Is Circumcision Ethical and Legal? The American Academy of Pediatrics vs Attorneys For the Rights of...

Attorneys for the Rights of the ChildNewsletter

© ARC Fall/Winter 2013 Volume 10, Issue 2Whole Number 29

Protecting Children'sBodily Integrity

Secular Medical Forum Reporton United Nations WorkAntony Lempert, MD

Chair, Secular Medical ForumThe (UK) Secular Medical Forum is a nonprofit organizationrun by volunteer healthcare

professionals concerned to protect patients from the forced imposition ofother people’s personal beliefs. As partof this work, we campaign, educate anddebate in the UK and beyond to endforced genital cutting of all children.

Forced genital cutting of boys inthe UK is mainly performed at the request of religious parents. The argument that they usually rely upon is thatthe perceived community rights of theadults who have chosen their religionsupersede the child’s right to autonomyand physical integrity.

In 2012, the SMF and the (UK)National Secular Society (NSS) workedtogether under the umbrella of theInternational Humanist and EthicalUnion (IHEU) contributing to certaindevelopments at the United Nations(UN),

The Nether World of Premature,Forcible Foreskin RetractionsJohn V. Geisheker, JD, LL.M.

Executive Director and General CounselDoctors Opposing CircumcisionOne of the services that DoctorsOpposing Circumcision(D.O.C.) provides – one we

blundered into – is advising parentswho are angry because their intact boywas injured by premature, forcible foreskin retraction (PFFR). Word that wewill help, pro bono, has been widely

circulated on parenting websites.Currently we areasked to intervenein about 100 casesper year, a tinypercentage of theincidents nationwide, which weestimate at wellover 100,000. Twoweeks ago, five cases came to me in asingle day. I keep a ‘hotline’ open forparents (my personal cell) and because Ilive on the West Coast, occasionally get

tearful 5:00 a.m. calls from anguishedEast Coast parents, usually mothers, butnot always. D.O.C. has been providingthis service for over a decade.

Perhaps a brief medical lesson, adose of continuing medical education(CME as it is called), is useful here:

Every boy is born with an underdeveloped penis, one where the foreskinis fused to the glans by a membrane, thebalanopreputial lamina (translation:glansforeskin layer). This membranecould be thought to provide the sameprotection to the developing foreskin andglans as the

...continued on p.17

John V. Geisheker

Antony Lempert, MD

Peter W. Adler, ARC Legal Advisor

...continued on p.19

United Nations Work EuropeanDevelopments p.21 ARC Updates p.28 Grassroots

Intactivism p.32 Charleston Debate

Is Circumcision Ethical andLegal? The AmericanAcademy of Pediatrics vs.Attorneys for the Rightsof the ChildPeter W. Adler

ARC Legal AdvisorOn October 18 and 19 at theMedical University of SouthCarolina (MUSC) in Charle

ston, Dr. Michael Brady of the American Academy of Pediatrics (AAP) TaskForce on Circumcision and AttorneySteven Svoboda of Attorneys for theRights of the Child (ARC) debated theethics and the legality of nontherapeutic circumcision in the United States.This was an important debate, the firstand likely the last between the two organizations, and something of a showdown insofar as the AAP is the primeforce in promoting male circumcisionin the United States (more about thatbelow) while Attorney Svoboda hasbeen a leader in arguing for the pastnineteen years that circumcision is unethical and unlawful.

...continued on p.5

2 Attorneys for the Rights of the Child Newsletter Volume 10, Issue 2

Attorneys for theRights of the Child

2961 Ashby Ave.,Berkeley, CA 94705

Fax/phone: 5104644530www.arclaw.org

email: [email protected]. Steven Svoboda......... Executive DirectorGeorganne Chapin.......... Technical AdvisorDavid Wilton....................... Legal StrategistPeter Adler.............................. Legal AnalystMarc Angelucci..... Gender Equity StrategistDavid Miller......... Director, ARC KentuckyDavid Llewellyn............. Litigation AdvisorAnthony Levin..... Director, ARC AustraliaTravis Konzelman. Networking CoordinatorJonathan Friedman... Web/Newsletter EditorJeff Borg........................... Graphic Designer

Associates of Attorneys for Rights ofthe Child receive no compensation. Allcontributions are tax deductible and godirectly towards paying the expenses ofprotecting children’s genital integrity.

Your comments regarding the ARCNewsletter and its contents are welcomed.

[email protected]

Inside this issue

Executive Director Steven Svoboda andWebmaster and Newsletter Editor

Jonathan Friedman, New York City,November 3, 2013

Message from the Executive DirectorSteven Svoboda........................................................................................3

Charleston DebateIs Circumcision Ethical and Legal?: The American Academy of Pediatrics

vs. Attorneys for the Rights of the ChildPeter W. Adler.......................................................................................... 1

Went to Med School to Talk About EthicsAubrey Terrón......................................................................................... 11

Charleston Debate Marks Turning Point in Movement to RecognizeCircumcision as a Human Rights ViolationSteven Svoboda.......................................................................................12

Intactivist ConferencesKeele Conference Proves a Resounding Success

Steven Svoboda.......................................................................................14The Cutting Edge: Making Sense of European Legal Developments

Amidst Growing Recognition of Children’s Legal, Ethical, andHuman Rights to Bodily IntegrityJ. Steven Svoboda................................................................................... 17

Feature ArticlesSecular Medical Forum Report on United Nations Work

Antony Lempert, MD...............................................................................1The Nether World of Premature, Forcible Foreskin Retractions

John V. Geisheker, JD, LL.M...................................................................1On Being an Intactivist Medical Student

Matthew H. H. Young............................................................................. 21European Efforts to Protect Children's Rights

Council of Europe Condemns Male Circumcision....................................21European Council Passes AntiRitual Circumcision Resolution............. 22Court: Circumcision Too Risky For SixYearOld....................................22Hamm Regional Appeals Court Defines New Circumcision Regulation 23Motion to Ban NonMedical Circumcision Introduced in Sweden..........23Circumcision Breaches Human Rights of the Child................................. 24Swedish County Eyeing Ban on Circumcision.......................................... 24Nordic Resolution on NonTherapeutic Circumcision

Dr. Morten Frisch, MD, Ph.D................................................................. 25Statement on NonTherapeutic Circumcision of Boys

Nordic Association for Clinical Sexology.............................................. 26Norway May Ban NonMedical Circumcision of Boys.............................26Norway to ‘Control’ Circumcision with Respect for Jews and Muslims 27Court: Circumcisions of Muslim Boys Not an Offence............................ 27

ARC UpdatesThe Perils of Circumcision (Feature Published by the National Post)

J. Steven Svoboda................................................................................... 28Questions to Ask Regarding Infant Circumcision (Letter to JAMA)

J. Steven Svoboda................................................................................... 29Steven Svoboda’s and Bob Van Howe’s Journal of Medical Ethics

AAP Paper Attacked by Brian Morris in JME.................................. 29ARC Media Updates................................................................................. 3031

Grassroots IntactivismSan Francisco Pride 2013

James Loewen.........................................................................................32“Los Angeles Will Hear Us” Protest

Marc Angelucci.......................................................................................33Orlando AAP Experience Protest............................................................... 33Cincinnati Demonstration

Jeff Cowsert............................................................................................ 34...continued on next page

Fall/Winter 2013 Attorneys for the Rights of the Child Newsletter 3Message from theExecutive Director

December 20, 2013This was certainly a year toremember, an amazing whirlwindof momentous events.

October marked what can only bedescribed as a smashing victory byintactivists at the Twentieth AnnualThomas A. Pitts Lectureship in MedicalEthics, held at the Medical University ofSouth Carolina pursuant to a conferencetitled, “Ethical and Legal Issues inPediatrics.” I was the only nonphysicianinvited, and debated the AAP’s Dr.Michael Brady in a talk entitled,“Newborn Male Circumcision – Is ItEthical; Is It Legal?” I also appeared in a“Seminar on Pediatric Controversies”opposite Dr. Brady and Dr. DouglasDiekema, also an AAP Circumcision TaskForce member. I’m still high from anawesome team win intactivists were ableto pull off over Brady and Diekema.

We proved we know the science farbetter than the Task Force and Bradyfound himself unable—after hearing myfiveminute presentation in theseminar—to rebut a single one of ourarguments. As they each personally toldme later, two (!) of the five physicianpresenters who are not AAP Task Forcemembers were completely convinced byour arguments and went from being prettystrongly procircumcision prior to theevent to coming to oppose the procedurebased on our arguments. This was a trueteam victory, with my coauthor, ARCLegal Advisor Peter Adler, AubreyTaylor, and Angel Alonso Terrónproviding awesome support and askingsome hard questions the AAP Task Forcemembers simply could not answer. TheJournal of Law, Medicine and Ethics willbe publishing the long article Bob VanHowe, Peter and I wrote as part of aspecial issue devoted to this conference.

In September, I traveled to the UnitedKingdom for one of the most pleasurableand productive meetings in which I haveever had the good fortune to participate.Genital Autonomy organized the twodayconference titled, “Promoting Children’sRights in Europe: Recent Developments”and held at the University of Keele inEngland on September 16 and 17, 2013.This newsletter includes my story on thisconference and photos.

My Keele presentation—which I amalso writing up for publication in thecoming months—analyzed the 2012Cologne court case holding that malecircumcision violates human rights, thelaw and even the German federallegislation attempting to overturn thatcourt case. I discussed four distinctreasons for why the current federallegislation is invalid, and why the earlierCologne court decision is soundly basedin medical ethics, law, and human rights.The talk went very well and the questionsafterwards were quite perceptive.

