First Prize

Emily Petrequin
Schenectady County Community College

The Ethics of Newborn Circumcision

Is routine neonatal circumcision ethical? The United States is the only country in which non-religious circumcision is widely performed on boys without any medical reason. In the United States today, around fifty percent of newborn males are subjected to a painful amputation of healthy, functional tissue against their will. This is contradictory to the human rights that every person is born with. It does not agree with the four general principles of ethics, which are non maleficence, beneficence, justice, and autonomy. Parents’ preferences, whether for religious, cultural, or aesthetic reasons, should never violate these. Between eighty and ninety percent of all of the world’s men have a whole penis, just as nature intended, and only a miniscule fraction of them ever encounter penile problems.

Every human being is born with a prepuce, or foreskin. In females it is also known as the clitoral hood and is there to protect the clitoris. In males, the foreskin exists to protect the glans, or head of the penis. It is also the most erogenous piece of skin on the body. During infancy and early childhood, a boy’s foreskin remains fused to his glans. This keeps the glans protected from urine, feces, and irritation from diapers. It becomes retractable at some point between early childhood and adolescence without any intervention, and continues its protective functions throughout life.

By definition, male circumcision is the removal of the prepuce from the rest of the penis. During neonatal circumcision, the newborn, used to being in the warm and cozy fetal position inside his mother’s uterus, is spread eagle on a cold plastic table equipped with Velcro straps to keep his arms and legs from moving. His foreskin is forcefully torn from the head of his penis, and it is then crushed and sliced off. He may become frantic and cry out in intense pain. If he stops crying it is because he’s in shock. Studies have shown that babies feel pain more intensely than adults. The baby is left with a bloody stump which will constantly be in contact with urine and feces during the ten to fourteen days it takes to heal. The mother child bond might be disrupted due to this unnecessary trauma, and during a crucial period. The child’s feeding and sleeping patterns may be interrupted as well. Unfortunately, the norm is to administer no anesthesia before the procedure and no pain medication afterwards. Even when pain medication is used, it is not completely effective.

The prepuce has important protective and sexual functions, which is why nearly every intact man is quite fond of his double layer of mobile skin. The head is lubricated at all times and is always protected from chafing and irritation due to abrasive clothing. The only time the head is exposed is during an erection, at which time the highly mobile foreskin can glide freely over it, producing levels of intense sensation that are denied to circumcised men. When a natural penis becomes erect, the foreskin acts to accommodate the erection. If unfolded, the foreskin at that time would measure to be about the size of a standard three-by-five-inch index card, which is around half of the penile skin. The outer layer is full of nerve endings and highly sensitive to touch. The inner layer is made up of mucocutaneous tissue, which stimulates the smooth, moist glans of the penis.

The foreskin prevents chafing from too much friction during both intercourse and masturbation.  Orgasms occur without excessive effort.

In addition, the prepuce allows the penis to more easily come in contact with a woman’s g-spot.

In an all too common case where this highly sensitive, functional tissue has been removed, most of the sensation is lost. Deprived of its natural mucous covering, the glans gradually becomes keratinized and therefore greatly desensitized. The frenulum, a sensitive elastic membrane identical to the one that attaches the tongue to the floor of the mouth, is usually amputated with the foreskin, and the man has to rely solely on his toughened, now external glans to reach orgasm. It is considerably more difficult for a circumcised man to tell when he is about to climax.

In order to get to that point, he now needs hard, rough motion which not only chafes his penis further but also does the same to his partner’s vagina. Since the penis no longer produces its own lubrication enabling it to glide inside of its own natural sheath, vaginal dryness and painful intercourse are common occurrences, and artificial lubrication is often needed. Without the gliding mechanism the skin on the penis is stretched, tight, and immobile; exactly theopposite of how nature intended it to be.

One of the main principles of ethics is nonmaleficence, or “do no harm,” and all medical establishments are required to put this principle into practice. It is a fact beyond all reasonable doubt that amputating a baby boy’s foreskin will negatively affect him for the rest of his life.  Effects include the initial pain, and both physical and emotional scarring. Circumcision alters the natural appearance and functioning of the penis. Complications, which occur more often when performed during the neonatal period, include excessive bleeding, infections, meatal stenosis, and uneven skin removal or the removal of too much skin. There have also been incidences of loss of the entire penis, and death. Some men suffer from penile curvature, painful erections, skin tags, cracking and bleeding at the scar, erectile dysfunction, and various other problems. Sometimes, upon discovering what was forcefully done to him as a defenseless newborn, a man may grieve for the piece of him that is missing, become angry, and not feel whole or adequate.  These are certainly valid feelings, although men in this culture are conditioned to remain in denial about it. In contrast, it is rare for an intact man to feel angry or upset about the state of his penis.

