UCLU ASHS 28/02/13
Antony Lempert (GP & Chair of the Secular Medical Forum)
Jonathan Arkush (Vice President, Board of Deputies of British Jews)
Here’s the full audio of the debate; it’s about 1hr 10mins but I’ve put highlights in my Pod Delusion report! I’ve also put timings on my notes below so that you can skip to the relevant bits if you like.
Antony had met Jonathan in July 2012 for Sunday Morning live, they had some email exchanges but they stopped because:
“he didn’t seem to like my Human Rights arguments and kept saying things like live and let live“
- which I thought was funny, because that is pretty much the crux of the anti-circ position. And that boring old “human rights” argument people keep digging up, ugh!
Antony has tried in previous years to get routine infant circumcision debated at the BMA annual meeting; apparently, though, changing the wording of a proposal to remove “female” so that you’re discussing infant genital surgery generally is a no-no. Better luck this year, hopefully.
It’s worth noting that some of the oft-discussed issues around MGM were irrelevant in this case. Arkush (I’ll refer to him as JA and to Antony as AL throughout) argues only from the perspective of a Jewish man upholding his faith; his interest is in the “religious rights” of individuals and families, so ignores arguments to do with necessity/benefit, health, female genital cutting and so forth. (For more on these, please see previous posts.)
I think an important take-home from this debate was something AL also pointed out: that there does seem to be a confusion in these of arguments. People cite “parental rights”, requesting tolerance, respect and permission to keep doing what they want to do. All well and good, until you harm other people.
The problem here seems to be that some parents do not believe their children are people in their own right. Interesting, as I wonder how many anti-abortion campaigners (especially in the USA) are pro-circumcision?? That’s a tangent though.
Without recognising that a child’s right to bodily integrity exists and you should really respect it, people end up thinking they can treat their child-property however they wish – sometimes culminating in something as disturbing as removing their most sensitive erogenous body part.
Obviously I am completely biased as a fully-fledged intactivist; there was no way JA would have convinced me of his position. He was at all times calm and polite, to his credit. However he also clearly holds some disturbing views about mental health (accusing all men who are unhappy about their circumcised status, who claim emotional trauma, to in fact have some other underlying condition) and the non-religious (with another worrying suggestion that lack of faith may lead to psychological issues, and people being devoid of values).
AL has kindly allowed me to use his slides to add information here, so you can find some interspersed with my notes below (part 2. AL 15 minutes).
JA considers it his right as a Jewish person to remove his sons’ foreskins in accordance with the traditions of his culture. He does not believe it is at all harmful. He argues against banning things we find distasteful, carrying this argument to an interesting and shocking conclusion when he disagrees with banning one of the most disturbing forms of male circumcision: the metzitzah b’peh, in which the Mohel sucks the blood off the child’s wound, thus exposing him to disease and an increased risk of death. Live and let live? The baby being worth little consideration here, apparently.
AL draws on strong arguments based in medical ethics to highlight that non-medically justified (it very rarely is) routine infant circumcision (RIC, or more accurately NTEF: non-therapeutic excision of the foreskin) is a permanently damaging procedure with complications that are often serious, and parents should not have the “right” to choose cosmetic surgery for minors, just because they are their parents. The child is not their property, and their responsibility is one of protection.
1. JA 15 minutes
Started with an appeal to tradition “Judaism is one of the world’s oldest faiths” (00:02:00)
The bible is clear that is matters “how we treat other people…” Indeed!
Rules, customs, values and ethical considerations
He follows Jewish traditions because he wants to
He would like family to inherit his tradition and values in turn
Judaism & Islam practise circumcision (asks us to note only boys at 8 days in Judaism) (00:02:45)
God commanded the practice from Abraham, with no reason given (00:02:55) “I wanted to keep that precept”
He “some Jews” pick and choose which parts of the tradition to keep, seemed to disapprove (00:03:30)
‘Brit’ (as in Brit milah, the circumcision ceremony) means covenant or promise (00:03:45)
It’s “more logical to keep all the rules I possibly can” (00:04:20)
Says circumcision is “safe and simple” (00:04:30)
Must be performed by specially trained and regulated individuals, “many are doctors” (00:04:45)
“Initiation Society” set up in 1752 (00:05:05)
Cited example of royal family being circumcised and the same doctor cutting him as did Prince Charles ?! (00:05:45)
“In the Jewish community, complications are virtually unknown” – cited high standards (00:06:00)
Appreciates the arguments against and respects them (00:06:50). Guesses they consist of:
1) Wrong to impose on babies? “There are many things we decide for our children” (00:08:00) Waiting would be worse, it’s “safest and kindest … when the child is 8 days old” (00:08:50) and “more painful at 18″ (00:11:15)
2) Psychological issues? He dismisses these, calls it an “odd” claim, saying “some people believe they are… not in my experience” thinks any problems are down to something else and people blame circ only as displacement. (00:09:45)
“Children have a right to be brought up in a faith we choose for them…” (00:10:20)
People are glad and relieved and grateful this was chosen (00:10:45)
“I would not like to look different from them” ! (00:11:00)
To “we disapprove of this ritual/custom/value so we ought to ban it” he says the fact you disapprove is not a reason to ban; unless socially harmful (00:11:45)
We regulate rather than ban e.g. smoking (00:12:20)
Taking away “rights to believe” (00:12:45) – “It is not a fair way to run society… unless you can prove it is harmful to society as a whole” – 4000 years Jewish/muslim tradition… 60% American men cut (00:13:30)
Somehow tries to justify by quoting BHA (00:14:25) “Recognises the dignity of individuals… treats them with fairness and respect… respects and promotes freedom, democracy, human rights and the rule of law, and equal treatment of everyone regardless of religious belief” – “so please give me that equal treatment, let me circumcise my son” – from the perspective of a parent who wishes to cut children.