On September 24, 2013, Swedishlegislators introduced a bill that wouldoutlaw circumcision of males youngerthan 18 years of age for nonmedicalreasons. On October 1, 2013, the Councilof Europe passed a recommendationendorsing a child’s right to physicalintegrity and a resolution discussing theright to physical integrity in more detailand specifically supporting genitalautonomy for children by opposingseveral practices including malecircumcision, female genital cutting(FGC), and “early childhood medicalinterventions in the case of intersexualchildren.”

A few days ago, I submitted anabstract for the 2014 BoulderSymposium, at which I will be discussingrecent European legal cases andlegislation, including the 2012 Colognecase and subsequent legislation, the 2013Hamm, Germany case, and earlier casesfrom Dusseldorf in 2004, from Austria in2007, and from Frankfurt in 2007. Thiswill also become a law review article, andwe have been paying for translations of anumber of German articles and cases tosupport this project. (All of thetranslations will be shared with theactivist community.)

In early October, the National Post,one of Canada’s major newspapers,published an article that I was invited towrite after submitting a letter in responseto the National Post’s reprinting of MarkJoseph Stern’s article, “‘Intactivists’Against Circumcision.” In recent months,I have been interviewed by no fewer thanthree different film crews that will eachbe featuring my work in upcomingmovies, and a fourth film interview isscheduled for later this month. Also, Ihave appeared four times this year on aLos Angeles radio show, the Maria

Meeting of Steven Svoboda and ChicagoActivists: (l. to r.) Matthew Weyer, Ron

Low, Steven, Dan Strandjord, RikPrzybranowski, Rich Eide,

December 8, 2013

(l. to r.) Argonne National Laboratory'stour guide Daniel West, Matthew Weyer,Steven Svoboda, Ken Drabik, Argonne

Laboratory, Argonne, IL,December 7, 2013

Baltimore DemonstrationDevon Osel................................ 35

Circumcision Crisis NortheastMarathonJonathan Friedman.....................36

News, Views, & ReviewsOn the Water: Circumcision is

Sadism, Not Culture................ 39Review: The Business of Baby

Review by J. Steven Svoboda....40R3m Claim for Six ‘Botched’

Circumcisions...........................41Mother Upset Over Botch...........42Circumcision Does Not Prevent

Sexually Transmitted InfectionsIntactNews................................. 42

Woman Fined $140 a Day forRefusing to Circumcise Son.... 42

Ethical Issues in Israel’s BizarreCircumcision CaseRebecca Wald............................ 43

Rabbi Sued After Baby InjuredDuring Circumcision............... 44

4 Attorneys for the Rights of the Child Newsletter Volume 10, Issue 2Sanchez Show, and a fifth appearance tosummarize events of this momentous yearwill be taking place on January 8, afterwhich I will announce the Internetposting of the podcast. On September 8, Iappeared on New York City’s public radiostation, WBAI (www.wbai.org) on the“Walden’s Pond” show of longtimeintactivist and radio show host SheltonWalden.

Early this year, the JME published apaper by Bob Van Howe and me, whichin turn criticized the AAP’s August 2012position statement and technical reportand which also provoked the highlyunusual step of a response by the AAP inthe pages of the JME. The same issue ofthe JME also included another paper ofmine that led off their special issue oncircumcision, demonstrating the profoundand numerous human rights principlesthat militate against neonatal infantcircumcision.

Earlier this year, Springer publishedin book form my paper showing thatinformed consent doctrine is inapplicableto neonatal circumcision.

We recently celebrated the twoyearanniversary of our release of our “KnowYour Rights” brochure. ARC continues tomake the brochure available on ourwebsite to provide information forpotential litigants on how to seek legalcompensation for the wrong ofcircumcision. This newsletter issue alsomarks the oneyear anniversary of therelease of our list of all known significantlegal awards and settlements incircumcisionrelated lawsuits.

This issue is stuffed with greatcontributions: 1) Eyewitness accounts byARC Legal Advisor Peter Adler, AubreyTaylor and I – as well as a photo spread –of the groundbreaking Charleston, SouthCarolina pediatric ethics debate betweenmyself and representatives of the AAP; 2)an article by John Geisheker on forcibleretraction cases in which he has beeninvolved; 3) an article by the UK’sAntony Lempert regarding progress beingmade at the United Nations; 4) myeyewitness account including a photospread of Genital Autonomy’soutstanding conference held in the UK inSeptember; 5) A piece by Matthew Youngabout being an intactivist medicalstudent; 6) a section summarizing thenumerous recent positive developments in

Europe; 7) several eyewitness reports onimportant grassroots events; 8) newsreports; 9) my book review of afascinating new book about problemswith the profitdriven US medical system;10) a reprint of my invited article in theNational Post, one of Canada’s topnewspapers; and more.

I am particularly gratified about thenews from the UN. As some readersknow, I organized a team that travelled toGeneva in JulyAugust 2001 (see photoelsewhere eon this page) and placed onthe official UN record the first (and to myknowledge still the only) document evercentrally devoted to male circumcision asa human rights violation. Now ourEuropean friends have picked up the balland moved it way up the field, which isfantastic news.

We are making serious progress, notonly in Europe but also in the US. I see atrend continuing whereby genital integrityis being discussed more in the context ofother issues and is filtering more intomainstream awareness. In addition to theUnited Nations now coming to see it inthe context of other human rightsviolations, Jennifer Margulis addressescircumcision as one of several issues inher book. Most strikingly, recentdevelopments with the Rabbi who gotinternational attention for botching acircumcision and the Israeli mother whowas fined for keeping her son intact arebringing this issue to the attention ofmany who may have not thought about itmuch in the past and inducing them toponder it carefully. Ten years ago or evenfive years ago, both these events—not tomention the Northeast Tour on whichARC Newsletter Editor/WebmasterJonathan Friedman fascinatingly reportsin this issue would have attracted muchless interest. And of course the successwe enjoyed in our team victory inCharleston, South Carolina could neverhave happened.

We are again very honored that InSearch of Fatherhood magazine(http://globalfatherhooddialogue.blogspot.com) featured me (along with a coupleother activists on other issues) on thecover of each of its four 2013 issues, witheach issue reprinting a different article orarticle excerpt of mine.

Webmaster (and Newsletter Editor)Jonathan Friedman and Legal Advisor

Peter Adler are two of the best comradesand colleagues I could possibly have.Peter was an invaluable key to oursuccess in Charleston on alllevels—practically, logistically, andemotionally. Jonathan continues to doawesome work on our website and instrategically planning ARC’s future withme and our wonderful board members.Social Networking Director TravisKonzelman and my local colleague, ARCLegal Strategist David Wilton have alsohelped tremendously with what has trulybeen a team effort.

As always, we sincerely appreciatethe invaluable support each of you offersus, whether it comes in a form that isfinancial, emotional, logistical, ascolleagues, or a combination of theseroles. We literally could not do it withoutyou! 100% of all taxdeductible donationsgo directly to defraying the costs ofsafeguarding children. Donations can besent to J. Steven Svoboda, ARC, 2961Ashby Avenue, Berkeley, CA 94705, ormade through Paypal at our website(www.arclaw.org/donate) or using thePaypal address [email protected].

I retrospectively wish all the happiestof Hanukkahs and the merriest ofChristmases, and I hope everyone has avery joyful New Year. J. Steven SvobodaExecutive DirectorAttorneys for the Rights of the Child

Steven, Eli (age 11) and Sarita (age 8)

Fall/Winter 2013 Attorneys for the Rights of the Child Newsletter 5

This article summarizes with minimal commentary Dr. Brady's and AttorneySvoboda's presentations on day one of theconference and the heated argumentsbetween physicians and intactivists onday two. It then asks, what conclusionscan be drawn from the debate? Is circumcision ethical and legal, unethical and illegal, or a never ending controversy?DAY ONE – THE DEBATE

The AAP. Dr. Brady, a member of theAAP Task Force and also Chairman of theDepartment of Pediatrics at Ohio StateUniversity, led off the debate, arguing thatcircumcision is legal and ethical. TheAAP has issued several circumcisionpolicy statements since 1971, whereas theAmerican Medical Association has issued

only one, in 1999. Thus, the AAP ishighly influential among pediatriciansand parents in setting American medicalpolicy on circumcision.

As expected, Dr. Brady's presentationmirrored the conclusions of the AAP’sTask Force on Circumcision in 2012,published last August in Pediatrics, theofficial journal of the AAP. The Academyhas never recommended the circumcisionof any male infant. Nonetheless, in 2012,the Task Force concluded, based Dr.Brady said on an unbiased review of current evidence by its impartial members,that “the health benefits of newborn malecircumcision outweigh the risks,” and“justify access to the procedure for thosefamilies who choose it... Parents shouldweigh the health benefits and risks inlight of their own religious, cultural, andpersonal preferences.... The preventiveand public health benefits also warrantthirdparty reimbursement for newborncircumcision.”

According to Dr. Brady, there is clearevidence that circumcision reduces therisk of urinary tract infections (UTIs),penile cancer, and STDs including HIV.Randomized controlled trials (RCTs) inAfrica show that circumcision reducesHIV incidence by 51% to 60% over twoyears, and that the benefit is maintainedbeyond the study period. The lifetime riskof HIV in males in the U.S. is 1.87%. Circumcision reduces HIV risk in the UnitedStates by 15.7%. Reducing newborn malecircumcision in the United States to ratessimilar to Western Europe would increasemedical costs by one half billion dollarsper year. 18 states have ended Medicaidcoverage of newborn male circumcision,which Dr. Brady stated would result inover 100 additional HIV cases and $30million in additional medical costs.

