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Altering Baby Boys' Bodies
The Ethics of Infant Male Circumcision
From "The Ethical Canary - Science, Society, and the Human Spirit"
By Margaret Somerville
If someone asked you what our reactions to human cloning could teach us about the ethics of infant male circumcision, you might think it was a trick question. I was working on speeches on both these topics at more or less the same time and, with some surprise, recognized there was at least one important lesson that cloning would provide in relation to circumcision. When they first hear of human cloning, most people's reaction is "Yuck!" But as familiarity increases, and dread decreases, they move from this rejection and horror to neutrality to acceptance, usually with safeguards, and finally even to positive approval. In contrast, many people's view of infant male circumcision has gone in the opposite direction: from positive approval to rejection and sometimes horror. This is certainly true of my attitude.
When, in the early 1980s, I learned of the practice of female genital mutilation (FGM), I decided to speak against it. (In the past this practice was often referred to as female circumcision.) In its most severe form it involves infibulation-clitorectomy (the removal of the clitoris) and the removal of the outside parts of the genitalia and the reduction of the vaginal opening to a very small aperture. Bettie Malofie, the founder of ETHIC (End the Horror of Infant Circumcision), heard my comments and wrote asking what my position was on infant male circumcision. I replied that I thought it was a minor procedure, a harmless practice that for some people had important religious significance and for others was a matter of tradition. I said it was not a matter of concern. So how did I end up, in 1997, as the subject of a headline on the front page of the Ottawa Citizen, the major daily newspaper of Canada's capital, that stated, "CIRCUMCISING BABY BOYS 'CRIMINAL ASSAULT'. ETHICIST SAYS SOCIETY MUST CONSIDER BAN"?
Over the years I have been patiently and respectfully educated by many people who oppose circumcision or genital mutilation of any children. Many factors have combined to change my view and to lead me to conclude that circumcision of baby boys raises important questions of ethics and of law. A major factor was new facts.
As I have noted elsewhere, good ethics depend on good facts, and good law depends on good ethics. The medical facts about infant male circumcision have changed as a result of medical research. We now know that infant male circumcision is harmful in itself and has harmful consequences. Circumcision removes healthy, functioning, erogenous tissue that serves important protective, sensory and sexual purposes. The surgery also involves risks of further damage-ranging from minor to serious damage to the penis or even its loss or death. In one recent American case a baby died from the general anesthetic he was given in order to deal with the complications that had resulted from his circumcision. Some physicians who continue to support routine-that is, non-therapeutic-circumcision argue that its potential medical benefits-which research shows do exist-justify carrying it out on infants. But these potential benefits do not outweigh its harms when the procedure is not medically necessary, which in the vast majority of cases it is not. Moreover, when we look to the nature of the medical benefits cited as a justification for infant circumcision, such as a reduced rate of urinary infections, we can see that medical problems can be avoided or, if they occur, treated in far less traumatic and invasive ways than circumcision.
The most recent claim of a medical benefit from circumcision is a reduction in the risk of contracting HIV infection or other sexually transmitted diseases. The research on which this claim is based is being challenged, but even if it is correct, it would not justify circumcising infant boys. Even assuming that circumcision gave men additional protection from becoming infected with HIV, baby boys do not immediately need such protection and can choose for themselves, at a later stage, if they want it. To carry out circumcision for such a future health protection reason (assuming for the moment that circumcision is protective) would be analogous to testing a baby girl for the gene for breast cancer and, if it is present, trying to remove all her immature breast tissue in order to eliminate the risk of her developing breast cancer as an adult woman. I believe that most of us would be shocked at undertaking such a procedure on a baby girl, but some of us might not have the same reaction to infant male circumcision. Why is this? Quite simply we value breasts-we see it as a serious harm to a woman to lose them-and we do not value foreskins, in fact they are often devalued-spoken of as ugly, unaesthetic and unclean. Yet both are part of the intact human body and both have sexual and other functions. Consequently, to summarize, routine infant male circumcision cannot be ethically and legally justified on the grounds that it is medically required.
