On The Impermissibility of Infant Male Circumcision

This essay was originally published in the Journal of Medical Ethics

Prompted by last year’s court ruling in Germany that sought to make the circumcision of minors illegal[1], Joseph Mazor, a political philosopher at the London School of Economics, published an article in this journal entitled “The Child’s Interests and the Case for the Permissibility of Male Infant Circumcision.” Mazor’s argument is rather subtle and worth reviewing point-by-point. The position he arrives at is an evolution of the Benatars’ 2003 position[2]. While he argues that an orphan ward of the state should probably not be circumcised, he agrees with the Benatars that parents should be able to decide one way or the other, and he suggests that Orthodox Jewish parents in particular have good reason to circumcise their children. In this essay, I will directly address Dr. Mazor’s central arguments and explain why they are ultimately unconvincing.

The Right to Bodily Integrity

In the German court’s decision to make circumcision of minors illegal, there were two guiding principles. The first was that circumcision violates a minor’s right to bodily integrity and the second was that it violates his right to self-determination. Mazor correctly points out that the word “right” in this context is being used in the interest-trumping Ronald Dworkin sense of the word. He goes on to argue that these interest-trumping rights do not properly apply in the case of infant circumcision.

Mazor constructs a four-part argument against the notion that bodily integrity is an interest trumping right in the case of infant circumcision:

1. The right to bodily integrity is not absolute, because violations of the child’s bodily integrity are permissible in instances of medical necessity.

2. It is also permissible to violate a child’s bodily integrity when interests that do not rise to the level of rights are at stake. For example, surgery to correct a minor cleft lip.

3. In the cases of both circumcision and minor cleft lip surgery, the child’s body is not being used as a means for others’ ends.

4. Therefore, bodily integrity in the case of circumcision is an interest, not a right.

Parenting is a special situation in which one autonomous person has the responsibility of protecting the rights and interests of another pre-autonomous person. This raises many difficult cases in which out of practical necessity a parent must make decisions for their child, but this does not mean that the child does not have rights in these scenarios and only interests. Rights don’t disappear in this kind of situation; they simply become harder to discern. Nevertheless, the first part of Mazor’s argument as summarized above is undoubtedly true. If a child is wounded in a car accident and the only way for him to survive is for a physician to amputate a limb, then this surgery is permissible, because the child’s right to life trumps his right to bodily integrity. The second part is where Mazor’s construction begins to falter.

Minor cleft lip surgery is a deceptive case. To begin, it concerns a less severe form of a condition that all would agree rises to the level of medical necessity. Unlike other forms of cleft lip surgery, however, this form is not medically necessary and neither social convention, nor intuition alone is sufficient to deem it morally permissible. Indeed, it properly belongs in the morally difficult category of cosmetic surgeries performed on minors.

Imagine a Chinese couple who immigrate to Mississippi and experience anti-Asian racism upon arrival. When they have their first child, they decide that she should undergo cosmetic eyelid surgery to make her look more Caucasian. Is such a procedure a violation of her right to bodily integrity? I would argue that it clearly is. But according to Mazor, who believes that the only criteria for the right to bodily integrity is that the body not be used as a means for others’ ends, the right to bodily integrity would not be in play here. Now Mazor might still conclude that this surgery is impermissible because he accepts that there is an interest in bodily integrity, but the case would be much more difficult to make on his own terms.

The problem, of course, is with what Mazor considers to be a legitimate justification for the right to bodily integrity. Protecting a person’s body from being used as a means to an end is certainly an important justification, but surely it is not the only valid justification. Protecting an individual’s body from unasked for, irreversible changes comes to mind as a valid justification as well. Under normal circumstances this is not a difficult right to uphold. People are generally forthcoming when they want changes made to their bodies and unless otherwise instructed, we may not impose irreversible changes on them. So the normal manner in which this right functions is that it is in force until the individual explicitly states otherwise. In the special case of a parent contemplating an unnecessary, but potentially beneficial intervention for their child, we are incapable of knowing what the child would want were he or she autonomous. But this ignorance should not be taken as a carte blanche by parents to start making permanent modifications to their children’s bodies. On the contrary, following the normal function of this right, our inability to know the desires of the individual should recommend a conservative approach as a way of preserving the individual’s right to bodily integrity. Having said that, there are some exceptional situations in which intervention is time-sensitive and a parent is forced to make an educated guess about what her child would want.

To this end, I would like to propose the following three criteria as a guide to identifying beneficial permanent body modifications that do not violate the right of bodily integrity:

1. The benefit of the modification in question cannot be achieved in any other, less drastic way.

2. The modification in question cannot be delayed until the child is autonomous.

3. The modification in question does not impair the function of the individual’s body[i].

Here are some examples of modifications that meet these criteria: Orthotics and growth hormones for height-deficient children. Here are some examples that do not meet these criteria: Mole removal, ear piercing, foot binding as was once practiced by the Chinese, tooth pulling as is currently practiced by some of the Amish, and ethnic eyelid surgery. I accept that there will be difficult cases even with my criteria as a guide. Indeed, the case of minor cleft lip surgery passes the first and third criteria, but it is unclear whether it passes the second. It would seem that the case of minor cleft lip surgery ultimately turns on whether or not the procedure can be postponed due to the structural changes that come with growth[ii]. What I don’t accept is that infant male circumcision is a difficult or exceptional case. Its purported benefits can be achieved by far less drastic means, it can be delayed until the child is autonomous, and it impairs the normal function of the penis[3]. It would seem, therefore, to be an unambiguous violation of the right to bodily integrity.