Brady asserted that the risk of acutecomplications in U.S. and U.K. hospitalsis low, less than one in 500 (.2%). Mostacute and late complications are minorand poor clinical outcomes are extremelyrare. Complication rates are higher whenperformed: outside of an accredited medical facility; by inadequately trained practitioners; without using sterile techniques;on an infant who is not medically stable;on a premature infant; and on an infantwith or with a family history of bleeding.These complications do not occur whentrained practitioners circumcise boys in asterile setting.

Dr. Brady acknowledged that newborn circumcision prevents the child frommaking his own decision for himself inthe future, and stated, “If the health benefits including lower complication rateswere not lost by deferring to a later age,the decision would clearly be to defer.”[Editor’s note: Svoboda later made use ofthis concession, as we shall see.]

Addressing a common criticism ofthe 2012 AAP circumcision policy, Dr.Brady stated that the Task Force did notignore the fact that circumcision removeshighly innervated tissue. Rather, “available data does not provide evidence ofalteration in sexual function or satisfaction, following circumcision... The TaskForce felt that removal of the prepuce[the foreskin] was accommodated by remaining anatomical structures. Its removal did not result in identifiableharm.” (Emphasis added.)

As to the ethics and legality of circumcision, Dr. Brady noted that parentsare given great freedom in making decisions for their children. Parents’ decisions should not be interfered with solong as the parents do not harm (he latersaid “seriously harm”) their child and actin their best interest. “Best interest”, heasserted, is informed by the parents’ experiences and culture, and by evidenceand information. The parents of all newborn boys should be informed that thereis strong evidence that the health benefitsof circumcision exceed the risks, and thatthey have the right to make the circumcision decision. Dr. Brady concluded bystating that no jurisdiction in the UnitedStates has any law prohibiting male newborn circumcision.

ARC. Attorney Svoboda then arguedthe opposite, that circumcision is unethical and already illegal. His goal goinginto the debate was to be very respectful,as always, and to try to induce a smallpercentage of the audience, primarilyphysicians and nurses, to be more openminded about the issue; that is, to makemodest inroads into their beliefs. Hebegan by stating his working hypothesisthat everyone in the room cares aboutchildren, is acting in good faith, and accepts the fundamental rule of medicalethics, "first do no harm".

All boys and girls, he said, are borngenitally intact. Nontherapeutic male circumcision is rare in the Western world; the

CChhaarrlleessttoonn DDeebbaattee

“Is Circumcision Ethical and Legal?...”...continued from p.1

Pitts Lecture audience, Charleston, SCOctober 18, 2013

Douglas Diekema presenting,Charleston, SC, October 18, 2013


United States is the exception. Unlike theAAP, medical organizations in the U.K.,Australia, and the Netherlands state thatthe disadvantages of circumcision exceedthe advantages, and that circumcisionraises serious ethical and legal concerns.

Circumcision is irreversible, unnecessary, nontherapeutic, invasive surgery thatis not recommended by any national medical association in the world, not even bythe AAP. Physicians do not irreversibly remove other functional tissue from childrenexcept when medically necessary after adiagnosis. Men rarely elect circumcision forthemselves, and men circumcised withouttheir consent may come to resent it.

Circumcision is dangerous. Therehave been many botched circumcisions.Physicians who circumcise are often notwelltrained (as Dr. Brady had conceded).The risk of serious untoward eventsranges from 2% (not 0.2%) to between10% and 20%. 7.4% of all visits to pediatric urologists at Massachusetts GeneralHospital over five years arose from complications of circumcision. At Georgetown University hospital, 45% requiredcorrective surgery (a second surgery necessitated by the first, unnecessary surgery). There is good evidence thatcircumcision causes more than 100 deathsper year in the United States alone. TheAAP’s claim that the health benefits ofcircumcision exceed the risks is contradicted by its own statement that the incidence of complications is unknown. Inaddition, the AAP left out the harmcaused by circumcision (e.g., loss of tissue and sexual harm) out of the calculation of advantages and disadvantages.

The AAP’s 2012 statement also failsto mention the anatomy and function ofthe foreskin being removed. Circumcision causes a loss of sexual function,removes the most sensitive parts of thepenis, and causes orgasm difficulties in

men and frequent sexual difficulties intheir female partners.

The likelihood that any boy or manwill benefit from circumcision is verylow. It would be necessary to circumciseat least 100 boys to benefit one, whichwould cause two cases of hemorrhage, infection, or even more serious complications such as death. In any event, UTIscan be treated with antibiotics. Boys arenot at risk of penile cancer, which is asrare among men as being struck by lightning. Moreover, rates of penile cancer inthe United States are greater than in Denmark, Norway, Finland, and Japan, wherecircumcision is rare. As to the AAP’sclaim that circumcision helps preventHIV, infants are not at risk of STDs, sothe circumcision decision can be deferreduntil they reach the age of sexual maturity. The AAP’s claim that circumcisionhelps prevent HIV is out of date; Garennewrote in 2013 that the protection fromHIV is “negligible or nil” – and contradicted by the AAP’s own 2012 statementthat, “key studies were performed inpovertystricken African populations withHIV burdens that are epidemiologicallydifferent from HIV in the United States.”Condoms are still required and suffice, sonothing is gained by circumcision.

The AAP’s most recent policy statement does not even discuss the fundamental principles of medical ethics.Ethical concerns about circumcision aremounting. As 38 distinguished physicians, most from Europe, wrote in response to the 2012 AAP statement, “thecardinal question is not whether circumcision can prevent disease, but how disease can best be prevented.” (Frisch et al.,Cultural Bias in the AAP's 2012 Technical Report and Policy Statement on MaleCircumcision, published online in Pediatrics on March 18, 2013.) The AAP’s ownBioethics Committee stated in 1995 thatthe child is the patient, not the parent; thatphysicians cannot ethically operate onhealthy boys for religious, cultural, orpersonal reasons regardless of parentalwishes; and that all medical decisions involving children that can be deferredmust be deferred. The circumcision decision can be deferred, and boys must beleft genitally intact so as to make the decision for themselves as adults.

The ethical rule is that minors mayonly be exposed to medical treatments ifillness or abnormalities are present. Even

then, the advantages of a procedure mustoutweigh the disadvantages, the intervention must be the only reasonable way toobtain these benefits, and interventionmust be necessary to the wellbeing of thechild. Nontherapeutic male circumcisiondoes not meet any of these conditions.

Svoboda continued that circumcisionalso violates the cardinal rules of medicalethics: to respect the patient’s autonomy;to “First, Do No Harm”; to do good; andto be just or fair, whereas circumcisionunfairly deprives boys and men of anopen future. The surgery also violatesAmerican Medical Association (AMA)ethical rule 2.19 that physicians shouldnot provide or seek compensation formedical services that they know are unnecessary. When the foreskins are sold topharmaceutical and cosmetics companies,this also violates AMA rule 2.08 prohibiting the commercial use of human tissuewithout the patient’s consent, which infants cannot grant.

Attorney Svoboda then discussedhow legal concerns are mounting as well.In September 2013, Swedish legislatorsintroduced a bill that would outlaw thenontherapeutic circumcision of minors.In October 2013, the Council of Europepassed a recommendation endorsing achild’s right to physical integrity and opposing male circumcision. Svoboda argued that circumcision is already illegalin the United States. Cutting girls’ genitals is prohibited by federal law, and boyshave a constitutional right to equal protection of the law. Every individual, including every child, has rights under thecommon law, constitutional law, and international human rights law to securityof the person or to be free from the harmthat circumcision causes, and toautonomy or privacy or to make important decisions about his own body forhimself. Under international human rightslaw, the supreme law of the land in theUnited States, children, who are especially vulnerable, also have special rightsto health, freedom and dignity, and to befree from mental and physical violence,and from traditional practices prejudicialto their health which includes circumcision. Circumcision also constitutes anunlawful assault on boys..

Legally, parents can only consent tonecessary medical treatments. The Supreme Court settled in 1944 (in Prince v.Massachusetts) that parents cannot risk

ARC Legal Advisor Peter Adler andSteven during lunchtime panel,

Charleston, SC 101813


harming, let alone actually harm, theirchildren for religious or other reasons. Oneperson’s constitutional rights, Svobodasaid, end at another person’s body.

Even if parents had the legal right tomake the circumcision decision, whichthey do not, physicians cannot lawfullytake orders from parents to perform surgery that they do not recommend. Circumcision is not medically justified and isbeyond the scope of medicine.

As to Medicaid, it only covers necessary medical care, not cosmetic, elective,or ritual procedures like circumcision. Itis unlawful for physicians and hospitals touse Medicaid to pay for circumcision.

Summing up extemporaneously, Attorney Svoboda stated that circumcisionhas many disadvantages without anymeaningful benefits, and is not medicallyjustified. It violates many ethical rules including the fundamental ethical principlesof autonomy and of doing no harm. It isalready illegal: boys have the right undermany laws to normal bodies and genitalia; parents do not have the right tomake the circumcision decision; andphysicians cannot lawfully operate onhealthy boys.DAY 2 – HEATED DISCUSSION

On day one, six presenters had debated three ethical issues. On day two,each presenter was given five minutes tospeak from the panel, then questions weretaken from the audience, composed onthe second day primarily of physicians.The ethicist Dr. Dougles Diekema, likeDr. Brady a member of the AAP’s TaskForce on Circumcision, who had given apresentation the previous day about theethics of refusing immunizations, joinedDr. Brady on the panel.

