything, Rezzy's the one saying that, since he thinks people should be circumcised perforce if it were proven to be of great medical benefit. I don't.

My answer re: medical concerns is about those concerns only. Don't make my arguments for me.

Also, let's not forget that the AAP is low-balling that report because they don't want to alienate doctors who have performed, and want to continue to perform, the procedure. There's politics there.

Substantiate. I was under the impression that they were hedging on the benefits because they didn't want to be seen as religious endorsers. If anything, word on grapevine that the coming report will be more strongly worded in favor, in light of recent considerations.

The report basically says there are measurable preventive benefits to circumcision. There would be measurable preventive benefits to performing mastectomies on pubescent girls as well. It's still not a good idea.

The reason it isn't is because of the risk/benefit profile. The measurable risks and complications outweigh the measurable benefits, especially on pubescent girls. Also, it's widely considered to be aesthetically disfiguring, so even people who have elective mastectomies for stronger reasons often also elect to have cosmetic surgery at the same time, if feasible, even though the benefits of the latter are purely cosmetic.

These are very specific, and measurable objections that go beyond "That's not a good idea." It's not comparable to circumcision.

LarryC wrote:

I'll refer everyone to the AAP report that Rezzy was good enough to mention.

http://pediatrics.aappublications.or...

If you actually read the report you will see that the 'benefits' were pretty inconclusive. Which was kind of the point of my bringing up this report.

Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision.
Evidence regarding the relationship of circumcision to STD in general is complex and conflicting.
The literature on the relationship between circumcision status and risk of squamous cell carcinoma of the penis (SCCP) is difficult to evaluate. Reports of several case series have noted a strong association between uncircumcised status and increased risk for penile cancer; however, there have been few rigorous hypothesis-testing investigations.
Although all these studies have shown an increased risk of UTI in uncircumcised male infants, it is difficult to summarize and compare the results because of differences in methodology, samples of infants studied, determination of circumcision status, method of urine collection, UTI definition, and assessment of confounding variables. Furthermore, in some studies, methods for determining the reliability of the data were not described.
There is considerable evidence that newborns who are circumcised without analgesia experience pain and physiologic stress. Neonatal physiologic responses to circumcision pain include changes in heart rate, blood pressure, oxygen saturation, and cortisol levels. One report has noted that circumcised infants exhibit a stronger pain response to subsequent routine immunization than do uncircumcised infants.
Compared with placebo groups, neonates who had EMLA cream applied spend less time crying and have smaller increases in heart rate during circumcisions.
Compared with control subjects who received no analgesia, neonates with DPNB cry 45% to 76% less, have 34% to 50% smaller increases in heart rate, and have smaller decreases in oxygen saturation during the procedure.
Although all treatment groups experienced an attenuated pain response, the ring block appeared to prevent crying and increases in heart rate more consistently than did EMLA cream or DPNB throughout all stages of circumcision.
Physicians counseling families concerning this decision should assist the parents by explaining the potential benefits and risks and by ensuring that they understand that circumcision is an elective procedure.
LarryC wrote:

If anything, Rezzy's the one saying that, since he thinks people should be circumcised perforce if it were proven to be of great medical benefit.

Incorrect. Read the words I type:
I believe a Society should be empowered to circumcise perforce if it were proven to be of medical necessity for the well-being of a child.
And how is that position different from what we have now? If a foreskin is endangering the life of an infant, who here would prevent a doctor from helping that child?

Rezzy:

The risks and the benefits were both small, NOT inconclusive. Here:

The literature on the relationship between circumcision status and risk of squamous cell carcinoma of the penis (SCCP) is difficult to evaluate. Reports of several case series have noted a strong association between uncircumcised status and increased risk for penile cancer; however, there have been few rigorous hypothesis-testing investigations.

Translation:

We have reason to think that they're strongly related, but the evidence isn't as rigorously structured as we could like; it's hard to really say one way or another because the methods of investigation were weak, regardless of how suggestive the current data may be.

Although all these studies have shown an increased risk of UTI in uncircumcised male infants, it is difficult to summarize and compare the results because of differences in methodology, samples of infants studied, determination of circumcision status, method of urine collection, UTI definition, and assessment of confounding variables. Furthermore, in some studies, methods for determining the reliability of the data were not described.

ALL studies point to benefits to circumcision, but it's hard or impossible to synthesize them into a meta-analysis for various reasons; reasons cited.

Those are NOT inconclusive. Those are fairly strong words. However, what you should have posted is that the relative benefits are on the order of 1% or less; though the risks are similarly small.

Ergo, physicians should "discuss potential risks and benefits." If the benefits were inconclusive, physicians would have been advised not to discuss them at all!

I believe a Society should be empowered to circumcise perforce if it were proven to be of medical necessity for the well-being of a child.

And how is that position different from what we have now? If a foreskin is endangering the life of an infant, who here would prevent a doctor from helping that child?

Not the same thing. Society and us here individuals are different. The test is to ask if Society can compel us to do a surgery that's medically necessary but which we find repugnant for various reasons.