The third part of Mazor’s argument is also problematic. The mere fact that the parents claim to be circumcising their infant for his own benefit does not foreclose the possibility that the child’s body is actually being used as a means for others’ ends. The most obvious example of this is the fact that hospitals sell amputated infant foreskin for medical research and cosmetics[4]. I will return to the issue of circumcision as an instance of the infant’s body being used as a means for others’ ends later.

The Right to Self-Determination

Mazor goes on to make a separate argument against self-determination as an interest-trumping right in the case of infant circumcision:

1. Sometimes doing something at an earlier age is less costly than doing the same thing at a later age. For example, learning math.

2. In order to avoid the higher cost of learning math later, a child’s self-determination might need to be violated.

3. Circumcision is more costly later in life.

4. Therefore, self-determination is an interest and not a right in the case of infant circumcision.

As with the right to bodily integrity, the right to self-determination is more difficult to discern in the special case of the pre-autonomous child. Under normal circumstances, the right to self-determination takes for granted that the individual’s will is known. We cannot take this for granted with children. For the first few years of life, in the absence of language, knowing what a child wants is not simple. Moreover, when they do acquire language, children might not actually have the cognitive capacity to know what they really want. In these situations, for practical reasons, parents must make decisions for their children. But the reality of this difficulty does not imply that children do not have a right to self-determination. Society trusts parents to make decisions for their children right up until they reach majority and this is typically standardized around a specific age for the convenience of the law. But the truth is that virtually all children have the cognitive capacity to know what they want well before that age. And an ethical parent should seek to respect her child’s present and future right to self-determination to the best of her ability.

Once again, the first step of Mazor’s argument is true. Certain skills like math, reading, and languages are much harder to acquire later on. But this fact in and of itself is not sufficient to establish that it is permissible for a parent to force her child to acquire these skills. For example, it may be more difficult to learn chess later in life, but this does not mean that it would be morally permissible for a grand chess master to override her child’s right to self-determination and force him to play chess. Making an argument that parents can override their children’s right to self-determination for the sake of education necessitates an extra step:

Some skills are required to navigate the world efficiently. Other skills act as multipliers in that they make the attainment of yet further skills possible. If a skill falls into one or both of these categories, one can make an argument that the child’s future right to self-determination is best served by overriding his present right to self-determination. But this is a case of a right trumping a right. It does not mean that in the case of education children do not have a right to self-determination. To the extent that parents and educators require their children and students to study skills that demonstrably fall into either the navigational or the multiplier category, they will be supporting their children and students’ future right to self-determination and this is morally permissible. On the other hand, skills that fall outside of these two categories ought not be forced upon children who explicitly do not wish to acquire them as this would indeed be a violation of their right to self-determination.

But even if we were to grant Mazor that self-determination is a mere interest when it comes to the entire category of education, there are morally relevant differences between education and permanent body modifications that would prevent the same logic from applying to the latter. Permanent body modifications like circumcision are irreversible in a way that education is not. The son of the chess master can grow up and decide never to play another game of chess again in his life. He might very well forget (that is, un-learn) much of the chess strategy that was once drilled into his head. But a circumcised person cannot decide to not be circumcised anymore. He cannot un-do the surgery. For this reason, permanent body modifications like infant circumcision are a clear and uncomplicated violation of the child’s future right to self-determination[iii].

Furthermore, the argument that circumcision is costlier at a later age is not quite as clear as Mazor asserts. Here are the reasons why Mazor believes adult circumcision to be more severe than infant circumcision:

a. The dangers of medical complications.

b. The anticipatory dread.

d. The unease relating to a change in what one is used to.

The first contention is dubious. The infant penis is such a small structure that it is more difficult to operate upon with precision than the adult penis. This is why partial glans amputation, buried penis, and total penectomies are complications that are limited to infant circumcision. In addition, due to the fact that infants are so small, the amount of blood loss that would result in exsanguination is so minimal that it is often difficult to catch before it is too late[5]. Finally, the risk that an infection may become life threatening is higher in infants due to their small size--the infection has less distance to travel--and inability to communicate with language.

It is true that adults face anticipatory dread when contemplating surgery, but this is usually mitigated by other psychological factors especially when the surgery is voluntary. It is further true that circumcision poses a disruption to adult life, but it does so as well to infant life. There is evidence, for example, that circumcision interrupts breast-feeding cycles and thereby impairs the mother-child bonding process[6].

