Genital cutting: the search for ‘health benefits’ is disingenuous and inconsistent

Posted: Thu, 27 Sep 2018 11:00

The principle of bodily autonomy is enough reason to end genital cutting, says Brian D. Earp. Allowing 'health benefits' to dictate its acceptability risks legitimising inconsistent, pseudo-scientific justifications.

This article was originally published by Quillette in August 2017. The NSS is republishing a lightly edited version of it with a different title, with kind permission, in the run-up to its Healthcare and Secularism Conference. Brian will speak at the conference.

Four members of the Dawoodi Bohra sect of Islam living in Detroit, Michigan have recently been indicted on charges of female genital mutilation (FGM). This is the first time the US government has prosecuted an FGM case since a federal law was passed in 1996. The world is watching to see how the case turns out.

A lot is at stake here. Multiculturalism, religious freedom, the limits of tolerance; the scope of children's—and minority group—rights; the credibility of scientific research; even the very concept of 'harm'.

To see how these pieces fit together, I need to describe the alleged crime.

The term 'FGM' is likely to bring to mind the most severe forms of female genital cutting, such as clitoridectomy or infibulation (partial sewing up of the vaginal opening). But the World Health Organisation (WHO) actually recognises four main categories of FGM, covering dozens of different procedures.

One of the more 'minor' forms is called a 'ritual nick'. This practice, which I have argued elsewhere should not be performed on children, involves pricking the foreskin or 'hood' of the clitoris to release a drop of blood.

Healthy tissue is not typically removed by this procedure, which is often done by trained clinicians in the communities where it is common. Long-term adverse health consequences are believed to be rare.

Here is why this matters. Initial (albeit conflicting) reports suggest the Dawoodi Bohra sect of Islam engage in this, or a similar, more limited form of female genital cutting – not the more extreme forms that are often highlighted in the western media. This fact alone will make things rather complicated for the prosecution.

The defence team has already signaled that it will emphasize the "low-risk" aspect of the alleged cutting, claiming that it shouldn't really count as mutilation. It is, after all, far less invasive than Jewish ritual male circumcision, which is legally allowed on minors in the US, no questions asked.

Based on this discrepancy, if attorneys for the Bohra can show a gendered or religious double standard in existing law, the ramifications will be not be small. Either male circumcision will have to be restricted in some way, or "minor" forms of FGM permitted. The outcome either way will be explosive.

I will dig into the male-female comparison—and explore its legal implications—later on. But the law will not actually be my main focus. Instead, what I'll suggest in this piece is that the question of health consequences, whether positive or negative, should not exhaust the ethical analysis of these procedures.

There is more to "good" and "bad" than healthy versus unhealthy.

In fact, as the Bohra case will show, there are serious, even dangerous downsides to medicalizing moral reasoning – and to moralizing medical research. On both counts, I argue, at least when it comes to childhood genital cutting, apparently biased policies from the WHO are making things a great deal worse.

"The tendency today is to roll over and 'scientify' everything," says Julian Savulescu, a philosopher at the University of Oxford. He goes on: "Evidence will tell us what to do, people believe." But people are getting it wrong. When you reduce your ethical analysis to benefit-risk ratios, you miss important questions of value.

Take the ritual nick, or male circumcision for that matter, and ask yourself what might be morally problematic about these customs, benefits and risks to one side. A few possibilities come to mind.

First, the perceived need to cut children's genitals—whatever their sex or gender, and however severe the cutting—as a precondition for accepting them into a community should plausibly be questioned, rather than taken for granted.

Part of the reason for this is that, regardless of health consequences, many individuals whose genitals were cut when they were children grow up to feel disturbed by what they take to be an intimate violation carried out when they were too young to understand or refuse.

That prospect alone should weigh heavily in parents' minds when contemplating these sorts of practices. The genitals are not like other parts of the body. People assign different meanings to having their 'private parts' cut or altered, and they do not always appreciate, much less value or endorse, the intentions of the ones who did the cutting.

For example, realising that they needed to be 'marked' or 'purified' — that they were not seen as perfect the way they were born — can be hard to swallow for many 'cut' individuals, even if no tissue is removed. A person can always undergo a genital procedure later on in life, if that is what they want. But those who resent being cut cannot undo what has happened.

There is also the possibility of psychological harm, over and above the issue of contested 'meanings'. Although it is hard to measure scientifically, such harm undoubtedly varies with the mental and emotional disposition of the child and the timing and circumstances of the cutting.

Some Bohra women, for example, report feeling emotionally traumatised by what happened to them when they were little girls—the confusion, the pain, the embarrassment of being held down with their genitals exposed—while others insist that they didn't mind, and are proud of being cut. (Similar ambivalence can be found among religiously circumcised men.)

Both kinds of testimony should be taken seriously. Yet those who claim there is no harm in 'mild' forms of childhood genital cutting often ignore such individual differences. Instead, they point to vague, impersonal averages or talk in abstract, theoretical terms.

Not uncommonly, they claim to be speaking on behalf of their entire religious community, as though it were a monolith (at least with respect to attitudes about cutting). Meanwhile, dissenters from within the community are often ridiculed, waived away, or simply silenced: those who speak out may be faced with "excommunication and social boycott".

The power of tradition to smother resistance can be intense.

All of that said, even if 'health consequences' were the only thing that mattered morally, the fact that a given act of cutting is less severe than some alternative does not eliminate the need for concern. This is because any time a sharp object is brought into contact with sensitive flesh, it poses some risk of physical harm, however small.

The knife could slip. Nerve damage could occur. Bleeding or infections could ensue. And while those factors might not be ethically decisive for more 'neutral' parts of the body—even ear-piercing and cosmetic orthodontics carry risks—a person might reasonably conclude that any chance of adverse outcomes is too great when it comes to their sexual organs.

