The need for a unified ethical stance on child genital cutting

Abstract

The American College of Nurse-Midwives, American Society for Pain Management Nursing, American Academy of Pediatrics, and other largely US-based medical organizations have argued that at least some forms of non-therapeutic child genital cutting, including routine penile circumcision, are ethically permissible even when performed on non-consenting minors. In support of this view, these organizations have at times appealed to potential health benefits that may follow from removing sexually sensitive, non-diseased tissue from the genitals of such minors. We argue that these appeals to “health benefits” as a way of justifying medically unnecessary child genital cutting practices may have unintended consequences. For example, it may create a “loophole” through which certain forms of female genital cutting—or female genital “mutilation” as it is defined by the World Health Organization—could potentially be legitimized. Moreover, by comparing current dominant Western attitudes toward female genital “mutilation” and so-called intersex genital “normalization” surgeries (i.e. surgeries on children with certain differences of sex development), we show that the concept of health invoked in each case is inconsistent and culturally biased. It is time for Western healthcare organizations—including the American College of Nurse-Midwives, American Society for Pain Management Nursing, American Academy of Pediatrics, and World Health Organization—to adopt a more consistent concept of health and a unified ethical stance when it comes to child genital cutting practices.

Non-therapeutic penile circumcision of minors: current controversies in UK law and medical ethics

“…Arguments adapted from Refs. 37,69,91 As noted in the main text, childhood NPC shuts down the option of the child to remain genitally intact upon reaching adulthood. However, one could also argue that a failure to circumcise someone in childhood, in infancy in particular, shuts down the option of the child, once grown, to have previously been circumcised at an age when the procedure is often claimed to be technically simpler and less medically risky than circumcision later on.…”

“…This would allow the children to decide, when they are older, whether they endorse the psychosocial or cultural aims of such surgeries, and if so, whether they also accept the particular risks and trade-offs associated with genital surgery as the chosen means of pursuing those ends. 13,[33][34][35][36][37][38] In fact, the World Health Organization (WHO) has recently condemned such surgeries, if carried out on children who are too young to consent to them, as human rights violations and as a form of "abuse" 39 (p. 1).…”

Is Circumcision “Necessary” in Islam? A Philosophical Argument Based on Peer Disagreement

“…According to one interpretative tradition, girls within the practicing subsets of Muslims are considered equally “worthy” of being circumcised as are boys (albeit by means of a less intrusive procedure), thus marking a break with the older Jewish covenantal ritual from which girls are, by contrast, excluded--arguably due to having a lower status than males within classical rabbinical Judaism (Shweder, 2021 ; Cohen, 1997 ). In the case of Islam, the forms of FGC in question include so-called ritual “nicking, pricking, or partial removal of the clitoral prepuce or hood”—the most common forms of FGC in some “parts of South and Southeast Asia,” where they are carried out, alongside male circumcision, for religious reasons within some sects of Islam (Bootwala, 2019 ; Dawson et al, 2020 ; Duivenbode & Padela, 2019 ; Earp et al, 2021 ; Earp, 2022b ; Rashid et al, 2020 ). Box 1.…”

“…With respect to Jewish practice, for example, as Cohen ( 1997 ) notes: “Of all the rituals from which women are excluded by rabbinic culture, the exclusion from circumcision is at once the most obvious and the most problematic” (p. 560). This suggests that it is the exclusion of females from ritual circumcision that “reflects their lower status” in certain contexts (Earp, 2022b ). Nevertheless, in the subset of Muslim communities where they are, in fact, included in the institution of circumcision alongside males, it does not follow that the practice ceases to be “religious” in nature only in the case of females.…”

Child genital cutting and surgery across cultures, sex, and gender. Part 1: female, male, intersex—and trans? The difficulty of drawing distinctions

“…We are proud to introduce this special collection of papers on child genital alteration practices spanning the Global North and South and transcending conventional boundaries of sex and gender. It is increasingly recognized that there is an urgent need to evaluate all forms of genital cutting or surgery, especially those carried out on presumptively pre-autonomous persons, in a systematic way [1][2][3][4][5][6][7]. It is necessary both to clarify what is known about these practices medically and scientifically, but also to work through the cultural, legal, and ethical implications of performing such significant operations on persons who are generally presumed to be incapable of providing morally valid consent to them on their own behalf.…”