What is the best age to circumcise? A medical and ethical analysis

Circumcision is often claimed to be simpler, safer and more cost-effective when performed in the neonatal period as opposed to later in life, with a greater benefit-to-risk ratio. In the first part of this paper, we critically examine the evidence base for these claims, and find that it is not as robust as is commonly assumed. In the second part, we demonstrate that, even if one simply grants these claims for the sake of argument, it still does not follow that neonatal circumcision is ethically permissible absent urgent medical necessity. Based on a careful consideration of the relevant evidence, arguments and counterarguments, we conclude that medically unnecessary penile circumcision—like other medically unnecessary genital procedures, such as ‘cosmetic’ labiaplasty—should not be performed on individuals who are too young (or otherwise unable) to provide meaningful consent to the procedure.     

CULTURAL CIRCUMCISION IN EU PUBLIC HOSPITALS – AN ETHICAL DISCUSSION

The paper explores the ethical aspects of introducing cultural circumcision of children into the EU public health system.
We reject commonplace arguments against circumcision: considerations of good medical practice, justice, bodily integrity, autonomy and the analogy from female genital mutilation.
From the unique structure of patient-medicine interaction, we argue that the incorporation of cultural circumcision into EU public health services is a kind of medicalization, which does not fit the ethos of universal healthcare. However, we support a utilitarian argument that finds hospital-based circumcision safer than non-medicalized alternatives.
The argument concerning medicalization and the utilitarian argument both rely on preliminary empirical data, which depend on future validation.     

Genital cutting and western discourses on sexuality

This article explores dominant discourses surrounding male and female genital cutting. Over a similar period of time, these genital operations have separately been subjected to scrutiny and criticism. However, although critiques of female circumcision have been widely taken up, general public opinion toward male circumcision remains indifferent. This difference cannot merely be explained by the natural attributes and effects of these practices. Rather, attitudes toward genital cutting reflect historically and culturally specific understandings of the human body. In particular, I suggest that certain problematic understandings of male and female sexuality are deeply implicated in the dominant Western discourses on genital surgery.     

A rose by any other name? Rethinking the similarities and differences between male and female genital cutting

In this article, we offer a critical examination of the tendency to segregate discussion of surgical alterations to the male and female genitals into separate compartments--the first known as circumcision, the second as genital mutilation. We argue that this fundamental problem of definition underlies the considerable controversy surrounding these procedures when carried out on minors, and that it hinders objective discussion of the alleged benefits, harms, and risks. We explore the variable effects of male and female genital surgeries, and we propose a scale of damage for male circumcision to complement the World Health Organization's categorization of female genital mutilation. The origins of the double standard identified are placed in historical perspective, and in a brief conclusion we make a plea for greater gender neutrality in the approach to this contentious issue.     

三种包皮环切术的临床比较与分析

目的:观察并评价改良后一钳式环切法临床应用优势。方法:回顾2009年12月至2012年3月间在我院实施的870例包皮环切术资料,对比分析改良一钳法(470例)、传统一钳法(337例)、袖套切除法(63例)三组术式在手术时间、术中疼痛发生率、系带损伤率、患者对外观满意率及并发症(血肿、水肿、延迟愈合、切口狭窄)等临床指标间的差异。结果:改良一钳法的手术时间(min)、术中疼痛发生率小于传统一钳法及袖套切除法(20.88±4.96 vs 26.6±6.48 vs 56.22±7.09,5.5%vs 28.2%vs 100%,P<0.01),袖套切除法在术后短期水肿发生率方面低于改良一钳法和传统一钳法(1.6%vs 10.9%vs 14.8%,P<0.05),改良一钳法的系带损伤率、血肿发生率、切口狭窄率均低于传统一钳法(0 vs 3.6%,0.4%vs 5.9%,0 vs 0.9%,P<0.01),改良一钳法的外观满意度高于传统一钳法及袖套切除法(98.1%vs 93.2%vs 95.2%,P<0.01),而各组的术后切口延迟愈合发生率无统计学差异。结论:根据患者具体情况选择包皮环切术式。其中改良一钳法因适用范围广、手术时间短,系带安全及外形美观,适用于绝大部分的包皮过长及包茎患者。     

"Taming tradition": medicalized female genital practices in western Kenya

This article considers the question of female genital practices at the hands of health workers in western Kenya. Recent articles in Medical Anthropology Quarterly have critically engaged with the biomedical arguments condemning such practices. This article studies the case of medicalized circumcision in which biomedical concerns over health risks have become incorporated in their vernacular practice. Although some suggest that medicalization may provide a harm-reduction strategy to the abandonment of the practice, research in one region challenges this suggestion. It argues that changing and conflicting ideologies of gender and sexuality have led young women to seek their own meaning through medicalized practice. Moreover, attributing this practice to financial motivations of health workers overlooks the way in which these "moral agents" must be situated within their social and cultural universe. Together, these insights challenge the view that medicine can remain neutral in the mediation of tradition.     