Finally, if health consequences in the form of 'health benefits' are seen as legitimising childhood genital cutting—as is often suggested in the case of male circumcision—then proponents of female genital cutting (FGC) who are loath to give up their valued custom might be motivated to find such benefits in order to appease their critics.

They might even succeed in doing so. For reasons I will get into later, it is not actually implausible that certain 'mild' forms of FGC, such as neonatal labiaplasty, could reduce the risk of various diseases.

But that wouldn't make the cutting a good idea. Instead, I will argue that children should be free to grow up with their genitals intact—no nicks, cuts, or removal of tissue—even if the risk of adverse health consequences turns out to be mild, and even if certain health benefits can be found.

What about the legal issues? I can't say too much about the particulars of the forthcoming trial because I don't want to prejudice the outcome, but I can make some general observations.

To be frank, the US government has probably picked the worst possible case to show it is 'serious' about addressing FGM. It is setting itself up for plausible accusations of anti-Muslim bias, as well as sexist double standards (as I hinted at before).

The main reason for this is as follows. If convicted, the Muslim minority defendants face 10 years to life in prison for allegedly practicing a form of FGM that is less physically invasive than other forms of medically unnecessary genital cutting that are legally tolerated in western countries.

I have already mentioned male circumcision. There is also intersex genital 'normalisation' surgery (which has been brilliantly discussed in this context by Nancy Ehrenreich); supposedly virginity-signalling hymen 'repair' surgeries (which I have written about elsewhere); and at least some so-called 'cosmetic' female genital operations, which are increasingly being carried out on minors.

I promised I would tackle the male-female comparison, so let's look at male circumcision (some details are needed to spotlight the inconsistencies, but I hope you will bear with me). Unlike the 'ritual nick', which does not typically alter the form or function the external (female) genitalia, male circumcision permanently alters both.

To begin with, it — by definition — removes most or all of the foreskin, which is about 50 square centimetres of elastic tissue in the adult organ and the most sensitive part of the penis to light touch.

It creates a ring of scar tissue around the shaft that is often discolored.

It makes sexual activities that involve manipulation of the foreskin—see here for a NSFW video—impossible. And it exposes the head of the penis, naturally an internal organ, to rubbing against clothing, which can cause chafing and irritation.

Those are the guaranteed effects. Possible "side effects" include painful erections if too much skin is removed (the penis is very small at birth and the choice of where to cut is essentially a guess), partial amputation of the glans due to surgical error, infections, cysts, fistulas, adhesions, pathological narrowing of the urinary opening, severe blood loss, and rarely—except in tribal settings where it is common—death.

Yet it is perfectly legal in the United States to perform a circumcision on a male child for any reason. Religion, culture, parental preference—regardless of the motivation, the cutting is tolerated, and you don't need a medical license to do it.

In fact, even ultra-Orthodox Jews who perform an unhygienic 'oral suction' form of circumcision, in which the circumciser takes the boy's penis into his mouth and sucks the wound to staunch the bleeding, are legally permitted to do so without state certification or oversight. This is despite confirmation of more than a dozen cases of herpes transmission, two cases of permanent brain damage, and two infant deaths likely caused by the practice between 2004 and 2012.

Those are just the figures for New York city. But still there are no legal restrictions. As the bioethicist Dena Davis has pointed out, "states currently regulate the hygienic practices of those who cut our hair and our fingernails, so why not a baby's genitals?"

She means "baby boy's" genitals; baby girls' genitals are protected by law.

The Bohra defense team will likely flag these inconsistencies. If ritual male circumcision is not only legally permitted but completely unregulated in the US, they will argue, then how can a procedure that carries fewer risks and is less physically damaging be classified as a federal crime? They will also point to the religious significance of 'female circumcision' among the Bohra. They will ask: aren't religious practices granted strong legal protections in the United States and other western countries?

The prosecution will almost certainly make two moves in response. First, they will argue that FGM is not truly a religious practice, but is 'merely' a cultural tradition, because there is no mention of female circumcision in the Koran. And second, they will point out that male circumcision has been linked to certain health benefits, whereas FGM 'has no health benefits' (as stated by the WHO).

But things are not so simple. It is true that female circumcision is not mentioned in the Koran; but neither is male circumcision. And yet the latter is widely regarded as a religious practice not only within Judaism but also Islam. As Alex Myers notes, "if we defer to religious justifications, we shall find that in many cases, the circumcision of female as well as male children could be permitted on this basis".

How could that be so? In her landmark paper Male and Female Genital Alteration: A Collision Course with the Law, Dena Davis notes that "binding religious obligations" can stem from oral traditions and other "extrabiblical sources," such as rabbinic commentaries or papal encyclicals in the case of Judaism or Christianity. Likewise, "Islam looks to other sources to interpret and supplement Koranic teachings."

One such source is the Hadith—the sayings of the prophet Mohammed—which is the other major basis for Islamic law apart from the Koran.

Both male and female circumcision are mentioned in the Hadith. Based on their reading of the relevant passages, some Muslim authorities state that 'circumcision' of both sexes is recommended or even obligatory, while others draw a different conclusion. There is no ultimate authority in Islam to settle such disputes, however, so debate continues to this day.

What this means is that, until a consensus is reached in the Muslim world, the status of female genital cutting as a 'religious' or 'cultural' practice will depend on each community's local evaluation of secondary Islamic scriptures. Dawoodi Bohra clerics view the practice as religious.

This leads to an uncomfortable thought. In the west, we seem more or less unfazed by the religiously sanctioned cutting of boys' genitals; but we go into a panic over less severe procedures performed on the genitals of girls by equally pious parents.

In fact, we bend over backwards to convince ourselves that the latter procedures are 'not actually religious' by selectively citing scholars who agree with us—as though not being 'religious' somehow made a practice less worthy of being respected, or being 'religious' made it morally OK. Neither of those propositions follow.

