German court: circumcising a child is bodily harm

Kraint:

Begging your pardon, but I didn't jump to any conclusion. My impressions were based on reading the article, and on the coverage of the decision itself. Even the court that made the decision acknowledged the rival forces at work. It just so happened that they ruled in favor of body integrity; though I have my doubts about whether that's incidental.

Gorilla.800.lbs:

That's really the core policy question here. Outlawing the practice won't make it go away. That's not what's going to happen. What's going to happen is Jews and Muslims will be criminalized and generally have a hard time; and it's going to be more dangerous because the practice will be driven underground.

In a way, this parallels the abortion question. In a similar fashion, making it illegal also won't make it go away; it'll only make it more dangerous. It's also parallel in that there are moral questions aside from the policy ones that are complicating the issue; and that proponents for or against are using to confuse the issue.

From earlier in the thread:

LarryC wrote:

Given that they have a history of disliking Jews, and an even more current history of a cultural divide against the Muslim underclass, I have no difficulty believing whatsoever that many German citizens want to make life harder for those kinds of people that they don't like and believe are "taking over their country."

This sure looks like an immediate gut reaction that shuts down discussion to me. We may have moved past this level in this thread, but this is the type of statement that results in what Grimmi Meloni stated.

LarryC wrote:

Gorilla.800.lbs:

That's really the core policy question here. Outlawing the practice won't make it go away. That's not what's going to happen. What's going to happen is Jews and Muslims will be criminalized and generally have a hard time; and it's going to be more dangerous because the practice will be driven underground.

In a way, this parallels the abortion question. In a similar fashion, making it illegal also won't make it go away; it'll only make it more dangerous. It's also parallel in that there are moral questions aside from the policy ones that are complicating the issue; and that proponents for or against are using to confuse the issue.

No one here is advocating to outlaw the practice of circumcision, or otherwise make it go away, they're trying stop people from practicing it on people who cannot consent. This (that I can see) is the biggest sticking point. You think it's a situation where the parent should be able to make the choice for the child, while we don't.

Kraint:

That's not a gut reaction either. That's an expression of what I think is going down politically. There's an undercurrent of resentment among the long-standing Germans against Muslim immigrants, not unlike that expressed by some Americans over illegal Mexican immigrants. You can't ignore that context in a decision of this nature, and the conspicuous absence of mention by the court of this political atmosphere has meaning.

Stengah:

It's a relatively safe surgical procedure with medical pros and cons. I would say the same for many similar surgical procedures and other such alterations. You can't draw the line at circumcision, you see, for the reasons you've mentioned, and not take a host of other procedures along with it. It has ethical repercussions.

LarryC wrote:

Stengah:
It's a relatively safe surgical procedure with medical pros and cons. I would say the same for many similar surgical procedures and other such alterations. You can't draw the line at circumcision, you see, for the reasons you've mentioned, and not take a host of other procedures along with it. It has ethical repercussions.

I'm fine with including any other similar procedures in the list of things you can't do to your children without their consent.

Stengah wrote:
LarryC wrote:

Stengah:
It's a relatively safe surgical procedure with medical pros and cons. I would say the same for many similar surgical procedures and other such alterations. You can't draw the line at circumcision, you see, for the reasons you've mentioned, and not take a host of other procedures along with it. It has ethical repercussions.

s
I'm fine with including any other similar procedures in the list of things you can't do to your children without their consent.

On this note, I'd like to know what LarryC and others think of cleft palette surgery .

rawr dp

Grubber788:

Same as with any other surgery; we let the parents exercise the right of the child. If they want or don't want it, that's up to them to decide, though there are clear benefits to it vis a vis cosmetic and speech pathology. The damage to a person's manner of speech after age 2 can be irreparable, so we recommend doing it before then. We still don't force it.

Likewise, parents of a child can refuse blood transfusion, even if that's life-threatening or will result in the child's death. We can't force that, one way or the other.