Before the panel discussion began,however, I overheard Dr. Brady expressing

annoyance to another physician that a nonphysician (Attorney Svoboda) had beenallowed to speak. This was odd insofar asthe debate concerned the legality of circumcision.

I also overheard one physician tellingthe moderator that he thought it unwise tovideotape the second day lest it be usedagainst the physicians, even though theground rules were that the debate, whichwas open to the public, would be videotaped. The moderator acquiesced andstopped further videotaping.

Dr. Diekema began by calling thecircumcision issue complex with arguments on both sides. The tendency ofmany when faced with these issues is totake a side, ignoring the complexities. Hesaid, “I think this issue [circumcision] hasbeen oversimplified, and that to eithermake the claim that people are better offbeing circumcised or better off not beingcircumcised is to ignore an important aspect of the issue and some of the data related to that issue. It’s one of the reasons Ihave deep concerns about trying to findlegal or legislative answers to that issuebecause it precludes, it basically ignoresthat there is another side to this issue.”

From the audience, after all panelistshad spoken, I challenged Dr. Diekema’sclaim that there are two sides to the ethicsand legality of circumcision. I said, theAMA’s principles of medical ethics andthe legal rules that Steven discussed arewell established and have been for manyyears. The AAP own Ethics Committeestates that the duty of the physician is tothe patient, regardless of the parents’ desires. I added, “It seems to me that theAAP has disregarded the ethical rules andhas disregarded the legal rules, andsimply makes claims that can’t be supported, such as that it is the parents’ rightto make the decision for any reason. I

think you’re not really looking at what arethe ethical rules and what are the legalrules, or responding thoroughly to thecriticisms that have been made, not justby Steven, but by European medical associations, that circumcision is unethicaland unlawful.... I don’t think that simpleanswers are good enough, like ‘parentshave the right to do this’.”

Dr. Diekema replied condescendinglythat he thoroughly disagreed: “This isyour view of the ethical issues and not acomplete view”. Diekema said, “Parentsought to decide precisely because it is acomplex issue. There is data here thatshows some medical benefit. It’s notstrongly in support of either polar position. You’re talking about a rightsbasedview of ethics, but there are other ways ofthinking about ethical issues, includingwhether a parent ought to be able to decide whether the benefit of this procedurefor their given child exceeds the risks.And I don’t want an advocacy group doing that for my child or any other child.”

I responded [Editor’s note:trenchantly] that I did not want a group ofphysicians such as the AAP making important decisions about boys’ and men’sbodies. Every man should make the decision for himself.

Despite suffering from jet lag, StevenSvoboda had woken up at dawn on thesecond day to prepare and practice hisfive minute statement. He addressedsome of Dr. Brady’s arguments from theprevious day. He emphasized that theAAP had acknowledged in its 2012 reportthat the true incidence of complicationsafter newborn circumcision is unknown.Steven said, we all agree that circumcision doesn’t prevent HIV/AIDS. Andalthough Dr. Brady claims a 60% relativerisk reduction, the absolute risk reductionis only 1.3%, unproven in Africa, letalone in the U.S., as the AAP 2012 itselfconcedes, so no man can rely on circumcision to protect himself from HIV. Theprotection against HIV in the UnitedStates, according to 2013 data from HIVexpert Garenne, is “negligible or nil.” Acondom is still required and suffices, sonothing is gained by circumcision.Svoboda reiterated that there is a risingtide of European doctors officially statingthat circumcision is both unethical andunlawful and should be banned. Svobodaadded, “On July 4, 2013, that wellknownradical anticircumcision group, the

Michael Brady presenting at MedicalUniversity of South Carolina, Charleston,

October 18, 2013Steven Svoboda presenting at Medical

University of South Carolina, Charleston,October 18, 2013

8 Attorneys for the Rights of the Child Newsletter Volume 10, Issue 2United Nations, issued a document inwhich it ‘expressed concern about reported short and longterm complicationsarising from some traditional male circumcision practices.’” The moderator cutSvoboda off in midsentence as evidentlyhis five minutes were up.

Although Dr. Brady had been allottedfive minutes to speak, he spoke onlybriefly, as follows. Activist groups have atendency to disregard evidence discounting their particular point of view, whichdoes not lead to ethical medical decisions.Brady continued, “nonbiased people(meaning physicians like himself and themembers of the AAP Task Force on Circumcision) need to be able to review itand to determine what the evidence suggests.” He then said, “Dr. Svoboda... erMr. Svoboda... reiterated a lot of what hesaid yesterday, but actually a lot of whathe mentioned today is inaccurate. But it’swhat he believes in, and I think that it’sunlikely that I’m going to change that, soI’m not going to try.”

Of course Dr. Brady’s job was not toconvince Mr. Svoboda of the merits of hisarguments, but rather to convince theaudience, which he evidently concludedwas “mission impossible.” If anythingMr. Svoboda had said had been inaccurate, Dr. Brady would certainly have pointed it out. The fact is that Dr. Bradysimply had nothing to say.

Dr. Diekema then said, amazingly,“This business about girls and boys beingequal (as if this were a shocking, novelconcept, rather than a founding Americanprinciple) ... no one has ever claimed anypotential medical benefit to female genital cutting.” Attorney Svoboda replied thatthat was false and cited a study byStallings and Karugendo. Dr. Diekemathen stated that the criticism of the AAP’s2012 report was by 38 European physicians, many of whom are known to activists against circumcision, but not byEuropean physicians generally. (Actually,circumcision is rare in Europe, manyEuropean physicians and medical associations oppose circumcision, and the AAPitself is a medical association.)

Attorney Svoboda then said, “Therewere arguments both for and againstslavery. The default is not to circumcise.The AAP’s own committee on bioethicshas repeatedly enumerated principles thatare violated by circumcision.” Dr. Brady

said, “That’s your interpretation,” and Attorney Svoboda replied “No, I’m readingwhat they said.”

Dr. Brady then said, “We are talkingabout whether parents can harm theirchildren, but that if the health benefits exceed risks, it’s not harm.” I then said,“That is incorrect. The law is that physicians cannot risk harming, let alone actually harm, their children for religious orother reasons. Under the law, any touching beyond a trifle is harm. Circumcisionis harmful: it harms all boys and men.”

Dr. Brady said, “It does not harmboys.” I said, “It does, they are disfigured,surgery removes part of their skin.” Dr.Brady conceded that it removed part oftheir skin, but said, “other than that, yourstatements are inaccurate because youhave strong opinions. There are a numberof things that are removed, it’s functionaltissue people have removed, parents havethe right because they believe it’s in thebest interests of their child.”Treating a Healthy Body Part Like a Tumor

Ms. Aubrey Terrón, an intactivist,then gave an eloquent speech. The foreskin, she said, is a healthy body part. Unless people are diagnosed with a medicalcondition that cannot be treated in anyother way, they have the right to keephealthy parts of their bodies. She said,“You are treating the foreskin like a tumor when it is a healthy body part.”

Ms. Terrón continued, “If you do nothave this body part, you are likely biasedagainst it and to dismiss its value. Otherbody parts could become diseased, likebreasts, but you don’t apply a riskbenefitanalysis to the removal of healthy breastbuds. You perhaps do not have a foreskinor value it, and believe that you have aright to intervene and remove it as if itwere a tumor. You have to respect theautonomy of the person who owns thebody part. It is not your place to take thattissue from a person. You’re in such ahurry to take this body part, perhaps youdo not understand its value.”

Dr. Brady then discussed immunizations, implying that circumcision is preventive medicine like immunizations.“They involve potential risk, although itis low, but there are health benefits.” Aubrey said, “Stop immunizing, and whathappens?” Dr. Brady said, “Lots ofpeople die.” Aubrey said, “Yes exactly,

take away circumcision, what happens?”Brady said, “You circumcise more, youhave fewer people dying.” AttorneySvoboda asked: “Why aren’t Danishpeople dropping in the streets? Why arethey healthier than men in the UnitedStates?” Aubrey continued with an extremely important point, “So are all bodyparts up for grabs?”

Mr. Angel Alonso Terrón, Aubrey’shusband, then asked of the male panelists,“Which of you have a foreskin, and canexplain the functions of the foreskin?” Dr.Brady replied – shockingly for a memberof the Task Force charged with informingAmericans about circumcision – “Theforeskin was created before clothing wasinvented. I don’t think anybody knowsthe function of the foreskin. .. nobodyknows the function of the foreskin.”

Attorney Svoboda suggested that Dr.Brady should read the studies by JohnTaylor and others showing the variousfunctions of the foreskin. Svoboda statedthat the foreskin is richly innervated andmoves in a “gliding action”, among otherfunctions that are lost to circumcision. Yetthere is not a word about the functions ofthe foreskin in the AAP’s statement. “Youshould educate yourself about its functions before you issue your next opinion.”

Mr. Terrón then said, “I have a foreskin and use it on a daily basis. Where Icome from, circumcision is rare. When Icame to America, I spoke to my Americanfriends about circumcision, and it wasclear that their experiences are different.Having a foreskin eliminates the need forlubrication. The foreskin creates a sealand prevents fluids from leaving. If youhave only a shaft with a head, it removeslubrication from the vagina.”

Mr. Terrón then said, “I exposed myglans for one month as an experiment. Inoticed that it became dry, and that sensation diminished, but the sensation returned once I covered it again. So theforeskin has protected my body sincebirth. It’s like the moist beginning of thevagina. It (leaving my foreskin retracted)was also bothersome: the glans rubbedagainst my underwear all the time and itbecame numb. You are like a group ofmechanics telling me why I don’t need todrive with power steering without everhaving driven a car with power steeringbefore. You have to drive a car to knowhow a car drives with power steering.”