There is no question that newborn circumcision harms both babies and men.

Infant circumcision clearly violates the principle of beneficence, another ethical guideline that all doctors are required to follow. In 1971, a statement was released revealing that there are no valid indications that circumcision is necessary during infancy. Routine neonatal circumcision is non-therapeutic, meaning that it provides not one single medical benefit. None of the world’s medical associations presently recommend it. Outside of Jewish and Islamic traditions, it stemmed from the theory that the removal of the foreskin would prevent masturbation, an activity once thought to cause an array of problems. This fact alone proves that cutting off the foreskin eliminates much of a man’s sexual sensation. Do human beings lack the right to feel as much pleasure as they possibly can? Eventually, new supposed benefits began to surface, and this continues even today. It has been theorized that circumcision reduces the risk of urinary tract infections, penile cancer, sexually transmitted diseases, and poor hygiene. All of these notions have been proven false; a fact that many doctors fail to disclose because circumcision is quite profitable. Circumcision does not benefit a boy who has been circumcised in any way, nor does it benefit the man he will become. It obviously doesn’t benefit his parents either. The only people who benefit from it are the people who perform it, and monetary beneficence does not fit into the principles of ethics.

There is no question that the circumcision of infants clearly violates the ethical principle of justice. For any alteration of the human body of a non-consenting minor against his or her will to be considered ethical, it must be necessary. So the question we must ask ourselves is; is male infant circumcision absolutely necessary? For starters, it violates the American Medical Association’s code of ethics, which begins with the statement that the well being of the patient is of paramount importance, and ends with a caution to doctors not to condone or participate in any torturous, cruel, inhuman, or degrading procedures, regardless of the attitudes of society. The only justified reason for subjecting a child to radical medical intervention is if that child has an illness or deformity that absolutely requires immediate intervention. Being born with a foreskin is neither an illness nor a deformity, and leaving a child’s foreskin intact does not threaten or diminish the quality of that child’s life in any way. It does, however, leave him with the choice of whether or not to alter his own body. 

Some tribes in Africa practice the ritual of female circumcision. It has the same “potential” medical and hygienic benefits, and is similar to the deeply held tradition of male circumcision among Muslims and Jews. However, female circumcision is illegal in the United States because it is recognized as a human rights issue. In all actuality, any unwillful bodily mutilation is a human rights violation. Shouldn’t baby boys be born with the same rights as baby girls; the right to be whole, the right to decide whether or not to have healthy body parts removed? The American Academy of  Pediatrics has released policy statements regarding both male and female circumcision. Regarding the circumcision of newborn males, the AAP believes that it is not in the best interest of the child, but if the parents choose to have it done, proper pain relief should be provided. Regarding the circumcision of newborn females, the AAP believes that it has serious, life threatening risks for girls and women, and therefore strongly opposes it.

These two statements do not coincide with the Fourteenth Amendment of the U.S. Constitution, guaranteeing equal rights for all people. Justice is clearly absent from the guidelines regarding circumcision.

Autonomy is essentially the right to be independent, another vital principle of ethics. If an unnecessary choice is made for someone who cannot choose for himself, this principle is violated. Parents do not own their children‘s bodies. No one has the right to consent to the surgery of an incompetent uninformed person unless failing to do so would pose serious health risks. Furthermore, routine amputation of the prepuce cannot even be considered surgery, because surgery is defined as the removal or repair of diseased tissue. The human foreskin is an integral part of the body and consists of normal, healthy tissue. Newborn circumcision mutilates the most personal and most sensitive part of a child’s tiny body in such a way that it will adversely affect his future sex life. Simply stated, circumcision is cosmetic surgery. If a boy wants his penis to be altered from its natural state, he can pursue this when he reaches the age of eighteen, as is the case with any other cosmetic procedure. Minors are not even legally allowed get a tattoo or a body piercing, regardless of whether their parents consent to it, because it is strictly cosmetic, as is routine circumcision. The fact is, most males who are given the choice decide to remain intact. The few who do elect to be circumcised as adults are operated on under anesthesia and provided with adequate pain medication afterwards. It is also easier for a doctor to produce aesthetically pleasing results on a fully developed penis. Excluding rare emergency situations, leaving the circumcision decision up to the owner of the penis is the only ethical choice parents can make.