The conscious awareness of a change in one’s body is obviously not something that the infant experiences, but violent and traumatic experiences early in one’s life tend to have lasting, difficult-to-measure effects[7]. We know, for example, that circumcised boys have a lower pain threshold than their intact counterparts[8]. Moreover, at birth, the foreskin is fused to the head of the penis by a membrane[9]. The first step in infant circumcision is to break this membrane with a probe and tear the two structures apart. This step, which is extremely painful to the infant, does not exist in adult circumcision as the two structures are no longer fused[10]. On the subject of pain, providing adequate analgesia is very difficult in the case of infant circumcision as general anesthesia is contraindicated at this age. An adult, by contrast, can demand adequate pain control, and can receive it safely.

I bring these objections to argue that at the very least, it is problematic to assert that adult circumcision is more costly than infant circumcision. The task of comparing the costs of a surgical intervention at different ages is not simple, but based on the above realities, I think that there is a compelling case to be made that infant circumcision is costlier, all things considered, than adult circumcision.

The Balance Sheet of Interests

Building on the above arguments, Mazor concludes that both bodily integrity and self-determination are genuine interests, but not trumping rights in the case of infant circumcision. He then attempts to weigh up the various conflicting interests in the hopes of arriving at a conclusion about what is in the overall best interest of the child. In this part of my analysis I will assume for the sake of argument that Joseph Mazor has come up with elegant, rational defenses to all of my above objections. In other words, I will assume that bodily-integrity and self-determination are mere interests and focus on whether or not Dr. Mazor’s interest math adds up.

The Secular Case

In the secular case, Mazor considers two scenarios. The first is an orphan who is a ward of the state. In the costs of circumcision column for this scenario, he counts the violation of the interest to bodily integrity, the violation of the interest to self-determination, the reduction in sexual pleasure, pain, and risks of medical complications. In the costs of not circumcising column he counts the slight increase in risk of minor medical problems (UTI’s), a slight increase in serious medical problems (HIV and Penile Cancer), and the extra costs that the boy has to bear if he chooses to be circumcised as an adult. Here Mazor argues that the interests of the child probably weigh against circumcision.

The second scenario is that of parents motivated by non-religious concerns. Here, Mazor believes that parents ought to be allowed to make a decision one way or the other for the following five reasons:

1. There is reasonable disagreement about the medical benefits of circumcision.

2. There is reasonable disagreement about the reduction in sexual pleasure.

3. There is reasonable disagreement about the effects of non-drastic reductions in sexual pleasure on human flourishing.

4. There is reasonable disagreement about the moral importance of self-determination

5. There is reasonable disagreement about how to weigh the medical and non-medical benefits and costs.

There is reasonable disagreement on the medical benefits of circumcision -- that much is true. But what no one disagrees with is the fact that infant male circumcision is an unnecessary procedure that carries serious risks. As it happens, there is reasonable disagreement on the medical benefits of prophylactic appendectomy, but no one takes seriously the argument that routinely removing the appendices of infants is permissible. Nor does anyone argue that not removing the appendices of infants constitutes an “extra cost” an individual has to bear due to the fact that she might grow up and choose to have her appendix removed. There are two reasons that don’t resort to the language of rights that explain why no one takes these arguments seriously. First, the notion of cutting away healthy, functioning tissue in the hopes of achieving some sort of probabilistic future health advantage is the very definition of throwing out the baby with the bathwater. Second, when a surgery is medically unnecessary, the tolerance for risk/complication is incredibly low and should weigh strongly against intervention. These basic principles are so widely accepted in the medical profession that there is a serious debate over whether elective coincidental appendectomies ought to be performed[11].

On the matter of sexual pleasure, Mazor asks us to imagine a procedure that can only be performed in childhood that would reduce the pleasure obtained from eating sweets. A child who was subject to this procedure might be at an advantage in avoiding diseases that are linked to the overconsumption of sweet foods. This is meant to be an analogy to the loss in sexual pleasure that accompanies circumcision. He tries to argue that the fact that reasonable people could disagree about the permissibility of such a procedure means that they could also disagree about the permissibility of reducing a person’s ability to experience sexual pleasure.This strikes me as a very weak argument. Even if we grant that bodily integrity and self-determination are only interests, the math doesn’t add up. On the one hand, is the interest of having access to all of your sensory end organs and the experiences that accompany their presence. On the other hand, you have hypothetical advantages that are not proven and can be achieved by other, less destructive means. How can reasonable people disagree that the balance of interests weighs heavily against such a procedure? 

But the fourth reason here is the weakest part of Mazor’s argument. Regarding the moral importance of self-determination, he tries to argue that when it comes to circumcision, the interest of self-determination is not as strong as it might seem. He grants that the procedure’s irreversibility and the fact that it’s on an intimate part of the body strengthens the interest of self-determination, but he argues that three factors weaken it:

1. The higher cost of adult circumcision.

2. The young adult is likely to be uninformed about the risks and benefits.

3. The decision is subject to biases.

As I’ve already addressed the first claim, let us take a closer look at claims 2 and 3. Mazor tries to argue that a parent with children is more likely to be informed about the costs and benefits of circumcision and less likely to be subject to present and status quo biases than a childless young adult. This, according to Mazor, weakens the infant’s interest of self-determination.