2. AL 15 minutes
Function & sensitivity; autonomy; irreversibility; indoctrination; confusion in discussing parental rights
It is often argued by those in favour of ritual circumcision that parents have the right to procure circumcision in much the same way as they decide which school to send them to, whether to baptise them and the favourite comparator, whether or not to vaccinate their child. (00:17:45)
Childhood immunisation is an intervention that cannot wait until adulthood and one with overwhelming evidence of protection from serious childhood diseases such as measles and tetanus. It does not remove body parts.
(00:18:15) Responsibilities of doctors
GMC guidance first words: “make the care of the patient your first concern”
Primum non nocere
(00:18:50) In September 2012 GMC issued a child safeguarding statement acknowledging possible damaging influence of religious and cultural beliefs:
In some cases, it may be difficult to identify where parents’ freedom to bring up their children in line with their religious and cultural practices or beliefs becomes a cause for concern about a child’s or young person’s physical or emotional well-being.
(00:19:20) Key principles of Medical Ethics:
1) Autonomy 2) Beneficence 3) Non-maleficance 4) Justice
People think “their rights are under threat when they can’t cut someone else’s body?!” (00:20:10)
constraints on personal autonomy should never be used by people claiming ‘cultural autonomy’ to justify the forced removal of healthy body parts from non-consenting people. (00:21:05)
It has been illegal to tattoo children from 1969 (00:21:50)
For those without the capacity to choose, questions must be asked about procedures: is it permanent or temporary? Is there clinical benefit? Any restriction of future decisions? (00:22:20)
Not only do medical associations not recommend it, many condemn (00:23:10):
The Royal Dutch Medical Association “…a violation of a boy’s rights to autonomy and physical integrity.”
The President of the British Association of Paediatric Surgeons, (BAPS) “…an irreversible mutilating procedure… rarely, if ever, an indication for male circumcision of boys aged less than 5 years old”
Chairman of the Swedish Paediatric Society “…an assault”
Australasian Association of Paediatric Surgeons “…does not support… routine circumcision”
Was promoted to limit masturbation (00:24:30)
1993 study in the Journal of Surgery, looked into complications (00:24:50):
- Meatal Stenosis (narrowed urethra opening)
- Scarring and sinuses
- Erectile dysfunction
- Denuding of penile skin
- Psychosexual problems
- Infection and bleeding
- Urinary difficulties
- Amputation of the Penis
Nigerian midwife manslaughter conviction 2013, baby Goodluck
Birmingham hospitals provide circumcisions on the NHS. FOI requests have revealed data showing that complications often cited as “tragic and unforeseen” “isolated incidents” are actually quite common (00:26:20)
For an operation the British Association of Paediatric Surgeons say is rarely if ever needed.
Sorrells 2007 and Hoebeke 2013 on sensitivity and function; circumcision removes the most sensitive area of the penis. (00:27:10)
Frisch 2011 reported on circumcision harms to women: “Frequent Orgasm Difficulties in Danish men… and a range of frequent sexual difficulties in women” (00:28:15)
Men who speak out about circumcision damage are often isolated by circumcising communities, threatened and ignored. They are not well-supported to argue their case and are conveniently seen as non-existent, with advocates always saying they “haven’t heard” anyone complaining. It’s a sensitive issue anyway and being shunned for disagreeing makes it even less simple to do. (00:28:45)
November 2009 lawsuit between 20 y/o man and his GP over his meatal stenosis, dysuria, abrasive pain, tight circumcision, a sinus and asymmetric scarring leading to bent penis; was told he had “no case for medical negligence, because this level of damage is fairly routine” (00:29:20)
The UN convention on rights of the child 1989 – signed by all countries except Somalia and the USA
Article 14 (1) Respect the right of the child to freedom of thought, conscience and religion
Article 19 (1) Protect the child from all forms of… violence, injury or abuse… including sexual abuse whilst in the care of parent(s)…or any other person who has the care of the child
Article 24 (3) Take all effective and appropriate measures with a view to abolishing traditional practices prejudicial to the health of children. (00:30:10)
Blinded by religious privilege, we can lose sight of the child, and the adult the child will become
3. JA 5 minute retort
Emotive language!! Anti-semitic? (!)
