J Med Ethics 2004 30: 248-253;S K Hellsten practice of genital mutilation.

J Med Ethics 2004 30: 248-253;S K Hellsten practice of genital mutilation.

–critical notes on cultural persistence of the
fashion, from public health to individual freedom
Rationalising circumcision: from tradition to
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SYMPOSIUM ON CIRCUMCISION
Rationalising circumcision: from tradition to fashion, from
public health to individual freedom—critical notes on
cultural persistence of the practice of genital mutilation
S K Hellsten
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . .
Correspondence to:
S K Hellsten, Centre for the
Study of Global Ethics,
University of Birmingham;
[email protected];
cc [email protected]
Received 24 March 2004
Revised version received
25 March 2004
Accepted for publication
25 March 2004
. . . . . . . . . . . . . . . . . . . . . . .
J Med Ethics 2004;30:248–253. doi: 10.1136/jme.2004.008888
Despite global and local attempts to end genital mutilation, in their various forms, whether of males or
females, the practice has persisted throughout human history in most parts of the world. Various medical,
scientific, hygienic, aesthetic, religious, and cultural reasons have been used to justify it. In this symposium
on circumcision, against the background of the other articles by Hutson, Short, and Viens, the practice is
set by the author within a wider, global context by discussing a range of rationalisations used to support
different types of genital mutilation throughout time and across the globe. It is argued that in most cases the
rationalisations invented to provide support for continuing the practice of genital mutilation—whether male
or female—within various cultural and religious settings have very little to do with finding a critical and
reflective moral justification for these practices. In order to question the ethical acceptability of the practice
in its non-therapeutic forms, we need to focus on child rights protection.
Despite global and local attempts to end genital mutilations,
in their various forms, whether of males or
females, the practice has persisted throughout human
history in most parts of the world. Today both male and
female genital mutilation are particularly common in poor,
developing countries with wide traditional communities, but
these practices have also been maintained in many modern
Western multicultural societies. This is particularly the case
with male circumcision, which in many parts of the Western
world is still practised almost routinely, as the articles by
Hutson, Short, and Viens on the justification of male
circumcision in this journal, show.1 2 3
Short and Hutson focus more on scientific, medical, and
public health aspects while Viens discusses the issue of
religious freedom and identity. More precisely, Hutson
analyses whether the public health argument holds water
in justifying male circumcision as a routine operation in
relation to its health related consequences (whether these are
negative or positive). Short’s commentary on Hutson defends
male circumcision on the basis of medical evidence that
the procedure (on males) has been scientifically proven to
improve both male and female reproductive health. Short
goes as far as suggesting that we might have some kind of
duty to develop better procedures to make the operation the
‘‘kindest cut of all’’. Viens, on the other hand, argues for the
justification of male circumcision on the basis of individual
freedom. Rather than speaking for the right of an individual
to make his or her own autonomous choices, however,
Viens draws his arguments from the parents’ right to decide
what is best for their children as well as from the parents’
religious freedom to choose the (religious) identity of, and
for, their children. While Hutson is the most hesitant of
these three authors to defend the general benefits of the
operation, none of these articles directly argues against male
genital mutilation. While Viens is most sensitive to religious
freedom and cultural identity, none of the authors discuss in
detail the different cultural, social, and economic contexts of
these values and practices across the globe. Instead, all the
above mentioned authors keep their discussion almost
exclusively within the framework of Western medicine and
a pluralist society. While, albeit briefly, supporting other
cultures’ rights to maintain their religious identities, Viens is
even willing to offer Western assistance in developing less
painful and medically safer practices for the operation on
children elsewhere in the world. In this symposium, and
against the background of the articles by these three authors,
I have taken it as my task to set this discussion on the
justification of male circumcision within a wider, global
context. I want to discuss how we find a range of rationalisations
to support various types of genital mutilation and to
evaluate whether these rationalisations have anything to do
with a critical and reflective moral justification of these
practices.
I shall pay attention to the following issues. Firstly, I find it
disturbing that even within the Western medical community,
there is evidently still a wide consensus on such an intrusive
and violent procedure as male circumcision, albeit that this
consensus is evidently based on very different ‘‘moral’’
justifications, which vary from public health, to scientific
proof, to religion and to a diversity of Western values. More
worrying is the fact that there appears to be a general
agreement that this violent procedure (as therapeutic and
non-therapeutic one) can (and according to Viens, even
should) be carried out on infants and/or very small children.