A common error made by those who want to justify infant male circumcision on the basis of medical benefits is that they believe that as long as some such benefits are present, circumcision can be justified as therapeutic, in the sense of preventive health care. This is not correct. A medical-benefits or "therapeutic" justification requires that overall the medical benefits should outweigh the risks and harms of the procedure required to obtain them, that this procedure is the only reasonable way to obtain these benefits, and that these benefits are necessary to the well-being of the child. None of these conditions is fulfilled for routine infant male circumcision. If we view a child's foreskin as having a valid function, we are no more justified in amputating it than any other part of the child's body unless the operation is medically required treatment and the least harmful way to provide that treatment.
Another reason to reject infant male circumcision is the pain it causes. In considering their obligation to "first do no harm," physicians must give great weight to one of the most immediate harms of circumcision-it causes pain. Research has shown that we have been insensitive to those who are unable to verbalize their pain, that is, to put their suffering into words. We have carried out procedures on children that would never be carried out on adults without adequate and full anesthesia; as recent research on infant male circumcision has shown, traumatic pain experiences in very young children heighten their pain sensitivity, possibly for life. Research also shows that newborn babies have a unique nervous system that makes them respond to pain differently from adults. As journalist Victoria MacDonald, describing the recent research of Maria Fitzgerald, professor of neurobiology at University College, London, reports in London's Sunday Telegraph:
|Reports in clinical and psychological literature indicate early injury or trauma can have long-term consequences on sensory or pain behaviour that extend into childhood or beyond. . . . Because the spinal sensory nerve cells worked differently in babies, even a simple skin wound at birth could lead to the area becoming hypersensitive to touch long after the wound had healed. By studying these sensory nerve cells in infants the scientists discovered that their reflex to pain or harm is greater and more prolonged than that of adults. The sensory nerve cells are also linked to larger areas of skin, which means they feel pain over a greater area of their body.|
People have a fundamental human right not to have pain intentionally inflicted on them and, where pain is unavoidable, to have fully adequate treatment for the relief of that pain. These people include babies and children. Breach of this fundamental human right should be regarded as very serious wrongdoing. Recent medical research, people's own observations and our own experience and common sense show that circumcision is an intensely painful procedure. It is therefore in violation of human rights unless it can be justified in particular cases. One issue is whether adequate pain relief can be obtained with local anesthesia, even a dorsal penile nerve block, or whether general anesthesia would be required to make the surgery involved in infant male circumcision pain-free. In my opinion, a physician would not be ethically or legally justified in administering a general anesthetic for a non-therapeutic intervention on a child who could not himself consent. There is also the question whether adequate pain relief can be obtained after the effects of the anesthetic have worn off. It takes approximately a week for the wound to heal, during which time, apart from other causes of pain, the open wound is in contact with the child's urine. It is, indeed, a harsh welcome to the world.
It is very difficult to believe that a person, especially a physician, could understand the new knowledge about circumcision and believe that it did little or no harm to the baby boys on whom it is carried out. And yet my experience has been that many physicians, especially those who are older and have performed very large numbers of circumcisions, are unwilling to accept this evidence or, it seems, even to give it open-minded consideration. In by far the majority of cases, this resistance is not connected with physicians' own religious beliefs, although it could, of course, be connected with concern that recognizing the harms involved in infant male circumcision could interfere with others' religious beliefs or traditional or cultural practices. This concern probably influences politicians and leaders of medical professional societies. When approached about the ethics and legality of infant male circumcision, they frequently fail to respond. If they do respond, either they state that the practice does not raise any ethical or legal issues or, if they recognize that it does raise these issues, they often justify the practice with statements that are ethically and legally wrong. I have spent many hours replying to letters signed by ministers of justice or of health, or presidents of colleges of physicians and surgeons. In these letters, I give the same arguments that I discuss in this chapter to explain why, in my opinion, they are ethically and legally wrong. Sometimes, I do not receive any reply, but I have found that when I do receive a response, it rarely addresses the ethical and legal issues I have raised and often simply repeats the same statements as those in the letter to which I replied that I argued were wrong. I assume that these statements are made in good faith. Probably the people making them are acting out of a concern not to distress their constituents or members of the colleges who would be deeply dismayed by recognizing the harms involved in infant male circumcision that are not compensated for by medical benefits, and therefore the practice's ethical and legal unacceptability. No doubt they are also dismayed to realize that as parents who consented to routine circumcision, they may have inflicted harm on their sons or, as physicians who carried it out, on other people's sons.