But as Gillian Longley has documented[12], the level of information provided by the medical establishment to expectant parents about circumcision is so poor that it is actually inadequate for the purposes of informed consent. Given this and given the fact that in today’s world access to information through technology is ubiquitous (and younger people tend to be more technologically savvy than their parents), I find it unreasonable to suggest that a young adult would be less informed than his parents about the risks and benefits of circumcision. Certainly a young adult would be highly motivated to investigate a procedure that has permanent consequences for his genitals.

Moreover, one of the most popular reasons that parents give for circumcision is for the son to “look like” the father[13]. At first glance, this justification may seem reasonable. After all, one might imagine that these parents are simply trying to avoid unnecessary confusion for their son. Upon further reflection, however, the justification is anything but reasonable. There are many ways in which a father may look different from his son and none of them warrant the permanent alteration of his son’s body for any reason. If we learned of a father who had lost a toe and was planning to amputate his son’s toe to avoid “unnecessary confusion”, we would probably call child protective services. This justification would seem to be more about the father and the way he feels about his body than it is about the son and his imagined confusion. Not only does this empirical reality contradict Mazor’s biases contention, but it also may indicate another way in which the child’s body is being used as a means for others’ ends.

The Religious Case

In the religious case, Mazor considers an infant born to Orthodox Jewish parents who are motivated by religious concerns. Here he argues that there are two salient factors that distinguish this case from the secular case and therefore change the calculus of interests. First, the chances that the child himself would choose to become circumcised as an adult are higher than in the secular case. This both attenuates the self-determination argument and raises the child’s interests in avoiding the higher cost of adult circumcision. Second, the Orthodox Jewish child who grows up intact might feel alienated from his religion.

I have already explained why I don’t accept the assertion that adult circumcision carries a higher cost than infant circumcision all things considered. In the case of Orthodox Jewish circumcision, I think it is fair to say that the risk of complication and pain are actually significantly higher than in a hospital setting[14].Orthodox mohels, for the most part, are not trained medical professionals and the use of any form of anesthetic is controversial in Jewish law. This without mentioning Metzitzah B’Peh, the direct oral-to-genital sucking practice which has been definitively linked with life-threatening infections and continues to be practiced in some Orthodox communities with impunity[15]. Moreover, if the motivation is religious, postponing the decision until the child reaches majority would actually enhance the religious experience of the practice, because the individual would be cognizant of the fact that he is fulfilling a commandment.

The possibility that an intact Orthodox Jew might feel alienated from his religion does not constitute a particularly strong interest in my estimation. As the philosopher Raja Halwani argues in my film, Cut[16], the relevant question is not whether or not a person feels shame about his intact genitals. The question is whether or not that shame is merited, and Halwani argues that it is not. After all, if a community would seek to shame an individual for not having had a part of his genitals removed when he was an infant, this would seem to reflect poorly on the community, not on the individual. Might an intact Orthodox Jew feel alienated from Judaism as a result of his foreskin? Possibly. But contrary to common belief, there is not a single ritual that an intact Jewish male is excluded from in contemporary religious life according to the strictest letter of Orthodox law[17]. So his feelings of alienation would be unmerited, not to mention reversible. And when we limit this argument to the fringe case of a weak-willed individual as Mazor does, the interest is weakened to the point of irrelevance.  

The fact of the matter is that we don’t know whether the Orthodox child will grow up to be grateful or resentful of the fact that he was circumcised. Circumcision is a roll of the dice in this regard, which is why leaving the choice up to the individual makes so much sense. Are the dice weighted in the case of a child born to an Orthodox family? Maybe. For the sake of argument, I’d be willing to grant Mazor that a child born to Orthodox parents is more likely to choose circumcision when he reaches adulthood than someone born to a secular family. But I don’t see how this statistical probability outweighs any of the aforementioned risks and costs of infant circumcision. And if we’re talking about an Orthodox Jewish circumcision, the problems are compounded by the fact that in Jewish law, the commandment is first and foremost incumbent upon the father[18]. In other words, for an Orthodox Jewish man to fulfill his religious obligations, he must use his son’s body as a means to the end of following religious law[16].

Conclusion

While Dr. Mazor’s argument at first glance appears to be somewhat compelling, upon closer examination it really falls apart. As I’ve sought to demonstrate above, he doesn’t actually prove that bodily integrity and self-determination are mere interests in the case of infant circumcision. Moreover, there are serious problems with the manner in which he weighs the various conflicting interests to arrive at his conclusions. Parenting is an ethical minefield and I’m willing to concede that under certain circumstances the child’s rights to bodily integrity and self-determination can be overridden. But nothing in Mazor’s argument convinces me that being born male is a sufficiently compelling circumstance to justify infant circumcision.

[i]The purpose here is not to point to some sort of ideal human body, but rather to expand the definition of bodily integrity to include function. This third criterion recognizes that modifications to the human body can have morally relevant consequences beyond the change to the tissue itself. For example, foot binding is more than just a physical change to the feet. It also has functional consequences for walking. This criterion argues that the functional consequences of body modifications ought to be considered as part of the violation.

[ii] The consensus surgical opinion on the subject seems to be that the first year of life is the best age for the surgery, but that may simply be when surgeons feel they can achieve the best results, which does not in and of itself answer the question of whether the surgery can be postponed. It is important to note that whether or not minor cleft lip surgery is a violation of the right to bodily integrity, it may very well still be impermissible upon weighing the interests of the child. One factor that is particularly disturbing about this surgery is that it requires general anesthesia which is dangerous in infancy (http://bja.oxfordjournals.org/content/105/suppl_1/i61.full).