Grubber788 wrote:

On this note, I'd like to know what LarryC and others think of cleft palette surgery .

I'd say that's in a different category than circumcision, as it can cause actual medical and developmental problems.

LarryC wrote:

Likewise, parents of a child can refuse blood transfusion, even if that's life-threatening or will result in the child's death. We can't force that, one way or the other.

I'm pretty certain parents can't do that in the US. If the child is old enough, they can refuse treatment themselves, but their parents cannot refuse it for them in life-threatening situations.

Stengah:

That's a key difference then. Out here in the boondocks we need consent for blood transfusion, even if it's life-saving, if we can get it. If we can't due to lack of legal representation, then we give it per bioethics of life-saving medicine. However, we can't force the treatment if the legal advocate refuses to sign the consent.

What you're suggesting is that doctors can institute whatever means and procedures they deem as "life-saving" on any child, regardless of parent input. That seems very strange to me.

Handing the legal power to enact services to providers of that service seems like a fairly reprehensible sort of conflict of interest. That can't be good.

LarryC wrote:

Stengah:

What you're suggesting is that doctors can institute whatever means and procedures they deem as "life-saving" on any child, regardless of parent input. That seems very strange to me.

I guess this is another weird cultural difference, because I feel like much of the West would feel like giving unqualified parents the decision over people who actually know what's best for a child was insane.

El-Taco-the-Rogue wrote:
LarryC wrote:

Stengah:

What you're suggesting is that doctors can institute whatever means and procedures they deem as "life-saving" on any child, regardless of parent input. That seems very strange to me.

I guess this is another weird cultural difference, because I feel like much of the West would feel like giving unqualified parents the decision over people who actually know what's best for a child was insane.

Maybe. I'm not sure that it's the case in the US. That would be really weird.

The point of "informed consent" is for the MDs to explain the situation in such a way as to empower the patient to make a qualified choice. Just because that has been transferred for parents to exercise doesn't mean that the principle is different; you explain the situation so that parents can make a qualified choice. Giving over that decision to "qualified experts" as a biothethical principle spills right on over to things like forcing surgery on people who didn't want it, which I'm sure will horrify many.

It's not like there are roving bands of doctors hunting down people to perform surgery on. What it means is that if, in the course of some other surgery, the child needs a blood transfusion, the parents cannot deny it. They can ask the doctors to do everything they can to avoid it, but if it's deemed medically necessary to save the child's life, the life of the child is considered more important than the wishes of the parents. The transfusion can be withheld if the parents get the child to say they don't want it (depending on the age of the child, see mature minor).
Medical necessity trumps a parent's wishes, but patient's wishes trumps medical necessity. So the slippery slope doesn't slip that far.

Stengah:

You'd be surprised. Private cosmetic clinics are essentially doctors prowling the population for people who'll accept their services. Any time you put that kind of incentive down combined with conflict of interest, the abuse is almost inevitable. Let's not pretend that doctors are more decent than the average human being. If you doubt that, consider that I'm one.

I'm extremely leery of the Mature Minor doctrine. The foundations of that were forged in the case of an 18 year old man playing the legal system for money. That's not sound foundation. As MDs we are expected to educate an average adult enough about medical information to allow them to make what is deemed an informed consent. It is not expected that this is possible to do with children; in general they are mentally and emotionally immature and incomplete. This is the entire basis for why their right of consent to their bodies is given over to their parents for guardianship.

Some of the ideas being thrown around in this thread are genuinely concerning. It's not a case of slippery slope. Some of those ideas have very scary and very direct implications; no further development is required.

While doctors can indeed suggest, recommend, and try to con people into getting unnecessary surgeries, in the US at least, they cannot force anyone to have a surgery they don't want. They can try to talk and influence people into getting work done they don't need, but they can't abduct people and give them a nose job because they think it'd be best.