In addition, male genital mutilation (MGM) should not be
considered in isolation from the issue of female genital
mutilation (FGM). In this symposium only Viens recognises
the existence of ‘‘female genital cutting’’. He, however,
regards it as part of the same tradition which encourages
MGM—that is, a tradition based on religious freedom/
cultural identity—without making any attempt to distinguish
the different nature of the medical and moral reasons put
forward in favour of FGM.
Secondly, I find that both the medical and the value based
arguments presented by these three authors lack either
plausible evidence or logical consistency. Instead of discussing
each article separately, however, I shall describe a wider
global framework that provides false reasons in defence of
genital mutilation, rather than providing any truly plausible
moral justification for this practice.
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RELIGIOUS FREEDOM, PAIN, AND CHILDREN’S
RIGHTS
Throughout history human beings have mutilated and
harmed their bodies (and minds) in the name of culture,
tradition, religion, and concepts of beauty, health, normality,
or social status. One of the most persistent forms of these
physical violations is mutilation of human genitalia. This
practice has been related to: taboos about human sexuality;
children’s initiation to adulthood, maturity, and reproductive
age; aesthetic values; the demands set by various religions,
and to hygienic, individual, and public health medical beliefs.
(See the articles by Hutson, Short and Viens in this journal,
and also those by Aldeeb Abu-Salieh, Bigelow, and by an
anonymous author in Echo).1–7 All in all, mutilation of human
sexual organs reflects our fears about human biological
needs—and even deeper fears about human sexual needs—as
well as fears to do with the maintenance of established social
hierarchies in a society.
In this symposium we are discussing the most common
form of genital mutilation, male circumcision. In its mildest
form, this means the cutting of the foreskin of the penis. (For
more detailed explanations see the articles by Hutson, Short,
and Viens).1 2 3 It is important to note, however, that the
same term, ‘‘circumcision’’ is also used in relation to
women’s genital mutilation, where it refers to the cutting
of the tip or the whole of the clitoris. There are, however,
various other, more radical and more harmful mutilations of
human genitalia, which can be relatively minor or extremely
serious. Female genital mutilation—for example, includes a
wide range of ritual and non-medical operations undertaken
on women’s genital organs, which include their total or
partial removal and amputation or incisions in the interior of
the vagina. According to the World Health Organisation
(WHO) female genital mutilation can be classified into three
major types: type I or clitoridectomy—removal of the tip of
the clitoris; type II—cutting of the clitoris and all or part of
the labia minora, and type III or infibulation or pharaonic
circumcision, in which the clitoris is cut together with part or
the whole of the labia minora and incisions are made on the
labia majora. When this latter operation is performed, the
edges of the wound are often tied up again leaving a small
opening through which body liquids such as urine or
menstrual blood can flow. The resulting mass of scar tissue
which covers the urethra and the upper part of the vagina,
completely closes the vulva. If the opening is wide enough,
sexual intercourse may occur after a gradual dilatation,
which can take days, weeks or even months. When the
opening is too small to allow sexual intercourse, it must be
widened with a razor or knife on the wedding night. Given
the severity of cuts and stitches occurring during initial and
repeated interventions, infibulation is the most harmful form
of genital mutilation, both to reproductive health and to
health in general. Other practices which prevail in certain
countries of Central, Southern, and South Africa, consist in
pulling the labia and introducing substances and minerals
into the vagina to dry it and to increase men’s sexual pleasure
(Anonymous,6 p 5). Male genital mutilation can vary from
body piercing through a range of various other modifications
to amputation, and castration.
While the moral justification for any type of genital
mutilation has been challenged from time to time, its
continuation for both men and women has been rationalised
over and over again via various medical, legal, moral, and
cultural arguments. The campaigns against MGM have not
been as vigorous as those against FGM since FGM is in
general considered to be a more violent and socially
suppressive practice than MGM. In addition FGM has more
serious and damaging physical, as well as psychological or
social, implications. On the other hand, the operation itself
has no medical justification, whereas a medical justification
is still put forward for MGM, as the articles by Hutson, Short,
and Viens show. Thus, male circumcision has been easier to
accept as a minor harm that can be justified, or at least
tolerated, if not sometimes encouraged (see Short’s paper in
this journal) as a part of a particular religious or cultural
tradition or as a measure promoting individual or public
health.