Infant male circumcision is certainly not the first procedure that was once thought to be medically beneficial but was later shown to be harmful. Everything from blood-letting to lobotomies was once considered a standard practice. As medical knowledge about infant male circumcision and, therefore, its medical justification changed, the ethics changed. In future, the application of the law may well change.
SOME PEOPLE BELIEVE THAT in order to make routine infant male circumcision undertaken for other than religious reasons illegal, we would need to change the law. This is not correct. The Criminal Code already prohibits assault, aggravated assault and sexual assault. An assault is any touching of another person that is more than what the law calls de minimis (a trifle) without that person's consent. (De minimis touchings include those involved in normal social interaction, unless the person touched has objected to them.) Aggravated assault is assault that involves a wounding. Legally, a wounding is constituted by any breaking of the full thickness of the human skin. Consequently, all surgery, including infant male circumcision, could potentially fall within the definition of aggravated assault. Under our present interpretation of the Criminal Code, surgery does not do so, however, in two situations. Surgery is ethically and legally justified when it is necessary therapy undertaken by a competent physician with the informed consent of the patient or the incompetent patient's legal representative. And non-therapeutic surgery that is not contrary to public policy (for example, cosmetic surgery or donation of a paired organ for transplantation) is justified if undertaken with the fully informed consent of the competent adult undergoing it. But some history of how we arrived at this current interpretation of the law is relevant to the debate on the legality of infant male circumcision.
In 1980, I published an article entitled "Medical Interventions and the Criminal Law: Lawful or Excusable Wounding?" in which I looked at the traditional legal justification for surgery-namely, that it was intended to be therapeutic, that it was necessary for the preservation of the health or life of the patient, and that its promised therapeutic benefits outweighed its risks and harms. The article also explored how we could justify cosmetic surgery and surgery carried out on live organ donors, both of which are non-therapeutic. I argued that the informed consent of a competent adult on whom such surgery was carried out could by itself legally justify it, provided in any given case the proposed surgery was not contrary to public policy. (For instance, a person cannot consent to having their leg amputated unless it is required for medical reasons; absent of therapeutic necessity, such an intervention, even if requested and consented to by a competent adult, would be contrary to public policy.) But the justification of a competent adult's personal informed consent" cannot, of course, by definition apply to an infant or a child. The other legal justification for some non-therapeutic interventions was that they were de minimis, that is, a trifle. For instance, piercing the earlobes of girls might fall within this category. According to the old saying "De minimis non curat lex (the law does not concern itself with trifles)," such interventions do not give rise to any legal liability.
When I was writing that article, it never occurred to me to consider whether infant male circumcision could be legally justified. If I had done so, I probably would have thought, in keeping with my understanding at the time, that it was either therapeutic and therefore justified, or a de minimis intervention. But routine circumcision cannot be classified as therapeutic, and everyone, including people who undertake infant male circumcision as a religious obligation, agree that it is not a de minimis intervention. Therefore, the issue is whether infant male circumcision can be legally justified in some other way than by regarding it as therapeutic or de minimis. Such an analysis must take into account that respect for the person, respect for the person's rights to physical and mental integrity and, when the person is competent to decide for himself or herself, respect for the person's rights of autonomy and self-determination, are founding principles in most of our Western societies. They are often expressed in our most important legal instruments, such as constitutions or codes of human rights, and at the international level in treaties, declarations and conventions. Can we reconcile the routine practice of infant male circumcision, other than for reasons of absolute religious obligation, with these fundamental norms? Clearly we cannot. Whether we can reconcile infant male circumcision undertaken for religious reasons is a more complex question that is discussed shortly.