Parent's don't get full right of consent to their children's bodies over here either. They get some, but not complete control over their children's bodies. The amount of control lessens as the child grows older as well.

Stengah:

I know you think that that's good, but here I'm thinking that if parents don't get control over their children's bodies, then who does? Someone is getting that control, and sure as heck ain't the babies. It seems to me that the control here is being exercised by the government, ostensibly in the name of the people. You may trust your government that much, but I don't. I prefer it keep its hands off my body, regardless of how young I might be.

I would rather trust parents to see to the well being of their children, even if some of them fail, rather than give that power and responsibility over to a central ruling power that has no vested, personal interest in these people; and that may have vested interests against.

LarryC wrote:

Stengah:
I know you think that that's good, but here I'm thinking that if parents don't get control over their children's bodies, then who does? Someone is getting that control, and sure as heck ain't the babies. It seems to me that the control here is being exercised by the government, ostensibly in the name of the people. You may trust your government that much, but I don't. I prefer it keep its hands off my body, regardless of how young I might be.

The control isn't given to the parents or "the government" or society. The control is being preserved by the government/society for the children to exercise when they're able to. And again, this is only in certain situations. It's not like the parent's wishes do not factor into things at all, it's just that they don't trump the wishes of the actual patient (if they're able to express them) or the life of said patient.

Stengah:

That doesn't signify. The right to consent is a continuing right of body. It doesn't get preserved, it gets practiced and enacted. What rights children get when they reach age of majority is theirs. Up to that point, it is employed for them, not preserved. This is true whether the use is to refuse surgery or to consent to it.

I simply do not trust a ruling body to accept and employ rights of body without the vested, personal interests of the individuals holding that power.

I do not hold the wishes of children to be worthy of consideration until they reach age of majority, except as a means of expediting events, or making them pleasant. A girl might want me to pierce her body all over with My Little Pony earrings, and express that desire most eloquently. No dice. She convinces her parents to consent, or I do nothing.

LarryC wrote:

Stengah:

That doesn't signify. The right to consent is a continuing right of body. It doesn't get preserved, it gets practiced and enacted. What rights children get when they reach age of majority is theirs. Up to that point, it is employed for them, not preserved. This is true whether the use is to refuse surgery or to consent to it.

We'll just have to agree to disagree then.

I do not hold the wishes of children to be worthy of consideration until they reach age of majority, except as a means of expediting events, or making them pleasant. A girl might want me to pierce her body all over with My Little Pony earrings, and express that desire most eloquently. No dice. She convinces her parents to consent, or I do nothing.

Does your stance change if the parents want you to pierce the girl but the girl is quite vocal about not wanting it done? How about if the girl is in for a different procedure (hypothetically one that requires her to be unconscious for it to be done), and the parents want you to do it while she's under "as a surprise."

Stengah:

I'll have qualms doing it, but I'll keep it to myself, and probably try not to be available or pass it on to someone who's only going to see the profit in it (there's always a fair number of those everywhere). It unsettles me personally, but this isn't about personal quibbles; it's about public policy and bioethics.

We have a quite a bit of children who do not want ANY surgery done whatsoever. We do it regardless, so it's clear that their particular wishes do not materially signify. This is abundantly clear in contrast to an adult patient who can refuse any and all life-saving procedures he or she wants. The contrast is clear here, and the principle by corollary is unmistakable - children's desires do not give them the ability to have informed consent, nor does it matter.

By the by, I have had people who had their ears pierced while they were under for another procedure. In fact, we do a lot of things here that people didn't know they were going in, often by necessity. By my understanding, you guys do it through the medium of blanket consent. We do it through legal advocates, usually implying family. We go in, we find cancer where we don't expect it; we resect immediately through the consent of your assigned health advocate. We practically require one for most confinements; and it's expected that you have one, even if you're an adult.

The contrast is clear here, and the principle by corollary is unmistakable - children's desires do not give them the ability to have informed consent, nor does it matter.