In general, the arguments against MGM or FGM claim that
both practices violate the physical integrity of children and
cause avoidable pain. In the worst cases they can lead to
irreversible physical or psychological harm, as noted by
Huston in his contribution to this symposium. It appears,
however, that while neither, Hutson, Viens, nor Short
recommend male circumcision as a public health measure,
in individual cases they all accept male circumcision either on
medical or on religious grounds, as long as it does not cause
pain. Thus, they recommend better pain management
measures and more refined procedures to perform the
operation. This is particularly true of Viens’s argument,
which defends, the practice in the name of religious freedom
but denies the fact that the operation is—or should be—
painful. This position appears to be contradictory, since as a
religious or cultural practice, the endurance of pain is often
an essential part of the ritual, showing the readiness of
individuals to transit from childhood to adulthood, from boy
to man, in the case of MGM, and from girl to woman in the
case of FGM. The other problem with Viens’s argument for
religious freedom in relation to male circumcision is that it
supports male circumcision being carried out on infants and
small children at the request of their parents, rather than
waiting for the children to be ‘‘old’’ enough to give their
‘‘informed consent’’ and to understand the real significance
of the ritual and ‘‘the need to tolerate pain’’.
From a human rights perspective both male and female
genital mutilation, particularly when performed on infants or
defenceless small children, and for non-therapeutic reasons
can be clearly condemned as a violation of children’s rights
whether or not they cause direct pain. Parents’ rights cannot
override children’s rights. If we allow parents to decide what
is best for their children on the basis of the children’s
religious or cultural identity, we would have no justification
for stopping them cutting off their children’s ears, fingers, or
noses if their religious and cultural beliefs demanded this.
Also, if we allow parents’ rights to override children’s rights,
we could not then forbid them from making any other
physical and spiritual sacrifices, (such as ‘‘cannibalism’’ or
‘‘human sacrifice’’ as extreme examples), particularly if we
follow Viens’s recommendation and manage to develop
techniques that minimise or abolish pain.
TRADITION OF GENITAL MUTILATION AND GENDER
This article focuses on male circumcision, but I do not want
to disregard the importance of mentioning female genital
mutilation in the same context. Some advocates of women’s
rights who emphasise FGM as a sign of gender based violence
which springs from the patriarchal oppression of women,
tend to be reluctant to allow any comparison between male
and female genital mutilation and may disagree with my
comparisons.8 In this article, however, parallels between
FGM and MGM are drawn only in respect of the implications
of performing any potentially harmful non-therapeutic, nonconsensual
procedure that in the end is, in one way or
another, a social issue rather than a medical one. My purpose
is not to diminish the ethical, social, and medical dangers
involved in FGM, but to widen the scope of the discussion in
this symposium. Focusing merely on male circumcision—and
leaving it almost exclusively within a medical context—may
make us forget that what we are discussing here is a
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historical tendency to look for rationalisations that allow us
to practise genital mutilation in one form or another, across
geographical, cultural, and religious boundaries.
I believe that examining the traditions of genital mutilation
from the point of view of both sexes may reveal more
clearly the irrationality involved in the justifications that are
made for continuing the practice of mutilating human
genitals. Thus, while there is a need to pay special attention
to the elements of social and political oppression involved in
FGM, it is also important to note that throughout time men,
as well as women, have learned to accept that there are good
reasons for the mutilations of human genitalia. Usually these
reasons raise false hopes that undergoing the operation
somehow improves people’s lives—and the lives of their
children—whether this be in the context of social status or of
a medical condition, while the true reasons for the practice
may lie elsewhere.
AUTONOMY V CULTURAL RIGHTS—UNTANGLING
THE DICHOTOMIES OF CULTURAL TRADITIONS
When the justification of genital mutilation is discussed, the
disputes are usually tangled around issues about the
universality and relativity of our value systems, and can
often centre on the conflict between the different rights that
might be involved. In most cases, the debates for and against
genital mutilation are set within the framework of collective
cultural rights v individual rights. The arguments against the
practice of genital mutilation tend to appeal to the promotion
of individual autonomy and universal human rights to
various freedoms, while those who defend the practice draw
support for their claims from demands to respect a person’s
particular cultural identity and/to protect the rights of
minorities, (minority cultures) as for instance is argued by
Veins.3 (See also Mills9 10 and in connection with genital
mutilation my own paper of 1999.11)
In fact, Veins’ argument further complicates this debate
between individualism and collectivism by supporting male
circumcision not only via an appeal to (religious) freedom
and identity as such, but also by defending parents’ rights to
decide what is the best for their children. He supports MGM
further by going on to defend our autonomy to decide what is
our concept of the good life and wellbeing, while simultaneously
refuting children’s rights as not being real ‘‘rights’’ of
autonomous and fully rational persons. This sets ‘‘autonomous’’,
‘‘adult’’ rights against children’s rights. While
children’s rights tend to create a problem for the defence of
autonomy and informed consent in general, Veins’ view
presents a rather contradictory rationalisation for male
genital mutilation by championing parents’ ‘‘cultural identity’’
against their children’s physical integrity. There is
always a danger in combining cultural and religious identity.