[iii] What emerges from this discussion is the notion that there are three sequential stages in the right to self-determination. The first is the indeterminate stage that lasts until a child knows what he wants. The second is the determinate minor stage when a child knows what he wants, but is still under the jurisdiction of his parents. The third is fully-fledged adult self-determination. It is clear that decisions made in the first two stages may have positive or negative consequences for the third stage. In the case of infant circumcision, a parenting decision made in the first stage has unambiguously negative consequences for the fully-fledged self-determination of the third stage

 

[1] http://www.bbc.co.uk/news/world-europe-18604664 accessed 5/18/13

[2] Benatar M., Benatar D. Between prophylaxis and child abuse: The ethics of neonatal male circumcision AM J Bioeth 2003 Spring;3(2):35-48

[3] Cold CJ, Taylor MB. The Prepuce. British Journal of Urology 1999:83, Suppl. 1, 34-44

[4] Daecher M.: Circumcision. Icon 1998;2(2):70-3

[5] Cropp GJ: Changes in blood and plasma volumes during growth. J Pediatr 1971,78:220-229.

[6] Howard CR, Howard FM, Weitzman ML. Acetaminophen analgesia in neonatal circumcision: The effect on pain. Pediatrics 1994;93:641-6

[7] Anand KJ, Runeson B, Jacobson B. Gastric suction at birth associated with long-term risk for functional intestinal disorders in later life. J Pediatr 2004;144:449-454.

[8] Taddio A, Katz J, Ilersich AL, et al. Effect of neonatal circumcision on pain response during subsequent routine vaccination. Lancet 1997;349:599-603.

[9] McLatchie, G., & Borley, N. (Eds.). (2013).Oxford handbook of clinical surgery. Oxford University Press.

[10] Boyle, G. J., Goldman, R., Svoboda, J. S., et al. (2002). Male Circumcision: Pain, Trauma and Psychosexual Sequelae. Journal of Health Psychology, 7(3), 329-343.

[11] American College of Obstetricians and Gynecologists Elective Coincidental Appendectomy. ACOG Committee Opinion No. 323. Obstet Gynecol 2005;106:1141–2.

[12] Longley, G, Framing the Foreskin: A Content Analysis of Circumcision Information Handouts for Expectant Parents. Colorado: ProQuest, UMI Dissertation; 2011.

[13] Rediger, C.& Muller AJ (2013). Parents' Rationale for Male Circumcision. Canadian Family Physician February 2013 vol. 59 no. 2 e110-e115

[14] Amir, J. (2010). Ritual Circumcision and Urinary Tract Infection in Israel. IMAJ 2010;12:303–304

[15] http://www.cnn.com/2013/04/07/health/new-york-neonatal-herpes accessed 5/18/13

[16] Ungar-Sargon, E. (Producer and Director). (2007). Cut: Slicing Through the Myths of Circumcision [Film]. Chicago: White Letter Productions.

[17] Cohen, Shaye JD. (2005) Why Aren’t Jewish Women Circumcised? Berkeley: University of California Press, 2005.

[18] Babylonian Talmud, Kiddushin 29a

When Bad Thinking Happens to Good People

When I encounter the argument often made by the new Atheists that religion makes otherwise moral people do immoral things, I typically respond by pointing out that this is an oversimplification. Complex systems of thought like religion are at least as much a reflection of human nature as they are constitutive of it. Nevertheless, when I read articles like Rabbi Shmuly Yanklowitz’s, A Moral Case for Brit Milah, I am forced to concede that there may be some truth to the argument.

In the interests of full disclosure, Rabbi Yanklowitz is a member of one of the Jewish communities that I belong to here in Los Angeles and I have a cordial relationship with him. He is the founder of Uri L’Tzedek, a wonderful Jewish group that is devoted to social justice issues. This is remarkable in so far as Orthodox Jews have historically not been as involved with social justice as Jews from the more Liberal movements. Rabbi Yanklowitz’s commitment to both Orthodoxy and progressive causes makes him something of a rare bird, which demonstrates a moral courage and awareness that few Orthodox Rabbis can manage. And yet, here he is trying to defend the indefensible.

Yanklowitz begins his article by declaring that he is someone who believes that mitzvot, religious commandments, have an ethical foundation. Taken literally, this statement is obviously false. There are a number of commandments that historically required Jews to commit acts of genocide and there are many other ethical problems with the structure of Jewish law (the status of women comes to mind as an obvious example). But the rabbi should not be taken literally here. What he means by this statement is two things. First, that he is not a fundamentalist, because he believes that human agency is a necessary part of religious interpretation and practice. Second, in his personal hermeneutics, ethics play an important role in shaping religious interpretation and practice. The rub, of course, is how one deals with situations in which morality conflicts with the Jewish tradition. Circumcision is an apparent, and I argue actual, instance of such a conflict. Yanklowitz seems to be trying to argue here that circumcision is not such an instance. Let’s examine his argument point by point.

