Saturday, June 30, 2012

When the Courts Intervene

These days the news are filled with stories of various laws, bills, and practices brought before the Courts system.  It must be difficult to be a judge, to sit in a position of logic when so many of the arguments brought forth are ones of emotion.  And when it may at first appear that the Courts overstep their boundaries, the reaction can be explosive.

In Germany, a curious ruling was made by a Cologne court: German Ruling Against Circumcising Boys Draws Criticism.  Of course Jews and Muslims are up in arms over this, believing the court overstepped its jurisdiction and invaded religious space.  The court basically ruled (paraphrased) that the child has the fundamental right to bodily integrity and must be able to consent to the procedure if it's not done for medically indicated reasons.  It sounds logical enough.

Now the vast majority of circumcisions are done in infancy or early childhood, when the child cannot of course consent.  By Jewish tradition it happens on the 8th day of life.  Muslim tradition, as I understand it, varies a bit - it could be in infancy or all the way in adolescence (when the child would be able to consent).

So the argument come back, does the child's fundamental right to bodily integrity trump the parents' rights to parent?  To dictate the child's religion?  This is a gray zone, to be sure, and I'm not sure why male circumcision gets such a pass (from a logical standpoint).  Courts have ruled previously that a parent may not tattoo their child.  Courts have ruled that female circumcision (aka female genital cutting/mutilation or FGM) is illegal.  Are those necessarily drastically different?  Tattooing inflicts a permanent mark on the child, but doesn't remove any part of his/her body.  Female circumcision exists on a spectrum - the most "benign" being a simple prick to draw blood from the clitoral hood (or removal of the clitoral hood) to practices way more extreme.

One medical body considered allowing physicians to perform the most benign on the FGM spectrum (pricking the clitoral hood to draw a few drops of blood, symbolically of female circumcision) to assuage parents who come from a culture that practices that, and to ensure they don't take their baby girls to a practitioner who'd do something way more extreme.  That consideration was met with a furious backlash and promptly retracted.  But we're allowed to do more than that to baby boys.  I mean, really now?

For the purposes of this post I'm ignoring the potential medical benefits/risks of male circumcision because the research on that waffles all the time, and whatever potential medical benefits that may be gained are easily achieved with other means (e.g. using a condom, good hygiene, etc).  But these procedures, because they are surgical in nature, do come with very real risks.  In an old Jewish tradition (fortunately not practiced by most - I think - Jews these days), the mohel sucks the blood away from the circumcision wound with his mouth.  This is obviously not sanitary and is against all medical standards.  How 11 New York City Babies Contracted Herpes Through Circumcision.  That's one of the complications of that particular practice.  Now in normal healthy older children and adults, herpes is annoying but nothing more really.  In babies, because their immune systems are next to none, a herpes infection can be deadly.

And when public health officials try to intervene to limit/stop these practices, religious backlash is again furious as they claim they can self-regulate.  Clearly not always.  Circumcision, as my ob/gyn attending once said, has a "narrow therapeutic window."  It's not a difficult procedure to perform, but when you mess up, you mess up big time and you can destroy that kid's life.  That's not a burden I'd like to carry.

If at this point you may think I'm bashing religion, I assure you I'm not.  But when a religion requires modification to a person's body, particularly to a person who cannot consent, there are at least standards that must be met.  I'm in full support of medical/public health/legal bodies regulating such practices to ensure minimal harm.  The Cologne court in Germany may have gone too far, but the issue they bring up is valid: does the parents' rights trump the child's right to bodily integrity?  What if the child grew up and wish he (or she) wasn't circumcised?  What consolation is there then?

On my ob/gyn rotation I met a young first-time mother who asked me, as she was in the last stages of labor, whether her son would get circumcised right after birth.  I tried my best to mask my shock.  I said that the baby must first be observed for at least 12+ hours to ensure he's healthy enough.  I told her if she wished it to be done, it'd happen the following morning.  She asked me again if it'd be done right after he was born.  I reiterated myself.  Her friend suggested she could just leave him uncircumcised, that there's nothing wrong with that - I agreed and said most of the world's men are uncircumcised and the vast majority of them have no health problems because of it.  She considered this for a full 3 seconds before asking me that question again.  I changed the topic, exchanged some polite words, and left.  This mother, in my opinion, shouldn't have had the right to make that snap decision for her son without full consideration of the potential risks/benefits.