The issue of religion and religious identity in the context of
culture is in itself very complex: different cultures have
different influences on the interpretations of religious norms,
practices, and identities. Whether we talk about Islam,
Christianity, Hinduism or any other world religion, each is
followed very differently, depending on the original culture
and the historical changes that have affected it: Islam and
Christianity—for example, are practised very differently in
Saudi Arabia, in Uganda, and in the UK.
On the other hand, Veins’ argument provides a good
example of how the dichotomy between individualism and
collectivism presents a rather black and white picture of the
cultural history of our world: individualism is tied inseparably
to universalism and the universal promotion of human
rights, while collectivist lifestyles are related directly to
relativism, which allows social suppression. This polarisation
of the positions simply overlooks the fact that individualistic
values and lifestyles can also fall into relativist reasoning that
rejects any interference with individuals’ ‘‘autonomous’’
choices. This position clearly disregards the fact that most
of our choices are made in a social context and may often be
influenced by social pressures, or even by some refined forms
of social coercion.
Also, an individualist culture, in the name of tolerance and
freedom, may justify extremely violent and irrational
practices, and ‘‘autonomous’’ parents can ask for their
children to be physically mutilated in the name of their
preferred collective identity. Collectivist value systems and
cultural traditions, for their part, rely on a universal demand
for the protection of religious and/or cultural rights and
identities.12 13
Reconsidering descriptive and prescriptive senses of value
systems can help us overcome normative cultural dichotomies
and to avoid culturally biased discussions about genital
mutilation and other harmful practices. In order to curb
injurious practices we need to acknowledge that what makes
some of these harmful customs so persistent is the tendency
to see them as essential, integral, and identifying parts of
particular cultures or belief systems. If, however, we
recognised openly that the same or similar practices tend to
appear universally—that is, the same or similar practices
exist in one form or another in most parts of the world but
with different rationalisations—we could see more easily the
smokescreen that tends to blur moral argumentation around
these practices. The best way to curtail any harmful and
violent custom is to find a way to raise resistance to it within
the communities themselves, by revealing the irrationality
and dishonesty of the reasons put forward to maintain such
customs as genital mutilation, and so their irrelevance to any
cultural identity.
MEN AND CIRCUMCISION IN THE ‘‘WILD’’ WEST
Arguing about conflicting rights and cultural identities may
lead us astray, if we do not invalidate some of the central
fallacies that persist as part of the rationalisation process of
genital mutilation. Firstly, if we are to have a serious ‘‘moral
debate’’ on the persistent existence of genital mutilation, we
need to recognise the various rationalisations used to defend
it throughout human history, not merely in any particular
time or age. Secondly, we need to further evaluate these
rationalisations to see how they are successfully shaped to fit
their local traditions and social environments. In most cases,
these rationalisations are full of inconsistencies and act as a
mere smokescreen to cover up the actual social, political, or
economic reasons that are behind the preservation of genital
mutilation in any given cultural context. Thirdly, recognising
the complexity of the cultural and ethical issues involved in
the justification process of genital mutilation may help us to
find new ways to get rid off the false reasons for the practice
and better ways to combat this violent practice worldwide.
Since the practice of genital mutilation has existed in
almost all known civilisations at some time or another in
various forms, we cannot say genital mutilation is a tradition
that is unique to a particular culture or religion as such; and
therefore we cannot say that defending the practice means
defending the right of that culture to exist and defending the
rights of its members to maintain their cultural identities.
Since genital mutilation has appeared in a number of cultures
and is related to various belief systems, it is not important
whether these cultures or belief systems themselves are
(more) individualist or (more) collectivist in their value
structure: what is important is to pay more attention to the
differences in the types of rationalisation put forward to
support them within different types of cultural frameworks.