40 million Jews, who collect data (really? Where is it?)
we don’t argue that it’s needed so that’s a moot point
WHO, AAP ‘pro’ stances
I don’t follow the practice because of health benefits “although HIV is drastically lower”
BMA and GMC have circ guidance! Ethical and religious values are important
These [negative comments] are minority views and not reflective of the whole practice
I want to make decisions for my children
in society we tolerate costly things e.g. drugs and smoking
4. AL 5 minute retort
We should aim for progress, not tradition
Actually the USA is the minority view.
Obviously it’d be better to have some actual data on here!
In Jewish law: if 3 of your babies die, you don’t have to cut the 4th
Mohel reports are… where? Also easily dismissed
Milah UK Autumn 2012 set up to challenge German ruling
BMA is clear on circ, illegal under Human Rights act? BMA conference debates
5. Questions and discussion
1) Edward Presswood
You said your son was circumcised and didn’t even cry. Can you describe how it was done without making him cry?
JA: “I’m a bit squeamish but I wasn’t there. Local anaesthetic, quick, guard in place, wine in mouth to encourage child to sleep, feeding after, Mohel visits for following 2 days” (00:41:10)
Defends Jewish practices in comparison to ‘less well regulated’ procedures (00:42:05) such as baby Goodluck and another boy who died after a Rabbi cut him (00:42:40). Blamed the mother for ignoring instructions to call doctor/hospital/mohel if there was any bleeding. AL interjects with further information (00:43:25). “The issue is that taking a knife to a normal child’s body exposes them to risk that they don’t need to have”
JA: “complications in the Jewish community are extremely rare”
2) Jewish audience member: possible harm to welfare [when not cut]? Would boys have preferred “most likely” to have had it when they were younger? (00:45:20)
3) Difficulty with making things illegal; wouldn’t it still happen (00:46:25) – see FGM. No prosecutions. Doesn’t mean we shouldn’t make things illegal.
4) USA ‘looking normal’ concerns (00:47:55)
JA: Jewish community isn’t responsible for USA high circumcision rate; social reasons
AL: AAP is a trade organisation; it’s a cultural phenomenon and doctors profit from it (00:49:25).
5) EP: Orthodox Judaism Mohels – what about tolerating/banning the sucking [metzitzah b'peh] practice? (00:50:15) – JA wouldn’t ban it!! “I’m just very chairy about going for bans” (00:52:25 – sorry about my phone buzzing there!)
00:52:50: AL on deaths from circumcision being excluded from studies’ data analysis (approx. 200/year)
6) 00:54:30 – asks AL for opinion on HIV/circumcision research. NB/ 57:30:00 a member of WHO circ “expert” board invented circumcision devices?
7) My question (00:58:15): would you really consider opposition to genital mutilation (as it is generally universal where it occurs; regarding male or female, hospital or elsewhere, religious or cultural etc.) to be anti-semitic?
I won the debate with this, because JA fell for Godwin’s law, and compared us all to Nazis and communists (00:58:45-01:00:40):
“the chancellor Angela Merkel was acutely concerned about a country where circumcision was last banned – incidentally 2 world rulers in modern times who sought to ban circumcision were Hitler and Stalin – so that’s the company you’re in”
At that point I did a \o/
8) How can you agree with criminalisation of theft and not with thieving a part of someone’s body? (01:02:10)
JA: parental decision because child is too young, a parent is entitled to that – compares to ear piercing or tattoos. Defends his right to remove healthy body parts from an incapacitated child. Cites “everyone I know in the Jewish community feels the same way”
AL: reiterates that those who speak out are ostracised by “the community” (01:04:30) and JA confirms that one woman on the Board of Deputies was removed because of her synagogue was ‘upset’ by her dissenting opinions (01:05:15). Insists someone would not be ignored if they said they were “born with” a circumcision that harmed them, but is picked up on this because he already dismissed them in his speech.
9) How would you feel if your son had to be castrated (?), how would you explain that to him? (01:07:00)
JA doesn’t seem to accept that risk of serious injury or death is a good reason to avoid this unnecessary surgery, saying hewould feel “desperately guilty and sorrowful” – he would say “I consciously exposed you to such risk as there was … but I probably would make the same choice again”
EP: asks if he does recognise there is a risk (yes) (01:08:45)
He also let slip that he believes those who lack faith also lack any values (01:09:15). Nice.