Finally, we attribute evil motives to the parents who circumcise their daughters, when the same parents almost invariably also circumcise their sons, sometimes more invasively, and often for identical reasons. (The stereotype that female circumcision is 'all about' misogyny and sexual control, while male circumcision is about neither, is one that I, and many other scholars, have deconstructed elsewhere: see here for a fairly short summary. Suffice it to say the claim is not true.)

So who are we kidding? The overwhelming majority of American parents who circumcise their sons do it for 'cultural' rather than religious reasons, and few seem concerned to bat an eye. Even many Jews who circumcise are committed atheists (and for all I know, so are many Muslims). Although the law may treat 'religion' as a special, separate category, the religious versus 'cultural' status of male or female genital cutting is not what drives our different moral judgments.

So maybe it's 'health benefits'. Maybe we think male circumcision is acceptable because it has medical advantages, whereas female circumcision only has 'social' advantages (eligibility for marriage, greater acceptance by the community, seen as more aesthetic, and so on).

I don't think that's the solution, either. First, the idea that 'social' benefits are less important than 'health' benefits would need some defending: I have already mentioned the pitfalls of capitulating to the domain of medicine in order to avoid having to think through complex moral issues. But let us just assume that all we care about is 'health' for a moment and see where this exercise leads us.

Most of the decent-quality data showing health benefits for male circumcision (primarily, a modest reduction in the absolute risk of some sexually transmitted infections) come from surgeries performed on adults in Africa, not babies in the United States or Europe. The findings cannot be simply copy-pasted from one context and age range to another.

But even if you could just copy and paste, you would still have to factor in the risks and harms of circumcision, which are not trivial. In fact, most national medical associations to have issued formal policies on the question have found that the benefits of childhood male circumcision are not sufficient to outweigh the disadvantages of the surgery in developed countries.

(There is one glaring exception to this, which we'll come back to.)

This suggests either that the scales are closely balanced, as the Canadian Paediatric Society claims, or actually tipped in the direction of net harm, as the Royal Dutch Medical Association has concluded. Further south, the Royal Australasian College of Physicians states: "The level of protection offered by circumcision and the complication rates of circumcision do not warrant routine infant circumcision in Australia and New Zealand."

In any case, the existence of 'some' health benefits (as opposed to net health benefits—and that would still not resolve the moral issues) would make for a very weak defence of the practice even on purely medical grounds.

Just think. Removing any healthy tissue from a child's body will confer 'some' health benefits: tissue that has been excised can no longer host a cancer, become infected, or pose any other problem to its erstwhile owner. But as the bioethicist Eike-Henner Kluge has noted, if this logic were accepted more generally, "all sorts of medical conditions would be implicated" and we would find ourselves "operating non-stop on just about every part of the human body".

Alarmingly, one place we might start operating is the paediatric vulva. Compared to the penis, the external female genitalia provide if anything "an even more hospitable environment to bacteria, yeasts, viruses, and so forth, such that removing moist folds of tissue (with a sterile surgical instrument) might very well reduce the risk of associated problems".

In countries where female circumcision is relatively common, this is exactly what is claimed for the procedure. Cited health benefits include "a lower risk of vaginal cancer … fewer infections from microbes gathering under the hood of the clitoris, and protection against herpes and genital ulcers".

Moreover, at least two studies by western scientists have shown a negative correlation between female circumcision and HIV. The authors of one of the studies, both seasoned statisticians who expected to find the opposite relationship, described their findings as a "significant and perplexing inverse association between reported female circumcision and HIV seropositivity [rates of positive test results]".

None of these findings is conclusive. I am not saying that female "circumcision" can ward off HIV or any other disease. But let us just imagine that some of the above-cited health benefits are eventually confirmed. Would anti-FGM campaigners suddenly be prepared to say that female genital cutting was ethically acceptable?

I would be surprised if that turned out to be the case. In other words, even if health benefits do one day become reliably associated with some medicalized form of female genital cutting, I expect that opponents of the practice—including the WHO—would say, "So what?"

First, they would argue that healthy tissue is valuable in-and-of-itself, so should be counted in the 'harm' column simply by virtue of being damaged or removed. Second, they would point to non-surgical means of preventing or treating infections, and suggest that these should be favoured over more invasive methods. And third, they would bring up the language of rights: a girl has a right to grow up with her genitals intact, they would say, and decide for herself at an age of understanding whether she would like to have parts of them cut into or cut off.

The same arguments apply to male circumcision. But as Kirsten Bell has pointed out, the WHO steadfastly refuses to connect the dots. In her words, they seek to "medicalise male circumcision on the one hand" by promoting it, over the objections and reservations of many outside experts, as a form of prophylaxis against HIV. But they "oppose the medicalisation of female circumcision on the other, while simultaneously basing their opposition to female operations on grounds that could legitimately be used to condemn the male operations".

The problem with appeals to "health benefits," then, is that they are disingenuous and inconsistently applied. As Robert Darby has argued, "official bodies working against FGC have condemned medicalisation of the procedure and funded massive research programmes into the harm of the surgery". The irony, as he sees it, is that the WHO "also frames male circumcision as a public health issue—but from the opposite starting point". Thus, we see that:

"Instead of a research programme to study the possible harms of circumcision, it funds research into the benefits and advantages of the operation. In neither case, however, is the research open-ended: in relation to women the search is for damage, in relation to men it is for benefit; and since the initial assumptions influence the outcomes, these results are duly found."

Perhaps even more striking, the WHO's asymmetrical focus on health benefits could backfire. Specifically, it could open the door for supporters of female genital cutting to mount a defence of the procedure modelled on the male parallel.

To put it simply, if the sheer existence of health benefits is so compelling to organisations like WHO, these supporters might think, then all we have to do is generate the right kind of evidence, and we can fend off critics of our cherished custom.