In most cases it appears that whether the practice withers
away or remains an integral part of that culture’s identity,
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depends on the strength of the rationalisations and the
availability of education in that culture.
Since genital mutilation is not alien to individualist
cultures, we can look at the medical rationalisation of male
circumcision in the Western individualist tradition. Within
Western medical history cutting off or extracting the male
foreskin has been believed to cure insanity, masturbation,
epilepsy, cancer of the penis, and even cancer of the cervix of
the future wives of the circumcised boys as well as sexually
transmitted diseases and particularly phimosis (either as a
disease or as a cause of other diseases such as cancer). Even
today the relation between male circumcision and HIV/AIDS
is still extensively studied and debated, as the articles by
Hutson, Short, and Viens show.1 2 3 In particular, the claim
that male circumcision is able in fact to prevent HIV/AIDS,
can have negative consequences, especially in parts of the
world where medical hygiene is poor and/or relevant health
education is not readily available.
The claim that being circumcised helps to prevent HIV/
AIDS may in fact lead to triple jeopardy in the fight against
AIDS. Firstly, where there is a lack of medical facilities for the
operation the knives and other utensils used for the
procedure might actually fuel the spread of AIDS. This
further complicates Viens’s argument for religious freedom,
because he also recommends that the operation be carried
out in modern medical facilities with more advance pain
management. If this requirement is set in a global context, a
logical, but nevertheless contradictory, consequence would
be, that (male or female) circumcision should be allowed in
the name of religion only in those parts of the world were
hygiene and advanced medical treatments and technology
are readily available. From the point of view of religious
freedom this is a rather restrictive requirement.
Secondly, the fact that people believe they are somehow
protected against HIV by being circumcised may cause them
to be somewhat careless or dismissive about the need for
other protection, to have promiscuous sex, and in general to
feel they are now immune to the virus. Thirdly, the fact that
male circumcision is seen to be medically related to the
prevention of HIV/AIDS may lead onto a slippery slope that
ultimately leads to it being culturally required that FGM is
practised for the same purpose. This would be even more
counterproductive, since there is medical evidence that
women are more vulnerable to the virus to start with.
Whatever medical indication there might be that male
circumcision actually prevents the spread of HIV/AIDS, the
effect of this in stopping the spread of the virus would be
undermined if, as a result, more women were infected
because of unsafe, and maybe also forced, sex.
All this shows that while opinions about the diseases that
male circumcision is to be used to prevent or to cure have
changed throughout time, male circumcision as such has
persistently maintained its place as a medically justifiable
practice in Western countries, and is gaining further
justification as the papers by Hutson, Short, and Viens show.
In addition, male circumcision has also had a longstanding
religious rationalisation in the Western cultural context
within Judaism, Islam, and even Christianity, as explicated
by Viens; it has medical rationalisation to the level of being
almost routinely practised in the United States and in
Australia, as discussed by Hutson and Short; and in most
cases it has an individual justification which is based on
alleged medical conditions, as noted by Short. The medicalisation
of this operation in the West has given the practice a
stronger ‘‘rational’’ justification in a modern society than
even traditional and religious demands can provide.14 15 16 17
Whether the rationalisations of genital mutilation are
cultural, aesthetic, religious, hygienic, medical, or scientific,
the truth behind the practice of genital mutilation might still
be a very different story. Even a medical rationalisation may
cover up other more hidden purposes. If we compare the
persistent continuation of male circumcision in the United
States with the same phenomenon in Europe we find rather
interesting results. The studies by Fletcher,14 and Fleiss18
show how in the United States, where the routine circumcision
of newborn males has been common until rather
recently, because of the widespread diffusion of the scientific
myths about its benefits, the medical data with counter
results were deliberately ignored or misinterpreted in order to
maintain the practice. For instance, the latest reports from
European medical research on the issue were neglected in
order to maintain the practice in the USA even when it was
already rapidly disappearing in Europe, as also noted by
Hutson.1 Behind the disguise of alleged medical benefits we
can find more gruesome reasons for the maintenance of the
practice. In a modern, American, market oriented society