1. Health

“Is it fair to avoid giving a boy protection when it is available? It’s not only Jewish law to maintain one’s health but also Jews should serve as a model for this important health practice.”

The health case for circumcision is incredibly flimsy. It is true that many in the American sphere of influence believe that male circumcision reduces the risk of certain kinds of diseases, but they are the exception in the world. Having extensively studied the literature and interviewed many experts on the subject, it is my opinion that male circumcision is a cultural practice masquerading as medicine. But even if I’m wrong and it turns out that there is incontrovertible evidence suggesting some health advantages to being circumcised, this is insufficient to recommend the practice. One could imagine all sorts of amputations that might confer “health benefits”. If we routinely amputated one breast from all women living in the United States, we could reduce the incidence of breast cancer in this country by a substantial amount. But it would be ludicrous to even suggest such a course of action. Merely demonstrating potential health benefits(which no one has yet done to my satisfaction with circumcision) is not sufficient in deciding whether or not to cut away healthy, functional body parts. Other factors must be weighed. All surgeries incur risks. And when we’re talking about an elective procedure on pre-autonomous individuals, the tolerance for risk should be very low. The UK dropped the practice of circumcision shortly after World War II when it was discovered that 16 out of every 100,000 boys circumcised were dying from related complications. 

2. Sexual Morality

“For centuries many have claimed that the removal of the foreskin reduces male sexual pleasure...Many empirical studies have put this into question...Perhaps circumcision can serve as a sacred reminder for men, in our over-sexualized world, to cultivate self control.”

Yanklowitz gets his facts wrong here. As it turns out, Maimonides and Philo had it right. The foreskin is the most erogenous part of the penis. It contains a higher concentration of nerve endings than any other part of the body and it provides a gliding mechanism that makes sex more comfortable for both partners. But beyond this empirical misstatement, the notion that circumcising an 8 day old baby reminds anyone of anything is absurd. If you’re thinking about sex while watching a Brit Milah, your problems may extend beyond self-control. Not to mention the fact that there is a deep form of sexism inherent in this understanding of the practice. If sexual restraint is something that we need to be reminded of at all (a dubious claim in and of itself), why is it that only men need to be reminded and not women?

 3. Utilitarian 

“If an uncircumcised man chooses to have the procedure done later in life, it will be much more painful (even with anesthesia) and dangerous than it would be for a newborn. It is the responsibility of parents to shield their children from unnecessary pain.” 

Once again, the facts are wrong. Circumcision is an excruciatingly painful experience for infants. The vast majority of ritual circumcisions are performed without any form of anesthetic during, or pain management after the procedure. Moreover, because the penis isn’t fully developed at infancy, the first step of circumcision is to tear apart the foreskin from the glans. Furthermore, the notion that circumcision is more dangerous for adults is patently false. Infants are much more susceptible to infectious disease than adults and they have much less tolerance for blood loss. On the other hand, I couldn’t agree more with the last sentence. It is the responsibility of parents to shield their children from unnecessary pain. And circumcision is the definition of unnecessary pain.

4. Parental Values & Social Acceptance

“Parents make health- and aesthetics-related value choices that affect their children’s bodies all the time. Should their child be vaccinated, receive orthodontia, get his or her ears pierced...Not circumcising a Jewish boy may hinder his social acceptance and his chances of finding a Jewish spouse.”

It is true that parents make many decisions for their children, but it does not follow that these decisions are immune from moral scrutiny. Some parenting decisions are morally neutral, some are right and some are wrong. Medically unnecessary permanent body-modifications are wrong, because they represent a failure to respect the future autonomy of the child. This includes ear piercing, although the pain, harm, and risk involved in that modification are far less severe than that of male circumcision. The second statement is the old argument from shame. As the philosopher Raja Halwani said so brilliantly in my film, Cut, arguments from shame turn on whether or not the shame is merited. Indeed, raising a child as an Orthodox Jew in the modern world may incur shame at some point in his or her life. The question is whether a person should feel shame for having an intact penis, or being an Orthodox Jew. I think it’s clear that the potential shame in either situation is unmerited and therefore not a moral argument for circumcision, or against Orthodox Judaism.

In the 5th and 6th points (“Modesty” and “Symbolic Reminder”) Yanklowitz is just rephrasing the point that he made in “Sexual Morality” so I will not address them here. But it is worth noting that Yanklowitz dips into more of the sexism that was hinted at in the sexual morality section. 

I believe that the motivation behind Rabbi Yanklowitz’s attempts to justify Brit Milah comes from a good place. Indeed, he has shown himself to be a man of courage in other areas of moral concern. But it’s hard to ignore the fact that he is proving the new Atheists right here. By allowing the weight of tradition to cloud his moral judgment on this issue, Yanklowitz, an otherwise morally courageous individual, is promoting an immoral practice. As I have shown in the above analysis, the arguments made here for circumcision are flimsy and confused. Brit Milah embodies a conflict between the Jewish tradition and ethics that is seen across many areas of Jewish interpretation and practice. How we negotiate these conflicts defines who we are both as Jews and as human beings. The first step towards recovery is realizing you have a problem. Shmuly, we have a problem.