The assault provisions in the current Criminal Code could be used to stop infant male circumcision, but this route is probably neither the most ethical nor the most effective way to approach a situation that involves long-standing, deeply held social, cultural and religious beliefs. In particular, we have to start from a basis of deep respect for religious belief and a requirement of very strong justification for any interference with the expression of this belief.
In May 1997, the Canadian Parliament amended the Criminal Code to include as a specific offence any interference with the genitalia of a female child or adult, except when it was clearly necessary for medical reasons. This provision was aimed at stopping the practice of female genital mutilation. Outside the traditions or cultures that practise female genital mutilation, there is widespread agreement that it should be prohibited, on minors in particular. Unlike some American states, Canada has completely prohibited it, even on consenting adult women. But not everyone agrees with this prohibition. Some people argue that if women can consent to breast augmentation or reduction because they believe that it makes them more sexually attractive, why should they not be allowed likewise to consent to certain alterations of their genitalia? They argue that there is a cultural bias in prohibiting genital mutilation (they also argue that to use the term "mutilation" is to pre-judge the issue) but not breast augmentation. I was once consulted by an obstetrician who had a patient who had previously undergone female genital mutilation. The woman's vaginal opening needed to be cut for the delivery of her baby, and she was extremely upset that the physician was unwilling to restore the infibulation after the delivery. He correctly believed that the medical ethics guidelines governing him prohibited him from doing this, and that probably (unless we argued that the reinstitution of the infibulation was required for the woman's mental health) the new Criminal Code provisions would prohibit it.
Under the Canadian Charter of Rights and Freedoms-as is true under most codes of human rights-discrimination on the basis of sex is prohibited. Legislatures must not pass laws that protect people of one sex but not the other when both are in similar situations. People who oppose infant male circumcision argue that the provision in the Canadian Criminal Code that specifically prohibits genital mutilation only on females is discriminatory in that it protects the "right to security of the person" of girls but not of boys and that this failure to protect boys is unconstitutional. In all likelihood, we will see this issue addressed by the courts in the not too distant future, probably in the context of a man suing a physician on the grounds that in circumcising him as a child, a legal wrong was done to him, and that governmental action, in either formulating or applying the law in such a way that he was not protected, was unconstitutional.
When I spoke out against infant male circumcision, one response that I encountered was an angry reaction from some feminists. They accused me of detracting from the horror of female genital mutilation and weakening the case against it by speaking about it and infant male circumcision in the same context and pointing out that the same ethical and legal principles applied to both. It is true that the harm caused by female genital mutilation is, in most cases, vastly more serious than that caused by infant male circumcision. But the fact that the harm of infant male circumcision is less than that of female genital mutilation does not justify our inflicting this lesser harm.
Using the criminal law to prohibit certain conduct is the strongest statement we can make in our society about the unacceptability of that conduct. One reason we have criminalized female genital mutilation but do not view infant male circumcision in the same context is that we do not perceive the actions and cultural practices with which we are familiar and which we ourselves engage in with the same cultural eye as we view those that are foreign to us. All these practices should be examined through a lens of "first do no harm" and respect for all persons, and we must act ethically in either allowing or prohibiting them.
Physicians who undertake infant male circumcision could be legally liable for medical malpractice (civil liability in battery or negligence), which can result in an award of damages simply for carrying out the circumcision even if it was competently performed. They could also, as explained, be charged with criminal liability for assault. In both ethics and law, a physician has a primary obligation of personal care to the patient. This obligation requires the physician both to place the patient first and to first do no harm. Physicians who undertake surgery on patients must prove that it is justified. The usual justification is that the surgery is necessary therapy and that the patient-or if incompetent, the patient's legal representative-gave informed consent to the surgery. In general, parents cannot authorize non-therapeutic interventions-that is, routine circumcision-on their children. A competent adult man could consent to non-therapeutic circumcision on himself, but this does not mean he may consent to it on his son. If the parents' consent to the circumcision of their son was held to be legally inoperative, the physician would be liable. Moreover, if, in the light of new medical evidence, a reasonably careful and competent physician would not consider it medically necessary to undertake circumcision on a child, to do so could result in legal liability regardless of the parents' consent. Such liability is even more likely if a reasonably careful and competent physician would consider it not just unnecessary but contrary to a reasonable standard of medical care to undertake circumcision on a particular child in given circumstances. A long-recognized example of such a situation is when the child suffers from haemophilia, a condition that could cause him to bleed to death from circumcision. But as our knowledge of the risks and harms of circumcision expands, the range of circumstances in which undertaking routine circumcision on any child is a breach of a reasonable standard of medical care also expands. To summarize, it seems to me clear that, certainly outside the religious context, recent medical research on routine infant male circumcision shows that this operation cannot be ethically or legally justified on the basis of its potential medical benefits.