There are already signs of this happening. At least one female Muslim gynaecologist—from Khartoum University in the Sudan—has been reported as saying: "If the benefits [of female circumcision] are not apparent now, they will become known in the future, as has happened with regard to male circumcision."

(Perhaps she will be inspired by the websites of American plastic surgeons, who already claim all manner of physical and mental health benefits for elective labiaplasty – and other purported "cosmetic" operations).

Similarly, the anthropologist Fuambai Ahmadu has written about the women of Sierra Leone: "Why, one woman asked, would any reasonable mother want to burden her daughter with excess clitoral and labial tissue that is unhygienic, unsightly and interferes with sexual penetration … especially if the same mother would choose circumcision to ensure healthy and aesthetically appealing genitalia for her son?"

And what about the Dawoodi Bohra? As reported by Tasneem Raja, herself a member of the community and a former editor at NPR, some Bohra women believe that female circumcision, which they call khatna, "has something to do with 'removing bad germs' and liken it to male circumcision, which is widely… believed to have hygienic benefits".

It is currently illegal in western countries to conduct a properly controlled scientific study to determine whether a "mild," sterilised form of female genital cutting carried out in infancy or early childhood confers some degree of protection against disease.

But if anti-FGM campaigners and organisations such as the WHO continue to play the 'no health benefits' card as a way of deflecting comparisons to male circumcision, it will not be long before medically-trained supporters of the practice in other countries begin to do the necessary research.

The history of male circumcision shows how this could happen. Alongside female genital cutting, male genital cutting originated in African prehistory as a ritual practice, and was later adopted by various Semitic tribes. For most of its existence, the only claimed advantages of the procedure were social or metaphysical in nature—identifying the boy as a member of a particular group, for example, or sealing a divine covenant, as in Judaism.

In the physical realm, by contrast, circumcision was largely believed to have negative effects, including on sexual feeling and satisfaction. By 'dulling' the sexual organ of male children, parents believed that their sons would pay more attention to important 'spiritual' matters and be less tempted by the pleasures of the flesh.

It was only in recent times that religious supporters of male circumcision began to argue it was 'physically' beneficial—recasting the procedure as a secularly defensible measure of individual or even public health, as opposed to solely a cultural or religious practice.

In the United States, for example, circumcision was adopted in part as an anti-masturbation tactic in the late 1800s (masturbation, at the time, was thought to cause not only moral but medical ills; see here for a video introduction). The resulting shift from 'religious' to 'medical' proved strategically important in Christian-majority societies, where genital cutting of children had otherwise been seen as barbaric.

The medical historian David Gollaher has argued that Jewish physicians, whose "attitudes toward circumcision were partly shaped by their own cultural experience," found the late 19^th century evidence of health benefits "especially compelling". Most of it was later debunked.

Nevertheless, the search for 'health benefits' continues to this day. A large proportion of the current medical literature purporting to show health benefits for male circumcision has been generated by doctors who were themselves circumcised at birth—often for religious reasons—and who have cultural, financial, or other interests in seeing the practice preserved.

Science and medicine are not immune from such agendas or biases. In 2012, the American Academy of Paediatrics (AAP) controversially concluded that the health benefits of newborn male circumcision outweighed the risks (this is the 'glaring exception' I said I'd come back to). Their conclusion was puzzling, since they did not have a method for assigning weights to individual benefits or risks, much less an accepted mechanism by which the two could be compared.

They were also missing the denominator to their equation. On page 772 of their report they state that, due to limitations with the existing data, "the true incidence of complications after newborn circumcision is unknown".

So how could we know they are outweighed by the benefits?

In an unprecedented move, the AAP was rebuked by senior physicians, ethicists, and representatives from national medical societies based in the UK, Canada, and mainland Europe, who argued that the findings were likely culturally biased. The AAP's circumcision task force later acknowledged that the benefits were only "felt" to outweigh the risks. It came down to a subjective judgment.

Reflecting on the debacle in a recent editorial, Task Force member Andrew Freedman tried to explain how he and his colleagues had reached a different conclusion to that of their peers in other countries despite looking at the same medical evidence. In doing so, he made a revealing comment:

"Most circumcisions are done due to religious and cultural tradition. In the West, although parents may use the conflicting medical literature to buttress their own beliefs and desires, for the most part parents choose what they want for a wide variety of nonmedical reasons. There can be no doubt that religion, culture, aesthetic preference, familial identity, and personal experience all factor into their decision."

In a separate interview, Freedman stated that he had circumcised his own son on his parents' kitchen table. "But I did it for religious, not medical reasons," he wrote. "I did it because I had 3,000 years of ancestors looking over my shoulder."

Arguing that it is "not illegitimate" for parents to consider such social and spiritual "realms [in] making this nontherapeutic, only partially medical decision," Freedman went on to say that "protecting" the parental option to circumcise "was not an idle concern" in the minds of the AAP Task Force members "at a time when there are serious efforts in both the United States and Europe to ban the procedure outright."

The women in societies that practice what they call female circumcision are just as devoted to their cultural traditions as are the men who practice genital cutting of boys. They don't want their customs banned either. If "medical benefits" are sufficient to ward off condemnation, a strong incentive will exist to seek them out.

I suggest, therefore, that by repeating the mantra—in nearly every article focused on female genital cutting—that 'FGM has no health benefits,' those who oppose such cutting are sending the wrong signal. The mantra implies that if FGM did have health benefits, it wouldn't be so bad after all.

But that isn't what opponents really think. Regardless of health consequences, they see nontherapeutic genital cutting of female minors as contrary to their best interests, propped up by questionable social norms that should themselves be challenged and changed.

I would go one step further. All children—female, male, and intersex—have a compelling interest in intact genitalia. All else being equal, they should get to decide whether they want their 'private parts' nicked, pricked, labiaplastied, "normalised," circumcised or sewn, at an age when they can appreciate what is really at stake.