male circumcision became a form of commercial exploitation
of children when physicians, in cooperation with transnational
biotechnology corporations, looked for the sales of
marketable and economically profitable products made from
harvested human foreskins that could further be used in the
pharmaceutical industry (Fletcher,14 pp 259–71), (Sorrells,15
pp 331–7).17
MALE CIRCUMCISION IN AFRICA AND BEYOND
The practice of genital mutilation plays a central role in social
hierarchies and personal relationships (not only between the
different genders, but also between men themselves and
between women themselves). Whether the rationalisation for
male circumcision is a religious, cultural, medical or hygienic
one, those men who remain uncircumcised in the societies in
which the practice is common, are made to feel somehow
abnormal and/or not equal to those who have undergone the
operation. Just to take a few local examples: in East Africa,
for instance, men of the Masai tribe see uncircumcised men
as adolescent, spineless, and timid cowards who do not have
full male qualifications (whether we talk about the uncircumcised
men of their own community, or those of other
tribes or races). Within the Cameroonian Nso tribe the three
main rationalisations for male circumcision have been firstly,
the belief that circumcision prepares the penis, puts it in a
state of readiness for coitus and procreation, secondly that it
tests the courage and endurance of a boy at the threshold of
adulthood, and thirdly, but rather in contradiction of the first
claim, it is thought to tame and moderate the sexual instinct
thereby helping a man to act more responsibly.19
The Tanzanian Chagga tribe, for its part, circumcises young
boys in different age groups (thus the age for circumcision
may vary from 4 to 18). In cases where the circumcision is
postponed for a long time, for one reason or another, by the
parents and relatives, many of the boys seek a way to go
through the operation on their own, endurance of pain being
a central element of the ritual. Before having the operation
done to them they feel socially and physically immature.
With the modern Chagga, many of whom are now Catholics
by religion, the rationalisation for circumcision is nowadays
hygienic rather than traditional. The Islamic Chagga, for their
part, can appeal to the demands of their religion, for
circumcision. In reality, however, the practice is clearly based
on peer pressure and the community’s social expectations.
Uncircumcised men in many African communities are seen
as undeveloped or ‘‘child like’’ and are thought to be inclined
to poor sexual or reproductive performance.
Social pressures are also typical in the societies in which
the rationalisation is more purely based on religious
demands. It may seem inconsistent to require genital
mutilation on a religious basis since this is perfecting the
work of God by cutting off, modifying or redesigning any part
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of a human body which has been created by God. The human
ability to find the needed false reasons, however, is
boundless; in the case of genital mutilation the attempt to
reduce sexual pleasure and to maintain chastity is seen not
only as an improvement of God’s work, but also as showing
obedience to whatever is believed and interpreted to be God’s
will in any given culture. In traditional Judaism, for instance,
male circumcision is a means to moderate the sexual pleasure
of men and their attraction to women. Similar views, to do
with reducing the sexual pleasure rather than fully suppressing
it, have been presented in Islam. In Islam the argument
linking pleasure to circumcision, however, is used more
frequently in the case of female genital mutilation. In most
religions (as for Jews and Muslims) circumcision is also a
mark that distinguishes the believer from the non-believer.
The fact that circumcision has, throughout history, been
practised also within traditional belief systems—for example,
by Australian Aborigines, the Mayas of Borneo, various
Native American tribes, the ancient Aztecs and Mayas, etc—
is not taken as undermining the claim that this practice is
seen as a sign that distinguishes a believer from a nonbeliever
in such world religions as Islam or Judaism.4 5 20–23
In general then when the justification of genital mutilation
is based on traditional or religious grounds, whether in
Arab, Eastern, Western or Southern cultures, the emphasis
has been on God’s will as well as the purity of body and
mind.
All in all, the inconsistencies between sexual performance
and religious identity in relation to genital mutilation do not
seem to reduce the power of the false reasons put forward to
support the practice. In some cultures circumcision is
justified as a means to control men’s and women’s sexual
desires, while in others it is used for precisely the opposite
purpose, that is to prove the sexual virility and endurance of
men. In yet other cultures it is used to enforce traditional and
natural cultural identity and social order, and in others it is
used to mark religious affiliation and God’s will.