There has been some confusion about the ethical and legal effect of this lack of a medical justification for routine infant male circumcision, particularly on the part of medical associations who seem to be concerned not to speak out against the practice. For instance, the American Academy of Pediatrics recognizes that the potential medical benefits of this procedure do not outweigh its risks to a degree that it can be recommended to parents as a routine procedure. But they then conclude that the decision about circumcision should be left to the parents in consultation with their physician. In my opinion, this conclusion is wrong both ethically and legally. Unless the potential and actual medical benefits of a surgical intervention on a child unable to consent for himself clearly outweigh its risks (and the academy has found that in the case of routine infant male circumcision they do not), then it cannot be ethically or legally justified just on the basis of the parents' consent and, therefore, the physician must not undertake it unless he or she has some other justification for doing so. The question therefore is how should we balance respect for baby boys' rights to physical integrity and parents' responsibilities and rights with regard to their children and to their freedom of conscience and religion?
Paradoxically the more global, pluralistic and multicultural our world, the more we need deep respect for religious, cultural and traditional beliefs. As pointed out often in this book, we humans need to feel that we belong, to see ourselves reflected in the eyes of other people and to form community. Although our modern travel and communications technologies have connected us, we feel disconnected; we have lost a sense of community even in our own local area; the extended family has broken down; and new scientific discoveries have left us with a feeling that we are so small and finite in the larger world or vast universe.
When considering infant male circumcision carried out for religious reasons, we must recognize people's rights to belong to a community of faith and to bring their children into this community. Some special factors must also be given great weight. After I first spoke publicly against infant male circumcision, some people in the Jewish community accused me of being anti-Semitic. Other people, including some rabbis, were appalled by these allegations. Much as they did not agree with my position, they were adamant that people must be able to discuss an issue such as infant male circumcision without being accused of anti-Semitism. We must, however, always be able to justify the harm that we inflict on others, and just because we are well intentioned, as I believe I have been in criticizing infant male circumcision, we do not necessarily have justification for doing harm. It is with such competing claims and concerns in mind that I have been struggling with the issue of infant male circumcision in a religious context.
In my view, the only way to justify the practice would be on the basis of rights to "freedom of conscience and religion" and respect for the religious beliefs of the parents as set out, for example, in the Canadian Charter of Rights and Freedoms. But as the Supreme Court of Canada has ruled in the Sheena B. case, in which, as explained in Chapter 7, the court authorized physicians to give a blood transfusion to a baby who needed it, despite the refusal of this treatment by her Jehovah's Witnesses parents, there are strict limits to what parents may decide with respect to medical treatment of their child on the basis of their freedom of religion and religious belief. They may not withhold medical treatment necessary to protect the child's life or health and they may not inflict harm on their child. Therefore, it is far from clear that the parents' right to freedom of religion would validate infant male circumcision carried out for religious reasons.
The law sometimes allows individuals to refuse to comply with certain laws when compliance would contravene their religious belief. These exemptions are implemented on the grounds of conscientious objection. For example, Quakers, who have a fundamental belief in pacifism and believe that to fight in a war is morally wrong, can be granted exemptions from laws that authorize conscription into the services. But in these cases, the beliefs are those of the person granted the exemption. In the case of infant male circumcision, the parents are using their beliefs to justify an intervention on their child who is not yet capable of holding any similar belief.