This doesn't mean a ban on such procedures before an age of consent is necessarily the best way to go. As I have argued elsewhere, legal prohibition can be a clumsy way of bringing about social change, often causing more harm than good. I worry, for example, that taking young girls out of their homes, invasively examining their genitals in search of "evidence," and throwing their parents—who no doubt love them—in jail, could be more traumatic than the initial act of cutting.

As for the Dawoodi Bohra case, we will just have to see how the judge interprets—and applies—the existing laws.

My own preference is for debate and dialogue, not bans and vilification. But whatever approach one takes, it is time to move beyond the tired (and false) dichotomies of male versus female, religion versus culture, and health benefits versus no health benefits. The focus for critics of genital cutting going forward, I contend, should be on children versus adults—that is, on bodily autonomy and informed consent.

Man arrested over alleged circumcision assaults

Posted: Mon, 9 Jul 2018 14:57

Police in Oxfordshire are appealing for information regarding a man arrested on suspicion of physically assaulting boys in connection to circumcision.

Mohammad Siddiqui, 52, was arrested on July 3 on suspicion of causing grievous bodily harm to boys who were circumcised in their own homes in Banbury in Oxfordshire and Bristol.

Siddiqui has since been released from custody but remains under investigation.

Hampshire Constabulary are leading the joint investigation with Thames Valley Police into the alleged assaults.

Detectives have called for any parents or guardians of boys circumcised, or healthcare workers who have concerns about procedures or aftercare to come forward.

DCI Fiona Bitters of Hampshire police, said: "This is a large investigation and we are already speaking to a number of people in relation to these allegations, however we would like to speak to anyone who may have information that can help us with our investigation or is concerned about a procedure which has taken place privately since 2015.

"We are asking parents or guardians of boys circumcised, or healthcare workers, who have concerns about the procedure, the aftercare provided, or the recovery to come forward.

"We are not investigating the practice of circumcision. We are investigating if any criminality took place relating to an individual's actions when undertaking this procedure or the aftercare provided."

An address in Birmingham has been searched as part of the investigation.

It is unclear from reports if Siddiqui is the same individual as a doctor of the same name who was struck off in 2015 for performing "botched and unhygienic" circumcisions on four babies in Southampton, Bath, Birmingham and Reading.

NHS paediatrician Dr Mohammed Siddiqui performed the non-therapeutic ritual circumcisions during a period spanning June 2012 to November 2013.

Siddiqui, who worked at University Hospital Southampton, carried out the operations in the parents' homes as an additional source of income outside the NHS.

Parents claimed Siddiqui did not wash his hands prior to the procedures, did not wear surgical gloves, failed to carry out proper examinations and did not have proper resuscitation equipment. He carried surgical materials in plastic carrier bags and used baby wipes during the procedures.

One baby suffered a seizure in response to a local anaesthetic but Siddiqui failed to act immediately and call an ambulance. The baby suffered two further seizures in hospital.

The parents of a second baby said Siddiqui accused them of "telling lies" when they phoned him because their baby was still in pain.

In a third incident, a baby began screaming in agony when the anaesthetic wore off half way through the procedure, but Siddiqui carried on, saying: "I didn't need to stop because the child was already crying."

He botched a circumcision on a fourth boy to such a degree that he had to carry out corrective surgery on the same child the following day.

An investigation by the General Medical Council revealed that Siddiqui had failed to secure valid insurance for each procedure and failed to register his circumcision service with the Care Quality Commission.

Following a three-week hearing at the Medical Practitioners Tribunal Service in Manchester, 69 separate allegations against Siddiqui were found proved and he was branded a risk to patients.

Panel Chairman John Donnelly said: ''His misconduct was both a particularly serious departure and reckless disregard of good medical practise and patient safety. Some of his behaviour as previously identified, involved breaches of very basic mandatory medical principles."

Siddiqui was suspended from University Hospital Southampton and subsequently resigned from the NHS. He continued to practice his private circumcision service.

In 2013 Consultant surgeon Feilim Murphy, secretary of the British Association of Paediatric Urologists, told BBC Radio 5live Investigates: "The biggest issue is there are a number of children who are circumcised by people who are not experienced and don't understand what is required, and there can be significant complications with that."

He added: "Unfortunately children have died in the last number of years in Britain and Ireland from circumcision-related complications."

The practice of circumcision came under the spotlight earlier this year when Icelandic lawmakers proposed a bill to prohibit circumcision without consent, calling it a violation of children's human rights.

The National Secular Society has long been committed to ending all forms of forced genital cutting.

Dr Antony Lempert of the NSS's Secular Medical Forum, commented:

"The situation in the UK is perverse. Ritual circumcision when performed by a registered doctor must be performed to the same high standards expected of all doctors. However, lay circumcisers are not held to the same standards which defies explanation considering the known dangers and the obvious risk of surgery performed outside a clinical environment with no medical supervision or aftercare.

"There is every reason to expect all surgery to be performed in registered surgical premises by healthcare professionals for a clear medical benefit or with the consent of the person whose body it is. By these standards it is clear that not only Mohammad Siddiqui but all lay circumcisers should no longer be allowed to operate. Instead all children must be protected from the surgical assignation on their genitals of their parents' beliefs whoever is performing the surgery."

Anyone with information on the current investigation led by Hampshire Constabulary can report using the HOLMES National Police Portal https://mipp.police.uk/operation/826 . If this is not possible you can call 101 and ask for Hampshire Constabulary quoting Operation Jetson. Alternatively you can call Crimestoppers anonymously on 0800 555 111.

Danish bid to create age of consent for genital cutting set to fail

Posted: Wed, 25 Apr 2018 16:57

An attempt to outlaw the cutting of healthy children's genitals in Denmark is set to fail, despite the opinions of children's rights activists and medical experts.

