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Ethical questions rise as circumcisions fall

Decreases in circumcisions reflect widespread concerns about the ethics of the procedure.

Circumcision, the surgical removal of the foreskin of the penis, has been declining in popularity in recent decades, but a recent finding by the American Academy of Pediatrics has affirmed the medical advantages of the procedure. Because circumcision often occurs shortly after birth, it raises questions about whether it is ethical to administer the procedure without the individual’s consent, said William O’Barr, professor of cultural anthropology, sociology and English, and author of the upcoming book “An Anthropologist Looks at Circumcision in American Life.”

“Some people feel when they discover it that their body has been permanently altered without their permission,” O’Barr said. “Does anyone have the right to alter someone’s body without their consent?”

Last week, the American Academy of Pediatrics reversed the long-standing understanding among scientists since 1975 that there was no demonstrable medical need for routine circumcision. The opinion reflects the findings of scientific papers over the past decade which have provided a favorable stance toward circumcision, Wiener said.

The AAP statement, released Aug. 27, said that the health benefits of circumcision for newborn males outweigh the risks it poses, so it should be available for families that want the procedure. Circumcision lowers the risk for cancer of the penis, urinary tract infections and transmission of sexually transmitted diseases, such as HIV. The Academy, however, did not find sufficient evidence to recommend universal newborn circumcision.

This trend of support for the procedure from the medical community runs counter to wider societal trends. Although the newborn circumcision rate in the U.S. ranged from 90-95 percent between 1950 and 1970, it declined to about 33 percent as of last year, O’Barr said. This drop could be attributed to an increase in anti-circumcision groups that have voiced concerns about the ethics of circumcision and are striving to ban the practice altogether.

The decrease could also be linked to states no longer funding the procedure, said Dr. John Wiener, section head of pediatric urology at Duke Hospital. Seventeen states, including North Carolina, no longer provide financial support for the procedure.

O’Barr said that circumcision should not be viewed as right or wrong, comparing the procedure to a girl who has her ears pierced.

“Either you are [circumcised] or you aren’t,” O’Barr said. “[There’s] nothing wrong with either way.”

Because circumcision has traditionally been so prevalent among men and in popular culture, the desire to fit in may pressure individuals to undergo the procedure, he said. Not only do drawings and models depicting circumcised males promote the procedure, but the use of terminology such as “uncircumcised” suggests that not being circumcised is undesirable. Adjectives such as “intact” or “natural” would be more appropriate and conscious of the sensitivity of the issue, O’Barr said.

He noted that there are multiple techniques for the procedure, each involving different instruments. The differing methods result in different aesthetic looks, which may account for the wide scope of male opinions on the subject. It is possible, however, to distinguish between safe and unsafe ways to conduct the procedure.

“Circumcision is not a foolproof thing—you can lose your penis in the process. Do not try this at home,” O’Barr warned. “Some people do, but that’s another story.”

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