Attempting a World RecordThe moderator, Dr. Robert Sade, a

professor at MUSC, then said, let’s turnthe heat down here. It was story time. “Iwas the only surgeon on an aircraft carrier.There were long periods of boredom withnothing going on, and to keep the operating room functional, so we could reactquickly, I did circumcisions. These youngsailors would line up at the door. Theywere anxious to have the circumcisiondone because they had heard from othersthat it improved sex. You could last longer.(Robert S. Van Howe, M.D., coauthor ofa paper we have written in connectionwith the debate, suggested that perhapsthey lined up so that they could avoid active duty for a few weeks.) To many men,this is a very important issue. In fact, wewere planning one day to set a record. Wenever made it into the Guinness Book ofWorld Records, but we tried to do 100 circumcisions in one day. The reduction insensation is very valuable to many men.It’s beside the point to talk about the lossof sensitive tissue. The satisfaction level isincreased after adult circumcision.”

Mr. Terrón asked, “How can sensation be diminished, but satisfaction increased? Some men prefer moresensation.” Dr. Brady cited two studiesshowing that some men circumcised asadults reported unchanged satisfaction,some said sex was better, and some said itwas not better. He concluded (I must add,not very scientifically or credibly) that“somehow circumcision does not significantly alter function, satisfaction, orsensitivity.”

Mr. Terrón said that the data would beskewed. “Men with foreskins may be veryreluctant to part with them. If you don’t understand the pros of being intact, how canyou give an accurate medical assessment?The opinion of a doctor with a foreskin

would be better informed than the opinionof one without a foreskin.” Dr. Brady said,“Physicians can give good advice even ifthey don’t have a body part. For example,male physicians can inform female patientsabout the benefits and risks of a mastectomy.” Mr. Terrón replied, “Well, when Iasked, what is the function of the foreskin?,no one could answer me.” Indeed, Bradyhad said that no one knows the functions ofthe foreskin.

The pediatricians on the panel thenall said, nodding their heads, “Parents,parents have the right to choose circumcision.” A Jewish professor on the panel,a pediatrician in another field, remarkedthat Mr. Adler’s use of the term “disfiguring” to describe the effects of circumcision was too strong of a term. “A lot ofmen and women disagree. Some find thecircumcised penis more cosmetically appealing; it’s a matter of opinion.” Shecontinued, “We’re focusing on the individual here but millions of people havebeen circumcised over thousands andthousands of years. To say flat out that itis wrong, unethical, illegal, and shouldnever be done, is a smack in the face tothese millions of people who have had itdone.” She continued, “I find it perfectlyacceptable and good to do”, and addedthat the Jewish circumcision ceremony isa lovely experience for the family. Mr.Svoboda asked, "how does the boy feelabout it?"

Attorney Svoboda then discussed thepractice of footbinding in China and thefact that some Africans practice femalegenital cutting. “Those seem terrible andbarbaric to us. Is it possible,” Svobodaasked respectfully, as he was throughoutthe conference, “that our opinions aboutcircumcision are colored by the fact thatwe are familiar with it?”

Dr. Brady replied that unlike female

circumcision, “male circumcision is nobiggie.” Female genital mutilation is donepartly to reduce sexual function, and malecircumcision was never done for thatreason. Svoboda said that was untrue: “Inthe 12th century, Rabbi Maimonides saidthat that the principal purpose of circumcision was to reduce sexual pleasure. Infact, it was introduced in America to prevent masturbation by reducing pleasure.”

Dr. Brady then argued, “If circumcision reduced sexual function, it wouldhave ceased thousands of years ago. Mendon’t perceive circumcision to alter sexual function. Men dictate medical practices.” Dr. Brady noted, as had the theJewish professor, that circumcision hasbeen performed for millennia. “If circumcision were not a good thing, sincemost societies are run by men, it probablywould have ended.”

Mr. Terrón disagreed. “Even in patriarchal societies, men have pride andwould be reluctant to accept that they aredeficient in any way. If men in Sparta objected to brutality, they would have beencalled sissies.” His wife Aubrey Terrónagreed that circumcised men are reluctantto accept that they have been harmed.

Then a rural pediatrician on the panelwho practices circumcisions interjected,“About 20% of the time, all day long,parents ask, did they take off enough ofthat damn foreskin? They want moreforeskin taken off.” Angel interjected, “Goto Mexico, and you’re not going to findthat.” The physician continued: “Motherssay it doesn’t look good, they say, ‘I like itbetter when it’s shorter.’” Angel said,“Why would the lady care so much whather son’s penis looked like?” The pediatrician replied, “Because they want it tolook like daddy’s.” Attorney Svobodaasked, “What other medical procedure isdone to make a child look like the father?”The same physician then added that it ismuch easier to circumcise newborns.“Even slightly older boys squirm and arehard to hold down.” Attorney Svobodaasked, “easier for whom?”

Dr. Brady said, “I don’t think it’s abig deal in appearance or function, and itdoesn’t appear that men who were circumcised believe that they wereharmed.” Astonishingly, he said, “You(Angel) have given the foreskin a function that it doesn’t really have.” Angel’swife Aubrey replied, “Yes it does.” Dr.Brady continued, “Women who have had

Debate between Steven Svoboda andMichael Brady, Medical University of SouthCarolina, Charleston, October 18, 2013

Steven Svoboda taking notes as Dr. Bradytalks on panel, Charleston SC,

October 19, 2013


sex with circumcised and uncircumcisedmen were likely to express most satisfaction with their current partners.” Angel said, “Maybe that is why they aretheir current partners.”

One doctor said, “The benefits [ofhaving a foreskin] are modest.” Angelsaid that in that case, it would be better tolet the boy make the decision for himself.

The moderator then announced withevident relief that transportation would bearriving in three minutes, that it had beena very stimulating discussion, and theconference ended.CONCLUSION A Sweet Victory ForOpponents of Circumcision; A Defeatand Embarrassment For the AmericanMedical Profession

So, what happened at the debate?ARC's goals going into the debate

were modest, to induce a small percentage of the medical audience to be moreopenminded about circumcision.Svoboda accomplished that. Two youngphysicians who had given presentationson other subjects told him that he hadchanged their minds about circumcision.The others physicians were clearly notabout to change their minds. So was thedebate a draw?

In a word, no: the debate was a complete victory for the intactivist cause andthus for boys and men, and a defeat andembarrassment to the medical profession.In a masterful performance from start tofinish, Attorney Svoboda rebutted everyclaim factual, ethical, and legal claim thatDr. Brady, Dr. Diekema, and the otherphysicians made in support of circumcision, complete with citations to thelatest scholarly literature and the most recent developments in Europe. There are

few people on earth with such extensiveknowledge of the science, ethics, legality,and politics of circumcision, and suchclarity of speech. The other intactivistspersuasively drove his points home.

Financial Conflict of Interest. Themembers of the AAP Task Force on Circumcision are not, as Dr. Brady claims, aneutral, unbiased, group of scientists whoalone should be entrusted with the healthof boys and men. The AAP is a trade association, and like the rural physician, hasan obvious but undisclosed interest inperpetuating circumcision, a multibilliondollar industry when the sale of harvestedforeskins to industry is included. In fact,the 2012 AAP policy statement even callsits member pediatricians "stakeholders," aterm usually reserved for investors. In thewake of declining Medicaid coverage forcircumcision, the AAP is also calling forincreased coverage of circumcision, whenthey must know the fundamental principleof federal and state Medicaid law, citedby Svoboda, that it only covers medicallynecessary services, not elective nontherapeutic surgery.

Additional Biases. As the 38European physicians wrote, the AAP’smembers are also culturally biased in favor of circumcision. Many of the TaskForce members are religiously biased aswell, like the female professor, againmaking them highly motivated to perpetuate circumcision. Not one of themappears to have a foreskin either, or anyinterest in knowing its function or effecton sexuality, as any other physician orscientist studying circumcision would becertain to know or study. Had the TaskForce been neutral and scientific, itsmembers would have included men withforeskins, European pediatricians opposed to circumcision, researchers, ethicists, attorneys, parents, men angry to

have been circumcised, and intactivists. Aneutral and scientific Task Force alsowould have thoroughly analyzed the anatomy and physiology of the foreskin before extolling the benefits of its removal.Intactivists, by contrast, have no biases,and it costs them time and money to oppose circumcision: they are motivatedonly by sincerely held and, as Svobodashowed, justified beliefs.

Intentional Factual Misrepresentations. As Ms. Terrón said, the Americanmedical industry has demonized the normal penis and made circumcision appearnormal, when the surgery is rarely performed by physicians today except in theUnited States. Dr. Brady, Dr. Diekema,and the Task Force have knowingly understated the disadvantages and overstated the benefits of circumcision to sellit to largely uninformed and unsuspectingparents. The AAP report is, fundamentally, a sales pitch.

The disadvantages of circumcisionare almost too numerous to count. Infantsdo not tolerate pain well, as the AAP report claims, even when anesthetics areused, and often they are not. Circumcisionis not safe: even the AAP and the AMAadmit that it risks many serious injuries,which the AMA callously calls “untowardevents”. The risk of serious injury is not.2%; the study the AAP relies upon said2%; the actual rate may be 10% or higher;and as the AAP frighteningly admits, thereal risk is unknown. Dr. Brady’s claimthat circumcision is not harmful is plainlyfalse as well: pain is harm; the permanentremoval of healthy, functional tissue isharm; turning the penile shaft inside out isharm; preventing the normal function ofthe penis as Ms. Terrón described is harm;and the loss of sensation and satisfactionto which Mr. Terrón attested, is certainlyharm. He even proved by retracting hisforeskin for one month that circumcisionreduces sexual sensation and satisfaction.