On Tuesday the Liberal Party (Venstre) announced that it would oppose a proposal to introduce a gender-neutral age of consent of 18 for circumcision unless it is medically necessary. Venstre currently leads the ruling coalition in Denmark.

Lena Nyhus, the chair of pressure group Intact Denmark, launched the proposal as a citizens' initiative in January. This tool allows people to put items of interest on the parliamentary agenda if they can gain the support of 50,000 people within 180 days.

By this Wednesday afternoon Nyhus's petition had 44,932 signatures.

It says society has a "special obligation to protect children's fundamental rights until they reach an age and maturity where they can take over this responsibility themselves".

It adds that "all children under the age of 18 regardless of sex, cultural background or religious convictions" should "have the same legal requirements for bodily integrity and autonomy".

When she launched the petition Nyhus said: "If people want to let themselves be circumcised then they should have the opportunity to make that choice as an adult. Otherwise, they ought to be allowed to grow up with their body intact."

The two junior members of the ruling coalition, the Liberal Alliance and the Conservative Party, have said their MPs will be given a free vote on the issue. The Socialist People's Party (SF) is the only one requiring its MPs to vote in favour of the proposal.

Earlier this month SF health spokesperson Kirsten Normann Andersen said the issue was "very simple".

"We had no problems deciding to forbid female circumcision, we had no problem scrapping the right for parents to smack children, and now it's time to get to grips with this issue."

A spokesperson for Venstre, Jakob Ellemann-Jensen, told the Berlingske newspaper the issue had split the party. "Many have veered both for and against. There are really a lot of arguments both for and against, and many among us held different views."

Stephen Evans, the National Secular Society's CEO, said the latest developments were "frustrating" but added that it was "encouraging to see growing pressure for action to protect the right of children to grow up with intact bodies".

"There are two clear reasons why action on forced genital cutting is needed. Firstly there is a clear medical consensus that ritual infant circumcision is harmful. And secondly children must be given the chance to decide what to do with their own bodies when they are old enough to do so.

"It's frustrating to see politicians giving in to religious groups' scaremongering, but Intact Denmark has made a compelling argument which will resonate in its own country and many others. Politicians around the world should take note of it."

Earlier this month an influential children's rights group strongly criticised the ritual circumcision of boys in an official report. The Child Rights International Network said the practice "goes against medical ethics" and was a "violation of bodily integrity" which "unnecessarily" exposes children to risks.

In 2016 the Danish Medical Association said circumcision should only be performed with "informed consent". The Royal Dutch Medical Society, the Council of Europe and the Nordic children's ombudsmen are also among those to recommend discouraging the practice in recent years.

Opposition to restrictions is mainly driven by concern about Jewish and Muslim religious sensitivities. Earlier this month the Jewish group Mosaiske claimed the Danish proposal "threatens the right of religious minorities to exist on a par with their fellow citizens".

The Danish Health and Medicines Authority has recently estimated that between 1,000 and 2,000 boys are subject to forced genital cutting in Denmark each year, mainly from Jewish and Muslim backgrounds.

In 2014 an opinion poll by Danish newspaper Metroxpress found that close to three-quarters of Danes supported measures to ban the ritual circumcision of boys.

Meanwhile this week religious leaders have stepped up their lobbying of the authorities in Iceland to resist a similar measure. Jonathan Arkush, the president of the Board of Deputies of British Jews, told the JC he was "tentatively optimistic" that a ban on the circumcision of boys for non-medical reasons may not pass after visiting officials in Reykjavik.

Global rights group: forced genital cutting violates medical ethics

Posted: Tue, 17 Apr 2018 15:24

The National Secular Society has reiterated its call for an end to forced genital cutting after an international children's rights advocacy organisation said the practice "goes against medical ethics".

In its newly-released 2018 report the Child Rights International Network (CRIN) called the ritual circumcision of infant males for non-medical reasons a "violation of bodily integrity" which "unnecessarily" exposes children to risks.

"When performed for religious or cultural - not medical - reasons, it flatly designates routine circumcision as medically unjustifiable," the report said. "In fact, there's growing support within the medical community against male circumcision as a routine practice since its non-therapeutic basis means it does not comply with medical ethics.

"Routine male circumcision involves the removal of healthy tissue for no medical reason from one of the most sensitive body parts, unnecessarily exposing a child to the risks of surgery, and usually at an age when they lack the capacity to consent or refuse consent.

"Exposing a child to such risks without curative or rehabilitative justification goes against medical ethics, as well as parental responsibilities to protect a child from injury and harm."

The report noted that the recorded complications arising from male genital cutting include bleeding, panic attacks, infection, disfigurement, necrosis [the uncontrolled death of cells in an organ], amputation and death.

CRIN added that "the pace for legally recognising children's bodily integrity is increasing". It cited a bill currently under consideration in Iceland to introduce prison terms for anyone guilty of "removing part or all" of a child's sexual organs. It also highlighted Malta's decision to ban non-medical genital surgery on intersex infants in 2015.

NSS chief executive Stephen Evans welcomed the report and called on the UK government to "take steps to enforce an age of consent for ritual genital cutting".

"CRIN is a highly-respected organisation which puts children first. Its report rightly addresses a normalised form of abuse which violates children's bodily integrity and the basic principles of medical ethics.

"No child should have the decision to cut their genitals made on their behalf. Politicians in the UK and indeed around the world should heed this call and make sure those too young to consent to this procedure are not subjected to it for any reason other than medical necessity."

There are currently few positive signs of change on the issue in the UK. Earlier this month a report in the Icelandic press said British diplomats were among those who had given disapproving feedback to their Icelandic counterparts over the proposal to ban ritual genital cutting there.

The leading Republican and Democrat on the Foreign Affairs Committee of the US House of Representatives have also issued a joint letter urging Iceland to stop the bill from advancing any further.