FEMALE GENITAL MUTILATION AND GENDER
EQUALITY
Female genital mutilation, for its part, is usually seen as part
of traditional and collectivist cultures with patriarchal social
structures. It is not, however, fully alien to the more
individualist Western cultural tradition. Female genital
mutilation used to be practised in Western civilisations as a
cure for various medical conditions while the actual social
reasons for its maintenance may have lain elsewhere in
Western history. Clitoridectomy was, for instance, used both
in Europe and in America for hygienic reasons, as a medical
cure for masturbation, and for mental disorders such as
hysteria. Since in the West both male and female circumcision
were practised by qualified doctors for allegedly
legitimate medical indications, they were not considered to
be the same brutal and intervening mutilations of the human
body as they were seen to be elsewhere in so called ‘‘more
primitive’’ societies. This shows that science can be a double
edged sword that readily lends itself as an alibi for strongly
held preferences and cultural biases. In particular, the
medicalised nature of the Western culture itself can give
legitimisation to even violent and unnecessary physical
interventions on the human body in the name of science,
progress, normality, and health while the actual reasons for
such interventions may remain hidden.11
Today, female genital mutilation, now called traditional
circumcision, no longer exists openly in the Western cultural
mainstream, but it persists in the developing world. With the
relatively recent emphasis on pluralist values, tolerance, and
respect for personal autonomy, however, practices of genital
mutilations have recurred in the West. Body piercing and
other rather extremist forms of sexual (pleasure seeking)
subcultural practices have introduced new, less openly
condemned, forms of genital mutilation. These contemporary
forms of genital mutilation are taken to be more acceptable
since they are thought to have come about as a result of one’s
autonomous choice and free will. Thus, the main ethical
battle against genital mutilation in Western culture still
focuses more on preventing the traditional forms of FGM,
which also is practised (though mostly in secret) within
various immigrant communities in multicultural Western
societies. Here again, we can note that the culture itself
introduces the same practice (in different forms) over and
over again, succeeding always in finding a culturally fitting
justification for it, while being simultaneously more than
ready to reject the same or similar custom in other
cultures.8 24
While, however, many traditional communities where
FGM is practised remain clearly more patriarchal and use
female genital mutilation to control women’s sexual behaviour,
economic factors should not be ignored. Those
performing the operation earn a good income out of it and
thus, the practice provides livelihoods for many. Also,
circumcised girls guarantee better bride prices and higher
social status for their families. This may help us to understand
why not only men, but also women themselves, while
victims of the practice of FGM, are often its strongest
proponents. It is true that the more traditional types of
female genital mutilation clearly have more devastating
medical consequences for their victims, particularly in poor
environments and in unhygienic conditions. In addition, they
are usually performed on vulnerable and defenceless children.
Thus, evidently there is an urgent need to find a ways to
curtail the practice. Additionally, as noted, female genital
mutilation tends to persist in societies that have a more
traditional, a more patriarchal social structure, thus its
maintenance is more directly related to the low social status
of women. Female genital mutilation in traditional environments
is said to be harder to combat, since its persistent
maintenance is usually based on women’s lack of education
and decision making power in their communities. Thus, the
abolition of FGM is not merely in hands of its direct victims.
It is also in the hands of the society as a whole, and
particularly in the hands of those in social and political or
religious power. Power relations between the sexes, however,
are difficult to change and thus, the practice persists and is
justified in a manner that makes women themselves adopt it
as a part of their cultural identity and of their social pride
through history. In Africa, for instance, the history of female
genital mutilation dates back to 4000 years BC. Even today in
Africa FGM is still practised in at least 27 countries and every
year two million girls at least are exposed to sexual
mutilation. These mutilations constitute one aspect of a
series of traditional practices harmful to women’s health and
welfare—that is, forced marriages and early pregnancies,
force feeding, tattooing, scarification, and nutritional taboos.
Also, although some people consider the practice of FGM to
be recommended by Islam, Christianity, and traditional
religions, there are non-believers who practise this as well.
These practices are also found in Egypt as well as in the
majority of Arab Muslim countries of the Middle and Near
East as well as in Islamic societies in the Far East.6 8 25 Finally,
it should not be overlooked that women are also involved in
the maintenance of male genital mutilation. In the case of
MGM, setting aside religious or traditional rationalisations or
social pressures from the community, women (those who
themselves have not undergone any genital mutilation, as in
the US—for example) may prefer circumcised men as sexual
partners, either because their performance in sexual intercourse
lasts longer or because they consider a circumcised
252 Hellsten
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penis to be more hygienic and/or more aesthetic than an
uncircumcised one.
CONCLUSION
Human sexuality and the attempts to control it, particularly
to reduce or add sexual pleasure, have been, in one way or
another, a part of all known cultures and civilisations. While
sometimes this fact is acknowledged openly as the main
purpose for genital mutilation, in most cases other rationalisations
are put forward for the practice. These false reasons
have varied from religious and cultural demands to a number
of medical ‘‘explanations’’, depending on the wider cultural
tradition within which the practice has appeared. These
different rationalisations for the maintenance of the practices
in various cultures show that no matter what the cultural
differences are in beliefs and lifestyles, genital mutilation is a
universal sign of human civilisation—or maybe the lack of it.