It also merits noting that an exemption based on a conscientious objection is much less likely to be recognized if the intervention that is permitted involves harm to another. If we assume that carrying out infant male circumcision is technically a criminal assault, the legal question is whether the parents' conscientious objection to the prohibition of this practice could provide a defence to undertaking it. Conscientious objection is more likely to exempt a person from doing something they object to than to grant them legal immunity for having participated in prohibited conduct. In other words, the law is more likely to allow conscientious objection to validate a failure to do something that the law requires to be done than to justify an action that is prohibited. Consequently, an exemption based on conscientious objection might not be available to excuse those who undertake infant male circumcision from legal liability for doing so.
HOW THEN ARE WE TO deal with infant male circumcision undertaken for religious reasons? First, we must have great respect for people's religious beliefs, especially when these beliefs are long-established and by interfering, not only do we harm the people whose religious beliefs we interfere with, we also harm society. Respect for religious beliefs that differ from our own, or simply respect for others' religious beliefs if we are agnostic or atheist, is central to a general climate of ethical tolerance. We must consider whether the harm involved in prohibiting infant male circumcision could so far outweigh the harm that infant male circumcision does to the child that it should not be prohibited when undertaken for religious reasons. That is, in this situation of competing harms, should the claims of the community ever be given priority over those of the child? If they should, a further question is how could such an approach be legally implemented. This is addressed shortly.
Second, the people opposing a practice based on religious beliefs should have to justify any interference with this practice. Therefore, when infant male circumcision is carried out as an absolute religious obligation, the burden of proof, which is usually on those carrying out infant male circumcision to show that the surgical procedure is justified, would shift to those opposing it to show that it should be prohibited.
Third, we should not use coercive methods to interfere with the religious practice of infant male circumcision unless we can show that the practice involves serious harm to the children that cannot be avoided in any other way than by prohibiting the practice.
Fourth, ethics requires that, even when we are justified in interfering with others, we do so in a way that is least restrictive-here, to their practice of their religion-and least invasive of their rights With respect to those people who undertake infant male circumcision for religious reasons we should therefore first attempt ethical conversation, especially with religious leaders, not legal intervention A change from within a religion is vastly preferable to one that is imposed from the outside, and is more likely to accomplish real change than a facade of change. Legal intervention could be justified only if the harm involved were sufficiently serious, if other means of avoiding this harm had failed, and if the use of the law would be reasonably likely to prevent the harm. But we also have serious obligations as a society to protect children, to ensure respect for their human rights and to use the law when necessary to fulfill these obligations. Therefore parents' rights to freedom of religion must be interpreted in the light of the rights of the child and society's obligation to him.
Fifth, only those who believe they have a fundamental, absolute religious obligation to carry out infant male circumcision should be exempt from a prohibition on it. Those whose religion allows them any choice or for whom circumcision is only a matter of tradition, custom or culture should not be exempt.
Sixth, if an exemption for the "religious obligation" practice of infant male circumcision is allowed, harm-reducing measures must be adopted to the degree that it is possible. Harm-reducing measures would include fully adequate local anesthesia and pain relief; the least harmful and invasive form of circumcision that would fulfill the religious requirements; and both parents' fully informed consent. Some people believe that such a consent is possible only after the parents have witnessed the circumcision of another child.
Finally because the present law, at least technically, prohibits infant male circumcision, if we want to allow an exemption only on religious grounds, the law would need to be either interpreted or changed to permit this. One alternative is a more limited version of the current practice of prosecutorial discretion, in that prosecutors do not charge people carrying out infant male circumcision with any offence. This prosecutorial practice could continue to apply, but only to those infant male circumcisions that are carried out for religious reasons, and that also comply with all the other conditions outlined above.