All facts considered, how could anyone consider it ethical to strap down a baby boy, forcefully rip his foreskin from his glans, crush it, and amputate it, all without his consent? What right do his parents have to alter their son’s sexuality?  It is not legal or appropriate to have your newborn’s pinky finger removed, or one of his ears, or anything, unless immediate surgical intervention is deemed medically necessary. The male foreskin seems to be the only body part excluded from these laws.  And not only is healthy foreskin amputation not in the best interest of the child, it is detrimental to the child. There is no doubt that this useless procedure should be outlawed due to its unarguable violation of ethics.

Second Prize

Stacy Trinh
Hawaii Pacific University

Is Circumcision Ethical

With respect to medical practice, one of the most important developments to take place is that of patient empowerment. While in former times medical knowledge was perceived as a vast field of information too complicated and specialized for anyone but doctors to navigate, the trend of encouraging patients to get involved in making their own medical decisions reflects the recognition that patients are capable of being savvy participants who in fact ought have a say in what is done to their bodies. Today this is considered a basic human right, but there still exists at least one area in which the patient's say is all too often ignored: that of male circumcision in America. The norm is to have the procedure done to the child when he is still an infant, but opponents of the way circumcision is currently practiced call attention to the unethical implications of forcing onto a non-consenting person a disfiguring surgery that has not yet been proven to have substantial health benefits. In response to this, a legitimate point is raised that parents have certain rights to make decisions for their child, but a thorough examination of this issue will reveal that circumcision actually does not fall under the scope of parents' rights and, ethically speaking, the only right thing to do is to leave this particular decision up to the child for him to make when he is older.

          To understand why circumcision should be the boy's decision and his alone, it is necessary to first identify the rights and obligations of parents and then discuss their reach. The most basic parental responsibility is to care for the welfare of the child, including his physical welfare; under the scope of fulfilling this responsibility, parents are certainly entitled to make decisions to protect the health and safety of their son. Sometimes circumcision is performed for this reason, because parents think that such a surgery will protect their child from serious health risks like certain types of cancers or infections related to that area of the body. However, that belief is a myth because there is no convincing evidence that circumcision effectively prevents against those aforementioned conditions; indeed, there is certainly no consensus within the professional medical community in favor of circumcision. Another related claim is that if removing the penile foreskin does not help avert serious adverse health effects, it at least aids in maintaining the child's hygiene. The problem with this argument, though, lies in the extremity of the means. Rather than resorting to something as radical as surgery, proper instruction and encouragement, motivating the boy to practice extra sanitation habits, is a more than sufficient manner of dealing with this concern. As there is no medical research that defends the necessity of circumcision, then, it cannot be justified on the basis that opting for it is a necessary and ethical decision given a parent's moral fiduciary duty to their child.

          But parents do not only function in a custodial capacity in relation to their offspring; parents often act on the rights they are entitled to as creators of the child. If it is widely recognized that parents are basically at liberty to shape their child socially, culturally, and religiously, why then should they not be allowed to have their child participate in a socially accepted tradition? The best way to answer this question is to juxtapose male circumcision as practiced in the United States with female circumcision, more commonly known as female genital mutilation (FGM). Granted, this is not a perfect analogy for two main reasons: First, FGM is a sexist, oppressive custom, whereas male circumcision in America does not carry this stigma or negative connotation. Second, because of the horrific brutality associated with FGM, it is a very emotionally jarring topic; on the other hand, either because male circumcision is hardly in the limelight or because the standard use of anesthetics in the U.S. dulls the connection we make between pain and surgery, discussion of male circumcision does not evoke sympathetic responses. Despite whatever differences may exist between the two situations, though, both share the same fact pattern of involving unnecessary surgery that has no proven health benefits being imposed onto a particular group within the society. The common American public opinion is that compulsory FGM is morally wrong regardless of its cultural history; there is something obviously cruel and ethically questionable about requiring young girls to go through this intense ritual for the mere sake of keeping with tradition and socially accepted norms. As demonstrated by the history of women's rights and civil rights, Westerners can understand that some cultural institutions are morally wrong, even if they have been recognized and upheld for centuries; the condemnation of FGM is not a criticism of the people who practice it, but just of the custom itself.

          With instances of FGM in which the participating women personally consent to the practice, the attitudes of outsiders start to vary because the element of free choice is present. This sudden change in opinion reiterates the importance of individual choice, a characteristic that is essentially absent from the situation most boys face in the United States. If male circumcision is done when the boy is too young to speak up, he is literally incapable of articulating his consent or dissent; thus, that the child is deprived of a basic human right is largely ignored by the same society that is so quick to contest FGM, an ironic moral paradox. But probably few have contemplated male circumcision from an ethical perspective, so the hope is that discussing it from this approach will create a movement to resolve this strange hypocrisy.