But there is a growing medical consensus against the cutting of boys' genitals. In September a Belgian federal government committee ruled against the circumcision of infant boys for reasons other than medical necessity.

In 2010 the Royal Dutch Medical Society urged doctors to adopt "a strong policy of deterrence" on infant male circumcision. It called the practice "a violation of children's rights to autonomy and physical integrity". It also said any medical advantages of circumcision were significantly outnumbered by the risks and other disadvantages, such as the loss of up to 30% of erogenous tissue.

In 2013 an international group of physicians criticised the American Academy of Paediatrics for promoting infant male circumcision. The Council of Europe adopted a non-binding resolution advising member states not to allow the ritual circumcision of children unconditionally, at least for very young children. In a joint statement, the Nordic children's ombudsmen condemned non-therapeutic infant circumcision as violating fundamental medical-ethical principles.

And in 2016 the Danish Medical Association said circumcision should only be performed with "informed consent".

Children's right to physical integrity and protection from physical injury is protected by the International Treaty on the Rights of the Child.

CRIN is a global research, policy and advocacy organisation which bases its work on the UN Convention on the Rights of the Child. Its report also criticised sex assignment of intersex children, the forced sterilisation of children with learning disabilities and virginity testing as violations of children's bodily integrity.

Mother calls for boys to have legal protection from genital cutting

Posted: Sun, 8 Apr 2018 08:06

A woman is challenging a Crown Prosecution Service decision not to prosecute a doctor after her son was subjected to a harmful circumcision without her consent.

According to the Sunday Times, the boy was in such pain after his genitals were cut that he could not wear a nappy.

The mother's lawyer, Saimo Chahal QC, a partner at the London law firm Bindmans, is seeking to challenge a Crown Prosecution Service decision taken last November not to prosecute. His mother, who has not been named in order to protect her son, says boys should be given the same protection as girls get from FGM.

The Sunday Times has reported that the baby was conceived after the mother had a casual affair with a Muslim man. The baby was with the family during the Eid festival when the grandmother took him to be circumcised with the consent of the father but not the mother. The mother has sole parental responsibility.

Speaking to the newspaper, the mother said it was done to make her son identify as Muslim: "His dad said he's going to know he's one of us and he's going to hate you for the way you bring him up if I don't bring him up a Muslim."

Female genital mutilation has been a criminal offence in the UK since 1985. But the mother said "nobody really gets" the problem with male circumcision.

"I have had to lay my son on a towel and not even been able to put him in a nappy because he is scratching away and he is in that much pain and somebody has inflicted that on my child," she said.

"Somebody needs to be held accountable for what they are doing to little boys."

The CPS has reportedly previously written to her to say: "Had it been the case that [the doctor] had performed the operation knowing that you did not consent, then potentially his actions would have amounted to assault."

Infant male circumcision is increasingly under the spotlight largely due to an international community of medics, lawyers and human rights workers challenging the practice. A draft bill to end non-therapeutic male genital cutting currently before the Icelandic parliament says circumcision without consent is a violation of children's human rights.

The National Secular Society, which has long campaigned for an end to all forms of forced genital cutting, has called on the UK government to follow the lead of the lawmakers who introduced the bill in Iceland.

In response to the latest story NSS CEO Stephen Evans commented: "For too long, the most basic rights of young boys have been ignored due to an unwillingness to question this particular religious and cultural practice.

"The time has surely come to prioritise child safeguarding over parents' wishes to express their religious beliefs through the cutting of their children's genitals. Parents shouldn't be entitled to demand surgical procedures that are contrary to a child's best interests."

Religious freedom isn't a licence to violate others’ rights

Posted: Thu, 1 Mar 2018 13:39

Increasing clashes between religious orthodoxy and secular liberalism highlight one of the most pressing challenges facing contemporary societies; how to manage the incredible religious and cultural diversity that exist within them. This throws up important and controversial questions of freedom of conscience – and its limits.

Last week, Jewish, Muslim and even some Christian leaders united in condemning Iceland's proposed ban non-therapeutic male circumcision as an "attack on religious freedom". The UK Government, too, has been accused of 'attacking religious freedom' recently, for a range of initiatives – from making sex education compulsory, to seeking to regulate supplementary schools, and even for introducing an opt-out system of organ donation.

Too often, debates around religious freedom are framed solely by those who only really care about their own. Those narrowly focused on maximizing their own freedoms can sometimes be so blinkered as to fail to recognise and consider how their right to manifest their beliefs tramples on the right of others. In this way, the demand for religious freedom to be respected is often little more than a demand for religious privilege – for the state to turn a blind eye to the violation of other's rights and freedoms when done in the name of religion. Secularism demands state neutrality towards different beliefs, but there's an obvious and compelling reason for the state to intervene when manifestations of belief cause harm.

The real value of the secularist worldview is its consideration of everyone's rights and freedoms, including the most vulnerable – and its recognition of the need to balance competing rights so as to achieve freedom and fairness for all.

Take the recent debate over male ritual circumcision. This is the surgical removal of the foreskin from the penis of a baby boy for religious and cultural reasons. In Judaism, it marks the covenant between God and Abraham – effectively making this irreversible body alteration a stamp of religious identity. Some people try to justify this practice by citing 'health benefits', but no national medical, paediatric, surgical or urological society in the world recommends routine circumcision of boys as a health intervention. And as with all surgery, there is a risk – botched circumcisions in the UK have resulted in serious injury and even death. Given that we're also taking about the removal of erogenous tissue, the loss of penile sensitivity (sexual pleasure) should also be considered enough of a harm to justify a change in the law.

The primary justification advocates of genital cutting give for allowing it to continue is one of religious freedom. But what about the rights of the child? Why should parental freedoms override a child's right to religious freedom and bodily integrity?