Thoughts?  Should logic rule over emotion and tradition?  Did that German court go too far, or simply conform to laws regarding other somewhat similar practices?  Whose rights should respected first?


Uncutplus said...

Excellent post, Aek! You already know my position on circumcision, as my blog has railed against circumcision as its main theme.

I invite your readers to visit my blog for more information about why parents should leave their son's foreskins intact. And it goes without saying that female mutilation goes way beyond the pale.

Thanks for bringing this topic to our attention.

fan of casey said...

There should be room in the law for a religious exemption -- that should be a valid compromise. Just as most of our laws focusing on regulating behavior and enforcing fairness and equality -- there's always an out for religious folks. Just as I don't think religious people should force non-believers into their ways, we should not infringe on their beliefs. Of course, there always will be exceptions even in this principle (for example if religious people break laws claiming that their religion allows it).

As a soon-to-be doctor, one issue you may face is where people don't believe in medicine -- instead relying on prayer/faith to heal.

. said...

Hey I posted a great thought but I received an error message. I'm posting this back in case the other one shows up...if it doesn't, I'll go back and post again today. Great writing!! I always enjoy your blog!!

naturgesetz said...

To me, the central issue is the family as the institution for raising children, with the parents responsible for deciding what's best for the children. To this, when parents are Jewish or Muslim, we add freedom of religion. Normally, parents must be empowered to make decisions on behalf of their children. The state, whether through bureaucracy, laws, or court decisions, should interfere with parental decisions only in cases of obvious true necessity — not second-guessing them or undercutting their values.

For example, several decades ago, there was a well-publicized case concerning Christian Scientist parents of a sick child. The basic rule, as the case illustrated, is that parents have a right to decide when and if their children will receive medical care unless a decision goes to the point of putting the child's life in danger. Similar rules have applied to blood transfusions for children of Jehovah's Witnesses.

For a court to forbid circumcision is completely contrary to how things should happen in a free society IMO.

Aek said...

fan of casey, naturgesetz: Should religion get a "carte blanc" pass at things? Should people be allowed to do whatever they want to their kids? There have indeed been cases where parents feel that they can "pray away illness" and their children die. But they stuck to their beliefs and the law didn't intervene in time. It's a tenuous line, but one that must be discussed and examined - of course the law can't dictate every aspect of every thing, but religion should not get a carte blanc pass either.

fan of casey said...

Aek: I agree that society can't allow religion total freedom to do whatever they want, that's why I say if parents break the law under the guise of religion, then society will impose civil justice -- for example, religious people cannot abuse their kids or endanger their lives using religion as the excuse - the civil authorities will rightfully intervene.

The gray area as I proposed for you is medical treatment -- some cases have given religion a lot of leeway while others don't.

Biki said...

i know that when someone of non-jewish ancestery converts to Judism, one of the requirements is if its a male, and he's uncut, then he must go thru the procedure to be considered a true follower. Why cant the jewish parents wait until the child is 13 and go thru the cutting and their bar mitzva to be seen as an adult member of the faith?

if a religion has a cermony marking the passage between childhood and adulthood, and they require being circumcised to be seen as a true believer/adhearant, then whats wrong with combining the two? of course, it might be hard for a 13 year old boy to tell his parents, no. but at least he would have a chance to verbalize his feelings.

i think the time has passed for circumcision. its an outdated idea that needs to be tossed into the dust bin. something that would be read about in history books as an archiac ritural.

and your ever so right, use a condom, spare the foreskin.

naturgesetz said...

@ Biki —

The problem with your suggestion is that Genesis 16:12 requires that every male be circumcised when he is eight days old.