October 18, 2012
When Rites and Rights Collide
— Michelle Harrington
This summer, new rulings concerning an age-old practice surfaced on both sides of the Atlantic. In the United States, The American Academy of Pediatrics released an updated policy statement on male circumcision. Having undertaken a systematic literature review, its task force concluded that access to newborn circumcision is indicated on the basis of medical risk-benefit analysis "for families who choose it." Meanwhile, in Germany, efforts to criminalize the procedure and to institute a two-year moratorium on the practice had been underway since June, sending shockwaves through hospitals as far away as Norway, and prompting an outpouring of support for religious freedom of practice—mostly from Christians.
The juxtaposition is startling: to the east, the procedure garnered a modest endorsement from a professional organization, while to the west accusations of torture and grievous bodily harm within a nation no stranger to either were directed at mohelim, implicating German Jews and Muslims who regularly have their sons circumcised according to the tenets of their respective faiths in a nation where the practice is otherwise uncommon. On September 26, at the behest of Chancellor Merkel, Germany's Justice Ministry moved to allay the consternation of religious minorities by drafting legislation that would keep circumcision legal in Germany provided that certain criteria be met, including adequate training for the circumciser, the informed consent of the parents, and the use of effective analgesia.
Despite the proposed truce (expected to be debated in Germany's Parliament before year's end) both countries will continue to revisit this issue; a focus on the medical features that serve to legitimate the practice obscures the deep religious and political tensions that are exposed by globalization and skims the challenge circumcision continues to pose to the tenets of traditional medical ethics. Some of these tensions are displayed in responses to the AAP policy statement which include disputes about whether circumcision's recently lauded protective effect against HIV acquisition obtains outside of the African cultural contexts in which studies were conducted; others contest the ethical proportionality of a surgical excision which has been shown to reduce rates of urinary tract infection in the first year of life and to attenuate the transmission of sexually transmitted infections, but at the cost of violating the maxim of nonmaleficence: "first, do no harm."
It is, of course, the notion of "harm" that is at stake, grounded in different comprehensive conceptions of the good. The German citizens who brought criminal complaints in order to defend children's right to bodily integrity presuppose that harm lies in being prevented from fully exercising the right to self-determination and in the denial of a maximally "open" future in which the maturing child would choose what, if any, faith to follow, and make his own decision about whether to alter his genitals. In secularized Europe, the understanding that religion can bind, obligate, and be constitutive of one's identity has become partially unintelligible, hence the statement of the Norwegian Jewish leader quoted in the New York Times: "When I say that circumcision for us is an existential question, they don't always understand it."
In the U.S., the sheer preponderance of male circumcision irrespective of religious affiliation has obscured the logic of the ritual that purports to set apart a people and to mark an individual with a distinctive communal identity. Here the widespread medical practice has roots in mid-nineteenth century hygiene movements that were more thoroughly moral than physiologic; circumcision was intended to curb the "harm" of "self-abuse" (masturbation) among boys and adolescents. By the mid-twentieth century, circumcision had become the default aesthetic. Ironically enough, harm came to be construed in terms of social nonconformity, as parents were convinced that their sons would be stigmatized if they appeared different from their circumcised peers in the locker room.
The recent German legislation and the AAP policy statement affirm the right of parents to choose circumcision for their sons irrespective of motivation, religious or otherwise. While these judgments accord with strong understandings of family privacy that have reigned in the United States, the procedural and preventive medical rationales that are respectively used to legitimate the practice may bypass more difficult and important ethical considerations: if parental choice is the legitimating factor, is female genital cutting permissible if sterile procedures are followed and effective analgesia used? What view of the human person is enshrined when preventive surgery is promoted as part of a strategy to overcome the inadequate exercise of concern for one's sexual partner(s)? If the newly heralded health benefits eventually turn out not to obtain in the conditions of North America and Europe, or if the risks associated with more comprehensive anesthesia should skew the risk-benefit ratio of the procedure in an unfavorable direction, may one still circumcise one's son as an exercise of religious freedom? Is it possible for religious minorities to offer exoteric reasons to a majority culture, and for the majority to find these reasons intelligible, and the practice defensible? If the protection of religious freedom is really at stake, is it necessary to go through medicine to get to God?
"Circumcision Policy Statement," Pediatrics, 130:3 (2012): 585, doi: 10.1542/peds.2012-1989.
Jack Ewing, "Some Religious Leaders See a Threat as Europe Grows More Secular," The New York Times, September 19, 2012.
Melissa Eddy, "Proposal Sets Circumcision Regulations in Germany," The New York Times, September 26, 2012.
Roni Caryn Rabin, "Benefits of Circumcision Are Said to Outweigh Risks," The New York Times, August 27, 2012.
Michelle Harrington is a Ph.D. candidate in religious ethics at the University of Chicago Divinity School. She is a Martin Marty Center Junior Fellow and a MacLean Fellow in Clinical Medical Ethics.