The excision of the foreskin of boys is an ancient practice widespread in many cultures. Affecting the physical integrity of children, it is also regularly contested. An article published in July in The American Journal of Bioethicswritten by philosopher Brian Earp and co-authored by more than 150 researchers and professionals, provides new ethical arguments against circumcision when it is not justified by medical necessity.
Debates about circumcision generally center on whether the expected benefits to the child outweigh the risks he or she faces. On the risk side, there is the rare but catastrophic risk of a botched operation leading to mutilation of the penis. Or there are risks of hemorrhage or complications. Among the less vital but more frequent risks, there is the risk, reported by some men, of a loss of sexual sensitivity. And there is also the risk that the aesthetic aspect of circumcision may not please the person concerned.
Circumcision to fight HIV?
The expected benefits depend on the justification given for circumcision. When it is performed for religious or cultural reasons, the benefit is that of integration into a community. Circumcision can also be performed for hygienic reasons. In the United States, it became widespread because some doctors believed that it prevented masturbation. Currently, it is mainly promoted because it reduces the risk of contracting a sexually transmitted infection (including HIV).
One might think that the possibility of protecting against HIV would be a decisive argument. This is also the justification for mass circumcision programs of boys in Africa, under the aegis of the World Health Organization. The problem is that Circumcision protects men, not women. And it only reduces the risk of infection by about 60-70%. Which is significant, but not enough to be able to do without other protective measures. Especially since men circumcised under this pretext may feel protected and on the contrary increase their risky behavior. The benefit/risk ratio therefore remains debated.. While it may seem positive to adults, it is not clear that it justifies forcibly circumcising boys who are not immediately affected or old enough to fully consent.
The child’s right to bodily integrity
Brian Earp’s article leaves aside the risk/benefit calculations and places the debate on a strictly ethical level. It starts from the observation that non-medically justified genital cutting, when performed on girls, is considered to be sexual mutilation and constitute a violation of human rightseven when they do not involve the excision of the clitoris but of more superficial parts such as the labia. Similarly, there is a growing consensus around the idea that operations aimed at to make the genitals of intersex children appear “normal” are no longer acceptable.
These ethical positions are based on the idea that every child has the right to the integrity of his body and to his future sexual autonomy. When he reaches adulthood or sexual majority, he can of course make changes to his body, even irreversible and irreparable ones. But this must be a free and consensual choice. These considerations apply particularly to the genitals, which in all cultures have a special status and are specifically protected by most penal codes. This is particularly true for children. Consequently, the legal and medical provisions that protect the genitals of girls and intersex children from any medically unnecessary intervention, but exempt boys from it, are ethically inconsistent and must be revised.
If one is against genital mutilation on girls and intersex children, then consistency should lead to being against circumcision in boys as well. Not to be would be sexist discrimination. The right of boys to their physical integrity is as valid as that of girls and intersex children.
Franck Ramus is a research director (CNRS), he works at the Laboratory of Cognitive and Psycholinguistic Sciences (ENS), and is also a member of the Scientific Council of National Education.