It seems like every step we take down this discussion reveals yet another new disagreement. I can't even remotely agree with your interpretation of those statements, LarryC. When I read that, the report doesn't come to any conclusions at all, the definition of inconclusive. In addition, it shows that the task force was either too lazy or too underfunded to even bother with a real scientific study to determine the real costs or benefits of this procedure. Overall, the whole report reads like a position paper that says, "Yeah, we don't condemn the practice, but we don't recommend it either, and any point on which real determinations could be made, we didn't explore."

I'm done with this discussion. I'm content in the knowledge that I'm not a proponent for mutilating children who can't speak for themselves based on shaky and even nonexistent science.

Here's a baffling one for you.

My son is 21 months old, and has a problem with his little fella. Medical circumcision is the likely solution. I don't approve of religious circumcision in the slightest, but if it is the only way to resolve his medical problem, so be it.

The NHS referral to a paediatric urologist was taking a very long time, so we looked into private options. 2 of the clinics that we spoke to refused to carry out the procedure at all, and the other said it was unlikely that they would do it, saying that he was too young. There isn't anything about his condition that makes a circumcision any more dangerous than normal. It isn't anything that poses a major risk to his health (yet), so they don't want to risk it.

I will go with the medical advice from 3 different specialists, if course.

Why can a baby be circumcised for religious reasons at a younger age than that of my boy, but not for medical ones?

NSMike:

You can do whatever you want, but let's not misinterpret the science around this. The report does NOT say that none of the studies were even worth considering. It does say that it's impossible to subject them to meta-analysis; that is, a study technique that purports to grind up the results of multiple independent studies and say something new.

Yeah, I don't get how that's helpful either; I'm rather on the side that "meta-analysis" is just another word for "take my word for it."

The science is not shaky on whether there are benefits or not. There are. You can look up the individual studies, methodologies, sample sizes and what not, if you want to find out for yourself. What you shouldn't do is presuppose that the science is shaky because of your prejudices.

spider_j wrote:

Here's a baffling one for you.

My son is 21 months old, and has a problem with his little fella. Medical circumcision is the likely solution. I don't approve of religious circumcision in the slightest, but if it is the only way to resolve his medical problem, so be it.

The NHS referral to a paediatric urologist was taking a very long time, so we looked into private options. 2 of the clinics that we spoke to refused to carry out the procedure at all, and the other said it was unlikely that they would do it, saying that he was too young. There isn't anything about his condition that makes a circumcision any more dangerous than normal. It isn't anything that poses a major risk to his health (yet), so they don't want to risk it.

I will go with the medical advice from 3 different specialists, if course.

Why can a baby be circumcised for religious reasons at a younger age than that of my boy, but not for medical ones?

I'm speculating that this is more to do with where you are (UK) than anything else. Circumcision is the exception, not the norm, there, so I'm guessing that there's more resistance to it, and less doctors are comfortable/competant at the procedure.

NSMike wrote:
LarryC wrote:
It's not about competences. It's about whether the child is capable of expressing what she wants or does not want to be done to his/her body.

That's not a relevant issue. The ability to express desire does not lead to legal competency, especially with regard to consent and responsibilities. A child may not consent to life-saving surgery because she may not comprehend that the pain and the fear are temporary. She'll express extreme resistance, but we're going to hold her down and save her life anyway, if her parents consent.

And this is where the vast majority of the disagreement will arise. There is simply too much of a disconnect culturally, I believe, for you and just about everyone else here, to agree on this point.

Since the child is unable to express a desire to be circumcised or not, the child's right to remain intact and not receive elective surgery (and let's be clear, circumcision is 100% elective surgery until real medical COMPLICATIONS arise. Preventive measures do not apply) should be protected above all else.

Your comparison is also fundamentally flawed when you compare circumcision to a life-saving surgical procedure. Preventive circumcision never saved a life, and has, in fact, taken quite a few.

This.

This was a real juicy discussion, but I think we all have made our (very opposed) positions on the matter clear.

Looking at the topic from a different angle: a real bummer from my point of view is, that now the german goverment has become hectic in light of all the religious tam-tam that was in the press during the last weeks. So basically they are now rushing a decision. I am pretty convinced, that the discussion going on here, is probably more indepth and pro/con than anything going on behind the scenes in the german legislative.

So instead of having a broader discussion about this, what Germany now will end up with, is some rushed "do not try to step on anybody's toes" reglementation. I think this is a missed chance.

Austria joins the debate:

Austria: Governor Orders Hospitals to Halt Circumcisions

This seems to be rather a symbolical question than anything else. The decree is directed as state-ran hospitals. But the problem is really with the procedure being unsafe because it's done NOT at a hospital.

Grimmi Meloni wrote:

So instead of having a broader discussion about this, what Germany now will end up with, is some rushed "do not try to step on anybody's toes" reglementation. I think this is a missed chance.

That's the problem with the conclusion many (including LarryC) jumped to when they saw a headline that mentioned Jews and Germany.