Friday, July 23, 2010

Infant Male Amputation of the Prepuce is Already Illegal in America

©Guggie Daly 2010



Abstract
Routine infant circumcision has been practiced on infant males and females in America for many years. The reasons for circumcision, also called amputation and genital reduction, have varied over the years and include eliminating masturbation, training women, curing epilepsy and recently, even preventing HIV. In 1996, a federal law upheld the illegality of all female circumcision for all reasons, including for religious practice. Infant male circumcision is still widely practiced in America, with rates reaching as high as 50% in some regions. Based on the current laws and constitution, it appears that infant male circumcision is already illegal, despite being widely accepted culturally. The ban enacted in 1996 should be amended to be a law of equality by including both females and males.

Questioning the Legality of Routine Infant Circumcision in America

Infant Male Circumcision (IC) is a surgical method that amputates the prepuce organ. It is also called Routine Infant Circumcision (RIC), and Male Prepuce Amputation (MPA). Sometimes it is referred to as Genital Reduction Surgery (GRS) but that term is more commonly applied to Labiaplasties for adult women. Regardless of the name, the result is the same in successful surgeries; the entire prepuce is removed from the penile shaft on the infant. This removes the health, and later, sexual function of the prepuce. The prepuce, also called the foreskin, has many vital functions for health and sexual behavior. It contains tightly packed, highly erogenous nerve endings that increase sexual pleasure in the frenulum and ridged band, both of which are removed during circumcision.

The foreskin also has immunological functions. The inner layer of the foreskin is a soft mucosa lining of endothelial cells, the same as the inner layer of the mouth, nose, eyelids, vagina and anus. This lining is a primary immune system defense against bacteria and viruses. In the foreskin, this mucosal lining contains immunoglobulin antibodies (Cold & Taylor, 1999). It also has antibacterial and antiviral proteins such as lysozyme, which kills pathogens on contact. (Lee-Huang, Huang, Sun, et al., 1999). These immunological functions might better explain why men with foreskins have a decreased risk of some STIs. (Cook, et al., 1993).

Despite more than a hundred years of searching for a cure to continue to circumcise, no major medical organization in the world supports this practice for male or female infants. The American Academy of Pediatrics takes a moderate stance but still does not recommend it, “Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision” (AAP, 2005).

More importantly, the laws of consent make it clear that RIC is an illegal act against infants. Current law does not allow parents to consent to a permanently altering surgery for a minor unless it is medically indicated and conservative treatments have failed. Additionally, doctors are not legally permitted to perform surgery on a minor patient for the same reasons. (Svoboda, Howe & Dwyer, 2000). So for example, parents could not legally ask a doctor to trim the ear lobes of their son. And a doctor who took payment for and performed this request could be charged with battery and medical fraud.

Interestingly, all forms of Infant Female Circumcision (IFC) are currently prohibited in America under Title 18 of the U.S. Code as genital mutilation (GPO Access, 2007). The prohibition includes female circumcision for religious reasons and also includes partial circumcision and pricking, where the skin of the genitals is pricked to draw a drop of blood. The prohibition did not include any forms of infant male circumcision, which would seem to violate the Equal Protection Clause of the 14th Amendment to the U.S. Constitution.

In January of 2010, opponents of RIC submitted a bill that calls for legislation to expand the rights granted to infant females under Title 18 to infant males as well. With the many ethical, medical and legal concerns against RIC, this seems to be a common sense and important step to take to ensure that all infants in America are protected from non-consensual, non-medically necessary reduction of their genitals.

If the current law is extended to protect infant males, it does carry repercussions that concern many citizens. For example, the law currently bans circumcisions even for religious reasons. Roughly 10% of the male circumcisions done in America are for religious reasons. So on the surface it seems that extending the law to include infant males would infringe upon religious freedoms.

Such an argument, however, is forgetting a few important details. First, religious freedom is an individual right, and in this case, the individual is a minor, not the parent. Can parents choose surgery or other body modification for their infants and call it an individual religious right? Or is that in itself infringing on the individual’s right to religious freedom? The second detail is consistency. In 1996, the ban against IFC was passed almost unanimously and without much resistance, yet it also bans religious practices. Why the inconsistency?

One thing is for sure, the debate is going to rage on for awhile in this country. Perhaps as more parents become aware of the numerous vital aspects of the male prepuce and the downsides and dangers of performing surgery on a neonate, the bill to extend protection to infant males will garner more publicity and more support. In the meantime, parents who had their son circumcised against their will or without their full consent or a medical necessity can bring suit against the operator and hospital. The individual who experienced the non-consensual genital reduction can also seek closure and retribution as an adult.

References

American Academy of Pediatrics. (2005). Circumcision policy statement: Task force on circumcision. Pediatrics Vol. 116 No. 3 September 2005, pp. 796. (doi:10.1542/peds.2005-1377). Retrieved on April 3, 2010 from: http://aappolicy.aappublications.org/cgi/content/full/pediatrics;116/3/796

Cold, C., Taylor, J. (1999). The prepuce. BJU International 83, Suppl. 1, (1999): 34-44.

Cook, L. S. et al. (1993). Clinical presentation of genital warts among circumcised and uncircumcised heterosexual men attending an urban STD clinic. Genitourinary Medicine 69 (1993): 262-264.GPO Access. (2007). Sec. 116. Female genital mutilation. Title 18--Crimes and Criminal Procedure, U.S. Code 18USC116, pg 32-33. Retrieved on April 3, 2010 from: http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=browse_usc&docid=Cite:+18USC116

J. Steven Svoboda, Robert S. Van Howe, James G. Dwyer, Informed Consent for Neonatal Circumcision: An Ethical and Legal Conundrum. 17 J Contemporary Health Law Policy 61 (2000).

Lee-Huang, S, Huang P.L., Sun Y., et al. (1999). Lysozyme and RNases as anti-HIV components in beta-core preparations of human chorionic gonadotropin. Proc Natl Acad Sci (U S A) 1999 (Mar 16);96(6):2678-2681.

4 comments:

  1. Thank you, thank you, thank you! I love to read a well-written, academically-sound paper about the illegality and immorality of circumcision! What type of class did you write this for?

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  2. I fully agree with your position on neonatal circumcision. I only wonder about data used in this statement: "Infant male circumcision is still widely practiced in America, with rates reaching as high as 50% in some regions." Goodness, it appears to be as high as 80% in many parts of the midwest, where we lag embarrassingly behind the western states in saying no to circumcision.

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  3. You're right, anoynmous. That was incorrect wording. The overall rate was about 50%. Some areas, especially midwestern states, still reach over 75%.

    But the paper itself is now outdated, as the rates have hit a low of 32%. This article contains citations:

    http://www.drmomma.org/2010/08/us-circumcision-rate-falls-to-33.html

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