All societies have found the arguments that best fit their local
cultural traditions and environments in order to introduce or
maintain genital mutilation in its various forms. In the
Western, rather individualist tradition, these rationalisations
are based on benefit to the individual and/or autonomy; in
the Southern and Eastern cultures their support is drawn
more directly from social values and ties, or from the need to
protect one’s unique cultural identity against Western
cultural imperialism. Thus, in this regard one cultural
tradition cannot be said to be better than another. Rather,
with further education and knowledge the cultural smokescreen
around the real reasons for the maintenance of the
practice can be overcome in all societies no matter what their
cultural background.
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Option 1—Male Circumcision and Children’s Rights

Consider the following case:

MC is a practice found world-wide.  It is found among Muslims, Jews, Christians, and followers of African religions as well as in secular communities, and there are various reasons given for the practice.  Over the last 10 years there has been a drop in this procedure across Canada and the BC College of Physicians and Surgeons does not recommend it.
Suppose some parents take their infant son to see a physician in Canada with a request for the procedure.  Assume that these are new immigrant parents from a culture in which male circumcision is the cultural norm.  How should we balance in this case respect for diversity of beliefs and cultures with a concern for the patients’ best interests? Each of the following ethical values and principles can be applied to this issue:

1.    Beneficence—the welfare of the patient, or patient interests
2.    Respect for cultures and religious faiths—cultural and religious sensitivity
3.    Parental rights—the right to shape their children’s lives as they see fit: is there a limit here?
4.    Human rights: what rights are being violated, if any?
5.     Professional integrity and competence—the right of healthcare professionals to offer services that agree with their own codes of ethics

A)    What action might each item justify ethically? For example, if one thinks of the issue in terms of the welfare of the patient, one might think it would be best for him if…..If one wants to show cultural sensitivity one might argue…  If one looks at the issue from the point of view of the parents, one might argue… If one looks at the issue from the point of view of human rights violations, one might argue…   If one looks at the issue from the point of view of the physician and their codes of ethics, one might think he/she should….  Somewhere in this section briefly explain MC and reasons given for it.
(Section A: Write 450 words).

B)    What do you think the physician should do?
* Compare and contrast the case of MC with FC, saying how they are similar and dissimilar; and then after this exploration say what you think the physician should do in the case of MC.

**Think of at least two significant objections to your position—What could someone say in response to your view and how would they defend their view? Respond to the objections, thus tightening your position.  So, for example, say “Someone might argue against my position that I am being culturally insensitive but I think this is not true because…”
(Section B: Write 450 words).
In your paper you must refer to “Rationalizing Circumcision” by SK Hellsten (course webct) and the stance of the BC College of Physicians and Surgeons on male circumcision. You can refer to narratives, such as a narrative of an adult male who had the procedure as an infant.  Such a narrative could be used to support or challenge your perspective.  Another good source is the film Whose Body, Whose Rights? Examining the Ethics and the Human Rights Issue of Infant Male Circumcision which you can watch on youtube:   http://www.youtube.com/watch?v=W0kr6BiVZMM  Part 1; http://www.youtube.com/watch?v=qSAjpzpF6qM Part 2.
You should refer to at least 5 sources in total in your paper. (This 5 can include readings assigned in the course, such as the article by Hellsten).

Remember this is a paper in philosophy and critical thinking; an appeal to culture or religion does not constitute in itself an argument.  You may side with a view based on religious or cultural reasons but you need to provide ethical arguments and refer to ethics vocabulary in defending this view.

** Your essay should have a brief introduction (a few sentences) and a brief conclusion (a few sentences).  Your entire essay (without the reference section) should be approximately 1000 words.   Marks will be deducted if you go more than 150 words under or over the word length.   Please put a word count on your first page; do not include a title page.   In your introduction get to the point immediately about what you will be up to step by step in the paper.  Your conclusion should briefly sum up what you have argued and shown.  The paper will be marked according to completeness, clarity, organization and persuasiveness.  Please make an appointment with myself or our teaching assistant Mona Lee if you need help.

Marking grid final:   A)  10 points  B)  10 points   C) Introduction and conclusion—3 points    D) Works cited page—2 points      totalling 25 points