The incompatibility of the United Nations' goals and conventionalist ethical relativism

The Universal Draft Declaration on Bioethics and Human Rights seeks to provide moral direction to nations and their citizens on a series of bioethical concerns. In articulating principles, it ranks respect for human rights, human dignity and fundamental freedoms ahead of respect for cultural diversity and pluralism. This ranking is controversial because it entails the rejection of the popular theory, conventionalist ethical relativism. If consistently defended, this theory also undercuts other United Nations activities that assume member states and people around the world can reach trans-cultural judgments having moral authority about health, pollution, aggression, rights, slavery, and so on. To illustrate problems with conventionalist ethical relativism and the importance of rejecting it for reasons of health, human rights, human dignity and fundamental freedoms, the widespread practice of female genital circumcision or cutting is discussed. These surgeries are virtually a test case for conventionalist ethical relativism since they are widely supported within these cultures as religious and health practices and widely condemned outside them, including by the United Nations.     

包皮切割缝合器、商环及传统包皮环切术的临床疗效比较

目的:比较包皮切割缝合器与商环及传统包皮环切术治疗包皮过长或包茎的手术疗效及安全性。方法:将240例包皮过长或包茎患者随机分为传统包皮环切术组、商环组及包皮切割缝合器组(PCSD)。对比分析三组手术时间、出血量、术中疼痛评分、术后疼痛评分、切口愈合时间、感染、切口裂开、术后水肿、术后出血等情况。结果:在手术时间、术中疼痛评分、术后疼痛评分、切口愈合时间、感染、切口裂开、术后水肿方面,PCSD组都明显优于传统包皮环切术组及商环组(P0.05);PCSD组术中出血量明显少于传统包皮环切术组(P0.05),而与商环组比较未见明显差别;在术后出血方面,三组比较未见明显的差异。结论:PCSD可以明显缩短包皮过长或包茎的手术时间,降低术中、术后疼痛,减少术后并发症。     

The Enhancement of Children versus Circumcision: A Case of Double Moral Standards?

The application of enhancement technologies to children and non‐medical infant male circumcision are both topics that enjoy the continuous attention of bioethical research but are usually discussed in isolation from each other. Yet one can show that three major arguments used by opponents of the enhancement of children are also applicable to circumcision. These arguments are based on the insecurity of these procedures, the child's right to an open future, and human nature as a foundation of human dignity. People who reject the enhancement of children because of these arguments but accept circumcision hold mutually inconsistent moral convictions or apply double moral standards to these cases. This is particularly important when legislative systems treat the enhancement of children and circumcision in a considerably different manner, which is true for many contemporary legislative systems. At least three strategies can be adopted in order to avoid such inconsistencies, two of which, however, fail for various reasons. According to a third, more promising strategy, circumcision should be subsumed under human enhancement and treated like other enhancement technologies. This strategy justifies restrictions on, but not the prohibition of circumcision. Furthermore, proponents of circumcision should be prepared for future technologies that provide similar benefits as circumcision but are not as contentious as this intervention, so that, in the future, circumcision could become more and more unacceptable.     

From Health to Human Rights: Female Genital Cutting and the Politics of Intervention

ABSTRACT  The international campaign to eliminate female genital cutting (FGC) has, since the early 1990s, actively attempted to divorce itself from a health framework, adopting instead a human rights framework to justify intervention. Several key questions emerge regarding the prominent placement of FGC in the international human rights movement: What are the ramifications of framing FGC as a human rights violation? What actions are mandated by a human rights approach? What perils and pitfalls potentially arise from the adoption of a rights-based framework, and how might they be avoided? In exploring these questions it becomes clear that, although a human rights approach is promising, careful deliberation is required to develop action strategies that offer both protection and respect for the culture and autonomy of those women and families concerned.