As to the supposed benefits of circumcision, the only possible reason tomention penile cancer is to frighten parents,since it is as rare as being struck by lightning, and can be avoided by washing andnot smoking. The claim that circumcisionreduces the risk of HIV by 60% also mustbe calculated to prey on parents' fear ofHIV and to mislead. As Svoboda pointedout, the absolute risk reduction is at best amarginal 1.3%, among adults, in Africa.Even this is unproven. Circumcision

Steven Svoboda flanked by (l.) MinooKavarana and (r.) Eric Graham, two

physicians on panel who changed theiropinions re circumcision after his

presentation, Charleston, SC,October 19, 2013

(l. to r.) Minoo Kavarana, StevenSvoboda, Eric Graham, Michael Brady,

Charleston, SC October 19, 2013


plainly has not been effective in preventingHIV in the United States. Even if it reducesthe risk, the AAP and the AMA properlyconcluded in 1999 that behavioral factorsare far more important risk factors in acquiring HIV than circumcision status. Inany event, men who have unsafe sex withwomen must still use condoms.

The AAP’s widely disseminated conclusion that the benefits of circumcisionoutweigh the risks, which American parents rely upon, is also manifestly false. Itcontradicts the AAP's statements that therisk of serious injury is unknown, and thatcircumcision benefits only a small percentage of boys and men.

Legally Wrong. The claim by the AAPsince 1971 and by Drs. Brady and Diekemathat parents have the right to make the circumcision decision for religious, cultural,and personal reasons, which is to say forany reason, is also false. As Svobodashowed, the founding American principles

are that every person has the inalienableright to personal security, autonomy, freedom of religion, and equality. Parents canonly consent to necessary medical decisions that cannot be deferred. They alsocannot even risk harming their children, letalone actually harm them, for reasons having nothing to do with medicine. In fact,both parents and physicians have a legalduty to protect boys from the harm causedby circumcision.

Ethically Wrong. As Svoboda argued,even if circumcision had what the physicians at the conference agreed were atbest modest benefits, it is not ethicallyjustified. A physician’s duty obviously isto his or her pediatric patient alone. Physicians obviously cannot take orders fromparents to perform surgery without a diagnosis and recommendation, let alone to"look like daddy". The most fundamentalethical rules, which the socalled ethicistDr. Diekema no doubt teaches, are to

“First, Do No Harm”, and to respect theautonomy of the pediatric patient to makeall decisions about his body that can bedeferred.

Final Thoughts. Dr. Diekema claimsto reject a rightsbased approach to circumcision, but children do have the ethical and legal right to intact bodies, andtheir rights supersede their parents', as acourt held in 2012 in Cologne, Germany.I reject and everyone should reject theunsupportable opinions of the AAP's TaskForce on Circumcision. In a rationalworld, there would be no task force foramputating parts of helpless children'sgenitals. The opinions of Dr. Brady, Dr.Diekema, the members of AAP TaskForce are relics of an unscientific, callous,paternalistic, selfserving past. Theiropinions and circumcision should be relegated to the dustbin of history.

Went to Med School to TalkAbout EthicsAubrey TerrónI got to see firsthand the raging bias

that interferes with the logic of doctors in regard to male circumcision

when I attended the 20th annual PittsLectureship in Medical Ethics at theMedical University of South Carolina onOctober 1819, 2013. Among other debates, there was a debate on infant circumcision between Attorneys for theRights of the Child founder StevenSvoboda, JD, and the American Academyof Pediatrics’ (AAP’s) Circumcision TaskForce member Dr. Michael Brady. Audience participation was encouraged aftereach debate, and at the allinclusive seminar that wrapped the conference. Alsopresent was Dr. Douglas Diekema of thesame AAP Task Force (who, interestinglyenough, gave a great talk on not turning

away children/families who have not beenvaccinated).

Eye opening in some regards, frightening and sad in others, the discussionmade it clear that these people (the mostargumentative procircers there) are incapable of accepting four things:

1. The foreskin has function. Evenwhen a few of the many functions weredescribed in detail by someone who HADa foreskin, their response was, “You don’tknow that,” and they went back to the beginning again with insisting that there areno functions (or none that matter since wewear clothes).

2. Men WANT their foreskins. A lotof emphasis was put on various surveys ofnewly circumcised men showingsatisfaction, or anecdotes of men wantingcircumcisions while serving in the armedforces. Even though over 99% of circumcisions are forced, over 99% of men in theworld left intact from childhood die that

way, with thousands of men going to thetrouble of restoring their foreskins, it wasstill stated, “Men do not value their foreskin.” No logic got through. When it wassuggested that breast bud removal couldprovide a great benefit to society’s health,the objection was (of course) that women

Panel for Twentieth Pitts Lectureship on Pediatric Ethics, Charleston, SC October 19, 2013. (l. to r.) Norman Fost, Douglas Diekema,Minoo Kavarana, Steven Svoboda, Eric Graham, Michael Brady, Stan Block, Melissa Wasserstein

Aubrey Terrón and Angel Alonson Terrónon their recent honeymoon


Charleston Debate MarksTurning Point in Movement toRecognize Circumcision as aHuman Rights ViolationSteven SvobodaThe Twentieth Pitts Lectureship in

Medical Ethics at the MedicalUniversity of South Carolina in

Charleston, South Carolina, held on October 1819, 2013, marked an awesometeam win that activists for genital integrity were able to achieve when I debatedMichael Brady, M.D. and effectively alsodebated Douglas Diekema, M.D., twomembers of the American Academy ofPediatrics (AAP) Task Force on Circumcision. Other team members present andhelping immeasurably with this landmarksuccess were ARC Legal Advisor PeterAdler, longtime activist Aubrey Terrón,and her husband, Angel Alonso Terrón.

Brady was my opponent in the debate about whether circumcision is legaland ethical. Diekema, despite initialclaims of objectivity, joined with Bradyas a proponent of circumcision.

Brady gave a presentation on Friday,October 18, 2013 that closely tracked hisPowerPoint.

My response followed. Our PowerPoint was by that point persuasive enoughthat, as they each personally told me later,two (!) of the five physician presenterswho are not AAP Task Force memberswere completely convinced by our arguments and went from being pretty strongly

procircumcision prior to theevent to coming to opposethe procedure based on ourarguments. (This also is agood testament to the openmindedness and objectivityof these doctors.)

Following my presentation was a scheduled 45minute debate between Dr.Brady and me. We each gotour blows in, but it quicklybecame clear that Brady wasunaware of recent politicaldevelopments and pertinentmedical studies.

On Saturday, we wereeach allowed five minutes tosummarize our views. After Ispoke for the full fiveminutes, Dr. Brady was unable to successfully rebutany of my points, speakingfor just over a minute in aneffective concession of defeat. Brady referred to me inhis short talk as "Dr., er excuse me, Mr. Svoboda." OnFriday, Dr. Brady had audibly complained about howthe organizers had allowed"nonphysician presenters"to speak, of which I was theonly one.

On Saturday, October 19, after eachpresenter spoke, an open discussion ensuedamongst all eight panelists for about 2.5

hours, the last half of which was focused onmale circumcision. Peter, Aubrey, and Angeleach made very powerful and effective

Steven Svoboda (far left) making point to MichaelBrady (far right) while (l. to r.) Minoo Kavarana, EricGraham (back to camera), and Stanley Block look on,

Charleston, SC October 19, 2013

wouldn’t appreciate that when they gotolder, so, it’s best to leave it for then.

3. Boys have a right to theirhealthy bodies. I challenged [Editor’snote: in a powerful highlight of the entireevent] the bad habit of assuming that therisk vs benefit analysis can apply tohealthy body parts, even though it isclearly meant to guide a physicianthrough evaluating NEEDED treatment.The response ended up back at “it’s better,” an opinion. Thanks Doc, that’s veryrespectful of you.

4. This culture (and they themselves) are biased in favor of circumcision. It was said in several ways bymore than one person that if you don’thave a foreskin, and live in a culture thatdisregards its value, perhaps your views

might be skewed, preventing you fromacknowledging points 1 – 3. Interestinglyenough, this wasn’t denied, challenged, ordefended in ANY way. It was almost likethey were pretending that they didn’t hearit. Disappointing, but all in all, not ashock. God was only mentioned once, butvalidity of ritual, validity of culture,validity of tradition, validity of sheernumbers performed, and validity of proxyconsent were all mentioned, even thoughthose things have nothing to do with theethical requirement in medicine not to interfere where interference is not needed.

I do think that some people presentactually “got it.” The points were madeand made well, biases were challengedwith no logical or meaningful retort (other than continuing to argue in favor of

circumcision) and I think that it waspretty obvious to the people listening thatthe points and challenges were valid,which makes it all a success!

Aubrey Terrón asks question, Charleston,SC October 19, 2013

Steven Svoboda answering question, Charleston, SCOctober 19, 2013

Fall/Winter 2013 Attorneys for the Rights of the Child Newsletter 13points that helped move the discussion further in our direction. Aubrey and Angel alsovideotaped, as I had arranged with the conference organizers, all conference proceedings on Friday, and were supposed to recordSaturday as well but some presenters askedthat no recording be done on Saturday andthis was agreed to without informing me ofthe change.

A few of the key points Peter, Aubrey, Angel and I were able to drive homeover the two days included:

Even the AAP is calling for furtherstudies regarding the connection (if any)between male circumcision and HIV, andeminent scholar Michel Garenne says youneed a condom even if you are circumcised, so what does circumcision gain you?