How to Criticize a Jew

Introduction

As a Jew opposed to both circumcision and political zionism, I am often privy to discussions that verge on the antisemitic. This creates horrible rifts within the activist community which both impedes progress and wastes precious energy. Some people react by doubling down and defiantly continuing to make potentially offensive statements. Others steer clear of ever talking about anything related to Jews or Judaism for fear of being shouted-down as antisemites. The situation is further exacerbated by the fact that political correctness has become a deeply embedded social norm which discourages discussion of ethnic difference. As it happens, my commitments to humanism in general and to universal human rights in particular are rooted in my ethnic identity as a member of the Jewish people. I would like, therefore, to try to bring some conceptual clarity to this issue in the hope that it will create a space for more productive discussions going forward.

Terms Defined

The term “anti-Semitism” actually comes from 19th century Germany where a journalist named Wilhelm Marr published pamphlets arguing that the Jewish race was the root of his nation’s problems. In fact, anti-Jewish sentiment had long been a feature of Christian theology, but during the course of the 19th century, it went from being a religious animosity to one that was based on the new biological concept of race. Antisemitism is used today as an umbrella term to include all forms of hostility or prejudice against Jews. Much of the confusion that people feel around this issue comes from the fact that defining the word “Jew” is a somewhat complicated issue. Judaism is, of course, one of the world’s oldest surviving religions, but being Jewish isn’t simply a matter of adhering to the Jewish religion. There are three overlapping components to Jewish identity: Jewish ethnicity, Jewish peoplehood, and Jewish religiosity. 

Jewish ethnicity is a concept that exists historically in the Jewish tradition where according to Halakha (religious Jewish law), a person born to a Jewish mother is automatically and irrevocably considered Jewish (in the Reform movement, this ethnic definition was extended to include anyone born of a Jewish father as well). Incidentally, Hitler also had an automatic and irrevocable definition of Jewish ethnicity which was somewhat more inclusive. During the years of the Third Reich, anyone with a single Jewish grandparent was considered a member of the “Jewish race” and therefore a legitimate target for Nazi elimination. Jewish peoplehood is a much looser non-ethnic concept which is closer to the Muslim concept of the “Ummah”. It encompasses those around the world who practice the Jewish religion as well as converts. Jewish religiosity refers to all of the different forms of Jewish religious practice.

For our purposes, it is important to keep in mind that the vast majority of Jews alive today are NOT religious, although they do see themselves as ethnically Jewish and also define themselves as part of the Jewish people. In fact, the only group of Jews who do not fall into the ethnic Jewish category are converts though they are, of course, still part of the Jewish people and the Jewish religion.

It is important to note, that these three components of Jewish identity operate more as a venn diagram than as separate categories. While most Jews are not religious, they do occasionally engage in religious practice as a way of reaffirming their ethnic identity. To make matters slightly more complicated, political Zionism grafted Jewish ethnic identity and peoplehood on to the 19th century European concept of ethno-nationalism. Zionism was a secular movement which argued that Jews were a nation like any other and were therefore entitled to a state. This is the concept upon which the modern State of Israel was built.

Abuse of the Term Antisemitism

In recent years, there has been a concerted effort by some Jews to cast anyone who would criticize the State of Israel as an antisemite. The same strategy is used against vocal opponents of circumcision. The problem with these efforts is that it is quite possible to be critical of both Israel and circumcision without being an antisemite. But beyond the disturbing fact that good people have been unjustly besmirched by these smear campaigns, two serious and disturbing consequences of this strategy have emerged: First, the term “antisemite” has lost its bite and as a result, the world is less sensitive to the actual phenomenon. Second, they have shut down legitimate criticism on these issues and given the impression that Jews are incapable of listening to anyone outside the tribe. 

Genuine Antisemitism

Nevertheless, genuine antisemitism does exist. I have experienced it personally and it is on display in the comments section of my YouTube channel. Here is just a sample of the comments that I get on a daily basis:

"jews like money....one more "service" regardless if that means to mutilate a child"

"who said we want their opinion lmao , jews will vanish . the time near . really really really near , the khilafa is near , be prepared be a muslim and you will win be with any other side and you will lose , the final battle is near."

"Fucking jew, Shouldn't he be killing Palestinian infants back at israel or what?"

 "fucking kike"

 "Dirty.... DIRTY Jew."

These comments are not particularly subtle in their antisemitism and though some of them have a thin veneer of quasi-criticism, they are all obvious examples of hate speech. I call this classical antisemitism. But what about something a little more subtle? Take a look at the following comment that was part of an email conversation I had with an activist who is opposed to circumcision:

“These practices are so ingrained in Jewish culture and are encouraged so widely by Jews to the point of imposing on non-Jews, that I can understand why people throughout history have believed that all Jews are enthusiastic about these practices. Is it a long stretch from this place of being disgusted by Jewish practices to becoming anti-Semitic?” 