All I can really do at this point is emphasize that I find that mindset rather repugnant. A child is not a piece of property, they are their own being, and while their parents are in charge of making many decisions for them, there are some decisions they should not be allowed to make. I know you disagree with this, and that's fine, but I really don't see further discussion on this matter to change either of our minds.

In fact, we do a lot of things here that people didn't know they were going in, often by necessity

That's a pretty different thing than what we're talking about here. The "necessity" part is the key difference. You'd be hard pressed to argue that a dozen new MLP piercings were medically necessary. I highly doubt you're going to ask their advocate if they'd be okay with you giving their kid a bitchin' new ponycorn tattoo so you can get some practice with a tattoo gun in, or if they'd mind terribly much if you gave the patient a split tongue on the grounds that you think they'd look cool with one.

I was expecting something of this nature. It was in the wind back when we were talking about this here in the thread. I see it's been finally made public.

Comparing the procedure to vaccinations is an interesting analogy.

Seth wrote:

Comparing the procedure to vaccinations is an interesting analogy.

Hey! I made that analogy here, first. That's a patented analogy.

[size=6]Actually, I heard that wording before; many pedias were of that mindset[/size]

Chapin and other critics argue that the scientific evidence is questionable. For one thing, the studies about HIV have only been done in Africa, where AIDS is much more common among heterosexuals.

I never understood this one. Is African HIV/AIDS different from American? Is it like African and Indian elephants? American and European deer?

KingGorilla wrote:
Chapin and other critics argue that the scientific evidence is questionable. For one thing, the studies about HIV have only been done in Africa, where AIDS is much more common among heterosexuals.

I never understood this one. Is African HIV/AIDS different from American? Is it like African and Indian elephants? American and European deer?

Availability of condoms, hygiene practices, rate of infection in the general population, culture, understanding of infection mechanism, etc. all affect behavior and transmission.

The big benefit from circumcision re: STI transmission is apparently that the softer foreskin is more likely to tear during intercourse, creating a vector for pathogens to enter. When a condom can obviate the need for it, and you live in a country with a reliable supply and without a cultural/religious prohibition on using condoms, I don't see how you can claim circumcision has a measurable positive effect.

You could if you limit the positive claim only to incidents of sex wherein condoms were not used. Presumably, that still happens even in countries where condoms are plentiful and have no social stigma.

LarryC wrote:

You could if you limit the positive claim only to incidents of sex wherein condoms were not used. Presumably, that still happens even in countries where condoms are plentiful and have no social stigma.

Pretty sure that is how most children end up being made.

But some follow up info I would be interested in is for men with foreskin and men without who engage in oral and anal intercourse as well. Oral, in particular as that is an area where condoms are almost never used. Oral sex in particular is a large area of misinformation in the US and other parts of the world, due in large part to the focus on safe intercourse and pregnancy.

And Kraint. Male circumcision has been shown by this lengthy study, and the WHO to significantly decrease the chances a male will contract or transmit an STI. That is all the study has shown. If HIV, or any other STI is a disease we wish to seriously limit, male circumcision has to be a part of that. If you honestly think a parent, or an individual has some sort of right to be a carrier or breeder of disease, that is an interesting position to take. Public health should trump individual freedom to harm self or harm one's ward every time. Public health issues are not and cannot be optional.

KingGorilla wrote:

And Kraint. Male circumcision has been shown by this lengthy study, and the WHO to significantly decrease the chances a male will contract or transmit an STI. That is all the study has shown. If HIV, or any other STI is a disease we wish to seriously limit, male circumcision has to be a part of that. If you honestly think a parent, or an individual has some sort of right to be a carrier or breeder of disease, that is an interesting position to take. Public health should trump individual freedom to harm self or harm one's ward every time.

Wow, that's a hell of a strawman you've constructed there. I'll be sure to give your thoughtful point of view all the consideration it deserves.