Not everyone agrees with the idea of a religious exemption. After I first spoke out against infant male circumcision, I was presented with the International Symposia on Sexual Mutilations 1998 Human Rights Award. As I accepted the award at the symposium held at Oxford University, approximately one-third of the audience stood to boo me. Almost all the participants at the symposium were strongly against infant male circumcision, and some of them were appalled that I would argue, as I had in my award acceptance speech, we should consider an exemption on the grounds of profound religious belief and obligation. Someone remarked that I had managed to make everyone furious with me: the anti-circumcision movement; Jews and Muslims who felt that I was attacking their deep religious beliefs; feminists who were outraged because I had made comparisons between female genital mutilation and infant male circumcision and argued that both were ethically wrong; physicians who carried out circumcision and believed that I was accusing them of medical malpractice for having done so; parents who had had their baby boys circumcised and who interpreted my arguments against circumcision as accusing them of child abuse; and one young man who was an anti-circumcision activist from Tel Aviv who accused me of being anti-Semitic because my proposal for a possible exemption for religious belief meant that I was willing to protect all newborn baby boys in the world except Jewish ones.
Back from Oxford, at home in Montreal, I received a call from a woman telling me that she was an alumna of McGill and a donor to the university. She said she had written to the principal, Dr. Bernard Shapiro, demanding that I be dismissed. When I contacted the principal, he reassured me, saying that the real reason that we still need tenure is to allow us to say what we believe we must without losing our jobs. And one of my students reported that he had been listening to Howard Stern-the "shock-jock" on American radio whose program had been taken off the air in several Canadian cities because his comments were thought to offend the norms of public decency-who was strongly endorsing me and the position I had taken on infant male circumcision. As my student remarked in something of an understatement, "It's not really the kind of endorsement you need at the moment."
As the debate was raging in the media (our contemporary public square), I was in Ottawa for a colloquium and hailed a cab to go to the airport. The driver asked if I worked for the Canadian government-he had just picked me up from the government conference centre where I had been co-chairing the xenotransplantation forum. When I said no, he asked where I did work.
"McGill University," I replied.
"Do you know that woman at McGill who is speaking against circumcision?" he asked and then added, "I'm a Muslim."
I gulped and said, "That's me."
He swung around with a look of astonishment, and the car veered to the side of the road. He then turned back and we engaged in a respectful conversation in which he explained the basis of his disagreement with my views. He said to me, "My father did it [circumcision] for me when I was eight years old and I would do it for my son, if I had one. I only have daughters."
As I got out of the cab at the airport, he also left the car. He held out his hand to shake mine, smiled and said, "By the way, my wife and her friends agree with you." This was not as surprising to me as it would have been a few weeks earlier. Several young Jewish women who felt they had faced a terrible choice in deciding whether to have their sons circumcised had contacted me after the circumcision debate erupted in the media, to say that they were grateful that the debate was occurring.
We need to analyze carefully and sensitively what is required by a respect for children-a respect for their physical and mental integrity, and for their right not to be harmed, in particular, not to have pain intentionally inflicted upon them without medical and therapeutic justification. We must also carefully delineate the boundaries of parents' claims and rights with respect to their children. Finally, we must articulate what is demanded by respect for religion and freedom of religion, for traditional and cultural norms, for the institutions of family, community and society, and for ethical and legal principles in relation to our attitudes, practices and beliefs about infant male circumcision.
This complex and difficult area that at first glance can seem so simple touches on many of our most profound values and beliefs. It is, indeed, a very important area of individual and societal ethics talk that crosses millennia of human existence. We have learned much about it and we need to continue to learn more.
MARGARET SOMERVILLE is the founding director of the Centre for Medicine, Ethics and Law at McGill University, where she holds the Samuel Gale Chair in the Faculty of Law and is a professor in the Faculty of Medicine. As a consultant to numerous government and non-governmental bodies, she has worked with the World Health Organization, the United Nations High Commissioner for Human Rights and UNESCO. She Has received a number of honorary doctorates in law and is the recipient of many awards, including the Order of Australia. She lives in Montreal.
© 2000 Somerville, Margaret A.
The Ethical Canary Science, Society and the Human Spirit
Viking/Penguin Canada, Toronto
hardcover, 344 pages (chapter 8, pp. 202-219)
McGill Centre for Medicine, Ethics and Law
McGill University, Montreal, Canada
Intact - to end non-therapeutic male infant circumcision