Is this comment antisemitic? Let’s analyze it rationally. It is true that circumcision is deeply ingrained in Jewish culture. It is further true that individual Jews have played a prominent role in establishing circumcision as a medical practice in the English speaking world. It is not true, however, that Jews have “imposed” circumcision on non-Jews. Moreover, the implication at the end of the statement is that antisemitism comes from people being disgusted by Jewish practices. This is problematic for two reasons. First, it smacks of blaming the victim. Jews are not responsible for the fact that people hate them. Second, it implies that hatred of Jews is rational given the fact that Jews perform circumcision. But hating an entire people group because of a cultural/religious practice is not a rational move at all. That would be like hating Arabs, because of their genital cutting practices, or hating Muslims, because of Ashura cutting practices.

Here’s another example, from the same person:

“As you know, another issue about circumcision practice which concerns me, is that it has come to my attention that a medical doctor in ------, who happens to be Jewish, is performing Brisot Milah and Metzitzah. He might use a syringe rather than his mouth to harvest blood from the circumcision wound, but the fact remains that a child’s blood is being harvested for consumption by adults at a party.”

Some Jews do perform metzizah as part of the Brit Milah ritual in which blood from the circumcision wound is sucked away. A tiny minority of Jews even perform this part of the ritual with direct oral-to-genital suction (Metzitzah B’Peh). But the idea that the circumcision blood is “harvested for consumption by adults at a party” is nonsense that sounds very similar to historic anti-Jewish canards.

Here’s another example from a different person:

“Amnesty International is a Jewish dominated organization that is not going to address the circumcision issue.”

It is true that there is a correlation between being Jewish and wanting to protect Jewish rituals. But correlation is not causation. If there's one essential thing that defines Jews more than anything else, it is that we never agree about anything. The high level of vocal Jewish participation in the anti-circumcision movement is a case in point. So even if it were true that Amnesty International is a "Jewish-dominated organization" (a dubious claim at best) this alone says nothing about its ability to deal critically with the issue of male circumcision. Indeed, being pro-Israel is at least as much of a consensus issue among Jews today as circumcision and Amnesty International makes no bones about harshly criticizing Israel for human rights abuses. Once again, the language is eerily similar to historical anti-Jewish canards: Jewish-dominated banks, Jewish-dominated media, etc. In this instance, I would say that this is an inaccurate statement, but not by itself evidence of antisemitism.

Reading the first two circumcision examples, you might be tempted to assume that the genital integrity activist who composed them is a classical antisemite who has found that the anti-circumcision cause resonates with their racist predilections. If you were being fair, you might grant that this person is not representative of the larger intactivist movement (a fact that I can vouch for), but you might conclude that their hatred of Jews preceded their involvement in the Genital Integrity movement. Nevertheless, I think that what we’re seeing here is actually slightly different than classical antisemitism. I think that it’s possible to arrive at this kind of expression from a place of hating a practice so deeply that you allow yourself to hate anyone who engages in it. I call this regressive antisemitism. Having said that, from the perspective of a Jewish person, it doesn’t matter whether the antisemitism is classical or regressive, it’s still hate and it’s still directed at them. 

The Roots of Ethnic Hatred

Ethnic hatred is a pretty constant feature of the human condition. Fundamentally, it comes from that place in our brains that seeks to make order out of the world. More often than not, our ability to abstract from the particular to the general is a useful skill. Indeed, it is at the very core of our capacity to learn. If I eat a berry and it makes me sick, I learn to assume that any berry that looks the same will also make me sick. But when this move is applied to people, to actual human beings, the abstraction fails, because people who look the same, or who belong to the same group, don’t necessarily act or think the same. And yet, the way our minds are structured makes it intuitive for us to generalize about people groups and these generalizations become memes which then propagate out in the world. Antisemitic memes are some of the oldest negative generalizations about people groups in existence. But it’s important to realize that labeling someone as an antisemite is also a form of abstraction. It reduces a human being to a manageable category. This reduction is partly a defense mechanism, but it also means that you don’t have to think of that person as a person. They become “a racist” or “an antisemite”. 

Practical Advise

So what’s a Gentile to do? How can a non-Jewish person criticize a Jewish practice or the Jewish State without being antisemitic? The first thing to understand is that there are Jews who will accuse you of antisemitism in a knee-jerk attempt to shut you up. I recommend that you ignore these people. As long as you aren’t expressing antisemitism and you can demonstrate that fact when challenged, this tired strategy will backfire. Next, understand the way in which your issue challenges Jews of different stripes. Circumcision is a religious obligation to some and an reaffirmation of ethnic identity to others. This means that criticism of circumcision will sound different to different Jews. Likewise, criticism of Israel sounds different to Zionists than it does to ethnic/cultural Jews and different still to religious Jews. When criticizing circumcision, be clear about the fact that you don’t have a problem with Jews in general. It is the practice of infant circumcision specifically that you find problematic. When criticizing Israel, make it clear that you understand the difference between the State of Israel and the Jewish people. Be clear that your criticism is of the former and not the latter. Know your audience. Familiarize yourself with the history of antisemitism and try to avoid arguments that sound like classical antisemitic canards. Do these things and you’ll be surprised at how receptive people are to having a real conversation with you about your issue. Finally, don’t allow yourself to hate the people who transgress your issue. Remember that they too are imperfect human beings trying to navigate their way through a morally complicated world. Hate the human rights violations, not the human rights violators.