Aubrey had a great analysis of howDr. Brady was treating a healthy bodypart as if it is a tumor, pathologizingfunctional tissue.

Dr. Brady said in his PowerPoint: Ifthe benefits can't be clearly shown to outweigh problems, then circumcisionshould not be done. I argued, does not thefact that 38 eminent physicians (37 ofwhom are in Europe) say in the AAP'sown journal that we shouldn't do it in itself cast sufficient doubt that the practiceshould be stopped?

As I asked near the end of the event,“If circumcision is so great why doesn'tthe AAP recommend it? I would think theAAP would be taking out ads in the NewYork Times to say that everybody shouldget circumcised. Why the weird balancingact in which the AAP says that circumcision is not recommended but that Medicaid should cover it?”

Angel asked if people present couldexplain the functions of the foreskin andno one answered it, including Brady andDiekema. Brady said, “I don't think anybody knows the functions of the foreskin,” then reiterated, in nearly identicalwords, “Nobody knows the functions ofthe foreskin.” I noted that there was not aword about the functions of the foreskinin the 2012 AAP report, and asked,shouldn't we know something about thefunctions of the healthy body part that isbeing removed?

One amusing aspect: Diekema criticized me on Friday for allegedly being unfair in emphasizing a sentence where theAAP makes admission that the complication rates are unknown. So the next day in

my five minutes I read three sentencesfrom that same passage in full, quotingdirectly from the AAP report, and pointingout several other interesting points contained therein. Here's what I read: “Thetrue incidence of complications after newborn circumcision is unknown, in part dueto differing definitions of 'complication'and differing standards for determining thetiming of when a complication has occurred (i.e., early or late). Adding to theconfusion is the commingling of 'early'complications, such as bleeding or infection, with 'late' complications such asadhesions and meatal stenosis. Also, complication rates after an inhospital procedure with trained personnel may be fardifferent from those of the developingworld and/or by untrained ritual providers.” I then pointed out all the doubtand uncertainty contained therein: Confusion, complication rates differing, differingdefinitions, differing standards, unknownincidence. After all this, Diekema allegedin his five minutes that I was still quotingselectively.

The audience saw through all of thiseventually. An African woman was smiling at Aubrey toward the end and thewhole row of audience members wereclearly on her side. Angel and Aubrey andPeter each was awesome. Aubrey had thisbrilliant time in the sun where she was allowed to speak for over five minutes andthrew the whole issue into a new light in abrilliant way by developing the detailedanalysis I mentioned of the pathologization of healthy tissue. Angel talked abouthis own experience being an intact manand no one could argue with that. The circumcision advocates tried to blame female genital cutting on patriarchy andargued that if male circumcision was bad,men who have all the power under patriarchy, would have stopped it long ago. In

reply to this, Angel talked about maledenial and about Sparta, an extremelypatriarchal society where men faced extreme oppression, proving that societywide male oppression can and does exist,even under patriarchy.

I was able to cite the “wellknownanticircumcision group” the United Nations, the Council of Europe, and all ofthose other European organizations that Ididn't fit into my PowerPoint on Friday.The circumcision advocates couldn't saymuch about that except they offered theresponse that I was just citing individuals,not all of Europe. Diekema accused me ofoversimplifying, and I responded that no,these issues are incredibly complex and Iwasn't oversimplifiying anything. Rather,I used the word “Europe” to describe thelocation of several countries that have recently found circumcision to be illegal.Then Diekema said that those are onlyphysicians' groups, and hence not allphysicians, and that I was oversimplifying again. This weak argument essentiallyrefuted itself.

After we effectively prevailed inSaturday's panel, Brady responded byclaiming that he had inside informationthat both “Australia” (presumably theRoyal Australasian College of Physicians)and Canada are about to issue positionstatements echoing that of the AAP. Noevidence was presented, however, andone may be forgiven for suspecting thatperhaps no such evidence exists.

Today we submitted our paper to theJournal of Law, Medicine, and Ethics, whichis publishing a special issue in early 2014devoted to the proceedings at the TwentiethPitts Lectureship in Medical Ethics.

This was personally perhaps thesingle most gratifying experience I havehad in my nearly two decades as a promoter of genital integrity.

ARC Legal Advisor Peter Adler askingquestion of panel, Charleston, SC

October 19, 2013Douglas Diekema of AAP Task Force on

Circumcision answers question,Charleston, SC October 10, 2013


Keele Conference Provesa Resounding SuccessSteven Svoboda

I have just returned from the UnitedKingdom and one of the most pleasurableand productive meetings in which I haveever had the good fortune to participate.Genital Autonomy organized the twodayconference titled, “Promoting Children’sRights in Europe: Recent Developments”and held at the University of Keele inEngland on September 16 and 17, 2013.

My presentation–which I will bewriting up for publication in the comingmonths–analyzed the 2012 Cologne courtcase holding that male circumcision violates human rights and the law and theGerman legislation attempting to overturnthat court case. The title of my talk was“Welcome to the New Era—Four FatalFlaws in the German Law LegalizingMale Circumcision.” As suggested by thetitle, I discussed four distinct reasons thelegislation is invalid and the earlier courtdecision is soundly based in medical eth

ics, law, and human rights. The four coreproblems are: 1) the law fails to complywith the German requirement of equalprotection of males and females; 2) thelaw is oddly formulated under family lawrather than as an exception to the criminallaw, which would be expected; 3) the lawincoherently attempts to incorporate aconsideration of the reason for the procedure; and 4) the law contradicts itself inrequiring the procedure be performedeven by nonmedical practitioners to theexisting medical standard, which is impossible since anesthetic must be administered and under German law anestheticcan only be administered by physicians.

The talk went very well and thequestions afterwards were quite perceptive. (While I was on the plane home, another German court case was decided infavor of protecting the child’s bodily integrity, and this recent case will also beincorporated into the article I am writing.)

Other speakers included Dutch medical ethicist Gert Van Dijk, Australian

born British barrister James Chegwiddenwho gave an invaluable review of thelegal status of male circumcision in theUnited Kingdom, Antony Lempert of theSecular Medical Forum, the reliably erudite University of Oxford Research Fellow Brian D. Earp, NORMUK’s JohnDalton, eminent medical historian Frederick Hodges, powerhouse Danish activistLena Nyhus, the always impressive Norwegian Children’s Ombudsman AnneLindboe, Global Discourse’s MatthewJohnson, and Michelle O’Brien, who gavea broad overview of the intersex rightsmovement.

Lena Nyhus’s amazing efforts inDenmark have led to the Social Liberalparty passing a motion on September 18,2013 to oppose male circumcision in theabsence of medical justification. She asksthat the rest of the world support her workby putting the word out that we arewatching Denmark attentively to makesure it does the right thing regarding malecircumcision.

David Smith at brainstorming session,Stone, UK, September 15, 2013

Steven Svoboda at brainstorming session,Stone, UK, September 15, 2013

(l. to r.) Martin Novoa, Steven Svoboda,David Smith, Brian Earp, Stone, UK,

September 15, 2013

Lena Nyhus presenting regarding herDanish successes, University of Keele,

September 16, 2013Gert van Dijk presenting regarding RoyalDutch Medical Association developments,Univ. of Keele, UK, September 16, 2013

Audience, Univ. of Keele, UK, September16, 2013

IInnttaaccttiivviisstt CCoonnffeerreenncceess


(l. to r.) Marilyn Milos, Anne Lindboe, LenaNyhus, Keele, UK, September 16, 2013

(l. to r.) Brian Earp, Antony Lempert,Keele, UK, September 16, 2013

Frederick Hodges presenting regardinghistory of circumcision, Univ. of Keele,

September 16, 2013

Antony Lempert presenting regardingSecular Medical Forum, Univ. of Keele,

UK, September 16, 2013

Steven Svoboda presenting regardingflaws in the German law, Univ. of Keele,

UK, September 16, 2013

Steven Svoboda shortly after presenting,Univ. of Keele, UK, September 16, 2013

(l. to r.) Michael Thomson, David Smith,Brian Earp, Keele, September 16, 2013

(l. to r.) Michael Thomson and MarilynMilos, Keele, UK, September 16, 2013

Matthew Johnson and Steven Svoboda,Keele, UK, September 16, 2013

Brian Earp presenting on the ethics ofcircumcision, Univ. of Keele, UK

September 17, 2013,

Harald Winterling presenting, Univ. ofKeele, UK, September 17, 2013

Photos from Keele


(l. to r.) Steven Svoboda asking question,Travis Wisdom, Marilyn Milos, Univ. of

Keele, UK, September 17, 2013

Minister Matthew Walker presentingregarding religion and circumcision, U.

of Keele, UK, September 17, 2013

(l. to r.) Attorney James Chegwidden andSteven Svoboda, Keele, UK,

September 17, 2013

Michelle O'Brien presenting on intersexgenital integrity at Univ. of Keele, UK,

September 17, 2013

Victor Schiering, Univ. of Keele, UK,September 17, 2013

James Chegwidden giving his masterfulpresentation on UK law andcircumcision, Univ. of Keele,

September 17, 2013

Frederick Hodges walking with LenaNyhus, Keele, UK, September 17, 2013

Steven Svoboda and Lena Nyhus, Keele,UK, September 17, 2013

Steven Svoboda and Martin Novoa,Keele, UK, September 17, 2013

Photos from Keele


and in particular at the UN Human RightsCouncil (UNHRC) and the UN Committee on the Rights of the Child (UNCRC).The IHEU has official observer status atthe UN. The UN Convention on theRights of the Child (UNCRoC) was ratified by the UK in 1989; the USA is one ofonly two nations not to be a party to theconvention.