Whilst you have the absolute right to your beliefs, you don't necessarily have the right to impose those beliefs on others – and you certainly shouldn't assume to have the right to impose them with a pair of scissors or a sharp knife.

A similar debate is taking place across Europe about the religious slaughter of animals. The question here is: do the dietary preferences of Muslims and Jews justify an exemption from animal welfare laws that require pre-stunning so as to minimise pain, suffering and distress to farm animals? Or, when it comes to the treatment of animals, should there be one law for all?

Religious groups will point to the importance of maintaining 'traditions', but the argument from tradition really isn't an argument at all. It's the absence of an argument. Besides, religions have become adept at evolving over the centuries to reflect changing social attitudes and secular morality. This is evidenced by Jews increasingly choosing not to circumcise their sons and to hold a naming ceremony instead. Only those of a fundamentalist mindset will regard a harmful religious practice as "non-negotiable" – and religious fundamentalists shouldn't be dictating public policy.

Sometimes, the onus needs to be on religious communities to find a way of fitting in with the secular law of the land – and not on the state to accommodate every religious demand. Toleration is a two-way street. Yes, let's live and let live, but within limits. So when a religious accommodation would impede the rights of others, undermine legitimate public policy efforts or create an excessive financial burden, the state has every right to refuse.

The rhetoric of religious freedom is increasingly being used to justify religion running amok in the public square. Religious freedom should allow individuals to live out and practice their religion or belief in peace. It is not, however, a license to abuse, discriminate, indoctrinate, silence criticism, control the bodies and lives of others, cause unnecessary harm to animals or limit children's possibilities though the denial of knowledge.

Religious liberty is too important to leave to zealots to defend. Moderates of all faiths and none must make the case, too. True religious freedom means everyone enjoys freedom of conscience. This is the concept of religious freedom that the state should defend.

This piece originally appeared in The Huffington Post.

How cutting cultures deny dissenters their voice and identity

Posted: Fri, 23 Feb 2018 10:49

As Icelandic lawmakers consider whether to ban cutting infants' genitals for non-medical reasons, Dr Antony Lempert reflects on the ferocious backlash to the proposal in the UK.

This week non-therapeutic childhood male circumcision has hit the UK headlines like never before. As Icelandic parliamentarians debate whether to ban the procedure the BBC was among outlets which reported it widely.

On Monday morning, Radio 4's Today programme interviewed an imam and an Icelandic politician. On Monday evening I was interviewed on Newsnight, and on Wednesday evening the National Secular Society's CEO was on the Moral Maze, on BBC Radio 4. He faced an intemperate tirade of slurs from a man who had recently procured the cutting of his own child's genitals.

On Newsnight I could have refused to discuss my heritage. Not that I've ever hidden the fact that my parents were Jewish, that I had a Bar mitzvah, that I have been best man at two Jewish weddings and that my own best man used to run a Jewish deli. It's just that I've never thought my parents' choice of belief added to the debate. I could have refused to let Newsnight out me but they clearly wanted to highlight this angle of two apparently Jewish people with different views.

By Jewish standards I am claimed as one of their own, since my mother was Jewish and I had a Bar mitzvah whilst a child; I even have an A level in Classical Hebrew. But then Jonathan Arkush, the President of the Board of Deputies of British Jews, went on to assert that he's never met a Jewish man who would want to reverse the (patently irreversible) procedure.

So there you have it – I also can't be Jewish or this eminent barrister wouldn't have been so foolish as to say such a ridiculous thing in front of me.

It is starting to appear like the Jewish Schrodinger's cat or Schrodinger's penis. I pop in and out of Jewishness depending on the argument that's being used; arguments which are of course conveniently mutually inconsistent.

This demonstrates something that is rarely mentioned among the disputed claims for benefit of belonging and 'imperative to do it young', the absurd claims that it's less painful when one is a baby and the disregard for the evidence of harm and death. That is a complete disregard for the views and bodies of anyone who doesn't later choose to belong to the cutting culture. What Mr Arkush and his acolytes appear to want is for men who stay in the fold to have a voice - as long as they agree with the party line, whilst those who dare to challenge it are to be disregarded. In other words, it really doesn't seem to matter to the cutting communities how many innocents get cut, just so long as those who share their belief get their way.

If it looks like fundamentalism and acts like fundamentalism, maybe it should be called what it is?

On the Moral Maze, NSS CEO Stephen Evans and secularists in general were accused of trying to control people and of restricting religious practice. Giles Fraser effectively accused Stephen of dragging up the blood libel - even though he merely talked sensibly about the harm caused to children by cutting their healthy genitals.

Mr Arkush has form, too, in that respect. In 2013 I debated him on this topic at a London University. After the debate a member of the audience asked him his views on child protection workers trying to stop all forms of forced genital cutting. He replied: "The last people who tried to ban circumcision were Hitler and Stalin so that's the company you are in when you try to ban it." I reported this on the Secular Medical Forum website and Mr Arkush threatened to sue me for libel over several weeks for misrepresenting his position. Apparently he was only talking about organisations and not individuals.

Rebecca Steinfeld's work on the child's right to an open future – written eloquently from within the Jewish community – is key here. The child may be guided by parents but should not have avenues of education or physical integrity closed off to them. Discussions about the limits of parental 'direction' or control of children are not new. But one could be forgiven for thinking they are, considering the nature of debate when non-cutters are asked what gives them the right to stop normal healthy adults from cutting healthy functioning body parts off a defenceless infant.

For the record: I am not Jewish - belief is a choice. And names don't hurt people anywhere near as much as cutting off the most sensitive erogenous parts of their bodies in the arrogant assumption that the child will adopt their version of reality and not caring if they don't. The UN Convention on Human Rights asserts that every person has the right to freedom of belief from birth to death. So if an informed adult wants to pay a private surgeon to remove his foreskin he will have every right to do so and it won't be me stopping him.

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