          Without doubt parents are granted certain rights with respect to their child, but they also have a duty to exercise those rights with the child's best interest in mind. A key aspect of that responsibility is gathering information before making any decision, especially one as permanent and risky as surgery. Since further investigation will reveal that circumcision has not been proven to be as beneficial to one's health as often believed, there is something unethical about imposing it onto someone who has not expressed his permission. Opting for circumcision simply is not a choice that parents should elect for their child; to leave that up to the boy to decide is the most ethical, responsible, and caring choice a parent can make for their son.

Third Prize

Tamara M Blake
University of California, Riverside

An Ethical Mind vs. An Ethical Heart

The question of circumcision and its morality is a highly volatile and controversial issue in this and many other countries. America is the only country in the world in which a medical establishment circumcises the majority of newborn boys, even though the surgery is not recommended by any national or international medical organization —and some strongly oppose it. The answer to the question of whether or not circumcision is ethical is an easy one—yes.

The definition of ethical is: conforming to accepted standards: consistent with agreed principles of correct moral conduct. One might say that this definition clearly states that circumcision is not ethical because it is not moral. But the definition of moral is: (a) according to common standard of justice: regarded in terms of what is known to be right or just, as opposed to what is officially or outwardly declared to be right or just, or (b) good by accepted standards: good or right, when judged by the standards of the average person or society at large. So it seems by definition, circumcision is ethical, because it is what is okay when judged by the standards of the average person or society at large.

This answer, however, is not the one that some would agree with, and their arguments are completely justifiable. For example, anthropologists have debated over whether they should accept or approve of the practice of female circumcision, performed in many African societies. Female circumcision involves removing part or all of a woman’s labia and clitoris and is usually performed on girls entering adolescence. This practice is painful, and often harmful, to the women of societies that perform it, but many of those societies claim that the practice is important and deeply rooted in their culture.  The idea of a young girl having her clitoris and labia cut off because somehow it makes her “cleaner” or more “marriageable” is monstrous to most people. In many cases, the routine is not performed in sterile conditions and certainly not by a doctor. The girls are not given any anesthetic and frequently develop infections afterwards. Many people in this country are disgusted by the simple idea of this, yet would not think twice about having their newborn boy circumcised right out of the womb.

When a newborn boy is circumcised, his foreskin is torn from his glans, the tip of his penis, then slit so that a circumcision instrument can be inserted. Then the foreskin is cut off. There is usually no anesthesia used and even if it is, it is not 100% effective. Medical doctors suggest that the cutting of this skin does not serve any purpose and was originally done to prevent masturbation, which, in the earlier twentieth century, was thought to be the leading cause of prostate cancer in men. Society hopefully knows better than that now.

Circumcision is not a procedure that can only be performed during infancy, so why must it be done, Why not let the child get to an age when he can understand the benefits and the consequences of having the procedure done and decide for himself. We do not cut off a developing girls breast simply because she might develop breast cancer when she is older, why should we apply that logic to the foreskin of the penis?

The defenders of circumcision would argue that the medical benefits of circumcision are not myth but fact. Circumcision will not save someone’s life one day, but it does help to reduce the rate of urinary tract infection in infants to age one year. It also helps to reduce the risk of sexually transmitted disease (STD), prostate cancer, and HIV infection in adult males. It will also reduce the risk of transmission of STD’s to a male’s female partner.

 Those against circumcision would argue that not only is the statement that an uncircumcised, or intact, penis is more like to carry disease false, but also would question where the practices of safe sex come in to play. Condoms, a close second to abstinence, are one of the number one leaders against STDs, not a circumcised penis.

 Somewhere in the myths, beliefs, and traditions, we have lost our affinity for choice. Why not let a child choose whatever it is he (or even she) might want to do with his (or her) body when he (or she) is old enough to make those decisions? Many hold their bodies as a sacred temple that they would never willingly chose to mutilate, yet parents seem to make that decision for their children daily. A parent would have their newborn daughter’s ears pierced and not think twice about how she might feel about having holes in her body as she gets older. Those same parents would elect to mutilate their newborn son for traditions they do not understand. Most do not even know what medical theories there are behind circumcision let alone the facts. Most believe that it is to keep the penis cleaner. Is that not the same reason young girls are mutilated everyday in countries such as Africa and India?

So I say, when we think about how to treat our children, we must think about how we treat others, and ourselves. Let your child choose what is to be done to their body just as you chose what is done to yours.  Take the time to find out what is actually being done and weigh the benefits and the consequences of your choices. And know that although circumcision might be ethical by the book, it is not ethical by the heart.