Articles 14, 19 and 24 of The UNConvention on the Rights of the Child requires state parties to respect the right ofthe child to freedom of thought, conscienceand religion. The UN advises all appropriate measures to protect children from allforms of harm and they advise that all appropriate measures should be taken with aview to abolishing traditional practicesprejudicial to the health of children.On 17th September 2012 the followingshort statement was read out by the IHEUin the 21st session of the UNHR Council:International Humanist and Ethical UnionUN HUMAN RIGHTS COUNCIL: 21stSession 10 Sept to 28 Sept 2012

Speaker: IHEU Representative,Josephine Mackintosh, Monday 17

September 2012Agenda Item 4: Human rights situ

ations that require the Council’s attentionRitual Circumcision of Male Children

Madam President, The recent German[Cologne district] court ruling outlawingnontherapeutic infant male circumcisioncorrectly places the welfare, and the “fundamental rights and freedoms” of vulnerable children above the unrestrainedexpression of adult beliefs.

The court correctly determined that:nontherapeutic cutting of a child’s bodyis an assault; that children are unable togive informed consent; that surrogate parental consent is not valid for an operationwith no clinical indication and with thepotential to cause serious harm; and thatchildren have a right to be protected frombodily harm.

Such determinations cannot legitimately be overridden by adults convincedthat children might be harmed by denying them this forced, irreversible surgeryto their most intimate body parts. Whenthe children become adults they canfreely decide whether or not to undergothe procedure.

We understand, and have some sympathy with the sensitivities of certain religious groups which may feel threatenedor even attacked by the judgment, particularly in the light of recent history. But itwould be wrong to describe this judgmentas religious persecution, or antiSemitic;some Jewish voices are calling for an end

to the practice and there is even an association called Jews Against Circumcision.Powerful groups must not be permitted toimpose their views on the vulnerable onideological or theological grounds incontravention of international law.

The Royal Dutch Medical Association and seven other Dutch scientific associations concluded in 2010 that theprocedure can be harmful and that it violates the boy’s human rights to autonomyand physical integrity.

The German judgment is thereforeboth laudable and overdue. Reflecting as itdoes States’ obligations under the ICCPR,it should be followed by all member states.

Our written statement on this issue isavailable. Thank you, Madam

Feature Articles

Secular Medical Forum Report...continued from p.1

The Cutting Edge: MakingSense of European LegalDevelopments Amidst GrowingRecognition of Children’s Legal,Ethical, and Human Rights toBodily IntegrityJ. Steven Svoboda

Abstract for Presentation at theThirteenth NOCIRC Symposium,Boulder, Colorado, July 2426, 2014The 2012 Cologne and 2013

Hamm court cases from Germanyupheld a child’s human and legal

rights to bodily integrity. Previous decisions along similar lines were handeddown in Dusseldorf in 2004, in Frankfurtin 2007, and in Austria in 2007. These

cases—particularly the Hamm one—weredecided in a context of increasing acknowledgement of children’s right tobodily integrity from the United Nations,the Council of Europe, and numerous influential medical, ethical, legal, andpolitical bodies.

The legislation passed to reverse theCologne decision suffers from four coreproblems. The contention that the Cologne and Hamm decisions violate religious rights is erroneous. Germany lacksa churchstate separation and accordsparents a level of religious control that isnot available in the United States. Also,Germany lacks the precedentbased legalsystem of US common law. Accordingly,while these favorable cases retain theirvalidity, they must be used with care.

On August 14, 2001, ARC presented thefirst written and oral statement to theUnited Nations. Visit www.arclaw.org tolearn more.Above: Steven Svoboda presenting to theUN, Geneva, Switzerland, Aug 14, 2001Below: Steven Svoboda and Ken Drabik atthe UN in Geneva, Switzerland, Aug 18, 2001

18 Attorneys for the Rights of the Child Newsletter Volume 10, Issue 2The written statement covered the

medical, legal and human rights aspectsof male circumcision starting from thelandmark Cologne ruling.

The IHEU also wrote a letter to theUNCRC on the same subject during thistime period.

This letter resulted in an invitation totravel to Geneva within a few weeks tomeet with the chair of the UN Committeeon the Rights of the Child to discuss nontherapeutic circumcision.

I was honored to make the journey toGeneva together with the Chief Executiveof the NSS, Keith PorteousWood andRoy Brown, former President of the IHEUand their main representative at the UN.

On 4th October 2012, we met for anhour with the Chair of the UNCRC M.Zermatten, ViceChair M. Kotrane andActing Secretary Ms. Rinaldi. We werewell received. We were aware at the timethat M. Zermatten was approaching theend of his tenure as chair but did not findout until January who was to be his replacement.

I was invited to speak first and beganby explaining how a consideration of myGP child protection work and SMF interests had led to a consideration of NTC.

We discussed the basic medical ethicthat major, irreversible interventions onchildren should only be undertaken fortherapeutic reasons and only then whenthere is a pressing medical need to perform the procedure before the child is in aposition to consent. And I indicated howthis ethic is exceptionally broken in thiscase, suggesting that this is more of a human rights issue than a medical one.

M. Zermatten responded by mentioning that male circumcision is often performed for hygienic reasons and told usthat they had made observations on healthgrounds where the procedure is carriedout ‘traditionally’ with crude nonsterileinstruments in a UNCRC report aboutSouth Africa.

M. Zermatten, who told us that hewas a Catholic, shared his view that thisis a sensitive matter because of the involvement of religion and the generallack of knowledge about it.

He indicated that it had already beendiscussed briefly by the committee, andwas due to be discussed more formallyand in more detail following our meeting.

He referred to recent court decisionsin Finland and the European court, which

had found medical evidence against thepractice on the grounds that it is injuriousto health. M. Zermatten was very interested to hear more about the medicalevidence.

Responding to the implication thatthe harms relate solely to the lack of hygiene around the operation, I was able todraw on some Freedom of Informationdata from the UK. The unpublished FOIexercise undertaken by a volunteer in theUK who had written to every hospital inthe UK asking for details of circumcisioncomplication rates, had shown hithertohidden harm within hospitals including 11cases of serious, lifethreatening injuriessustained by babies as a direct result ofinfant circumcision in one Birminghamhospital in one year.

I explained that Birmingham hadcommissioned a National Health Servicenontherapeutic circumcision service afew years previously so it was likely thatmany of these seriouslyinjured babyboys would have been operated on by registered medical practitioners (althoughwith the absence of regulation and recording, it was simply not possible to determine for sure where these babies hadhad their operation nor who had operatedon them).

The ViceChair M. Kotrane, raisedtwo main objections relating firstly to religious rights and secondly to the perceived importance of operating at a youngage. M. Kotrane, who is a Tunisian professor of law, told us of his own experience of circumcising his sons at the ageof three.

Acknowledging the importance ofthe right to freedom of religious expression, I suggested that it was the child’sright to freedom of religious expressionthat should be the focus for an operationperformed on a child.

From a medical perspective, I explained that assertions about the benefitsof early surgery are not evidencebased.Babies and small children are not in a position to come forward to complain andparents who have procured the operationmay be reluctant to report problems.

I related the sad case of AngeloOforiMintah from North London, a 28day old baby who bled to death in 2012following ritual circumcision and whosedeath was described by the coroner as a‘tragic unforeseen accident’.

I drew attention to the excellent work

within religious communities to end thepractice and quoted from medical associations worldwide which have recommended an end to nontherapeutic malecircumcision on children.

After the formal meeting, SecretaryMs. Rinaldi took the trouble to explain tous how best to contribute to the work ofthe UNCRC. This information has beenextremely helpful and will be of relevanceto many organizations.

There are three or four sessions of theUNCRC every year. During each session,five or six nations will be examined anddiscussed for their compliance with theUNCoRC. Whilst all signatory nations tothe UNCRC have undertaken to adhere tothe principles and letter of the UNCRC,quite clearly, many don’t!

This rolling process means that approximately every 5 years a nation willcome under scrutiny from the committee.

We were fortunate in Geneva to havealso arranged to meet for lunch with Ms.Kirsten Sandberg, the Norwegian memberof the Committee and acting SupremeCourt Justice of Norway. Over lunch wehad a useful discussion with Ms. Sandberg. Several months later we learned thatMs. Sandberg had assumed the chair ofthe UN committee on the rights of thechild from M. Zermatten in January 2013.

From the UNCRoC website welearned that Israel would be coming upfor review by the UNCRC in May 2013.Since the majority of boys born in Israelare forcibly circumcised, the SMF decided to make our first submission to theUNCRC about the situation there. We coordinated with the Israeli organizationBen Shalem, an Israeli intactivist organization. In the event, the UN Committeereceived two separate reports – from theSMF and from Ben Shalem.

The SMF report addressed the available evidence of harm to male children inIsrael from the practice of nontherapeuticcircumcision.The SMF report recommended:

1) In Israel, operations on all childrenand particularly on children’s genitalsshould only be performed where there isan overriding medical need to operate foran identified therapeutic reason. The Israeli Government should be advised thatfailure to comply with this recommendation risks breaching UNCoRC articles19(1) and 24(3)

Fall/Winter 2013 Attorneys for the Rights of the Child Newsletter 192) All circumcisions should be per

formed under internationallyrecognisedsurgical standards

3) The Israeli authorities should introduce a central registry for all circumcisions. This should document themedical indication, the method used, theoperator and aftercare provided.

4) As with all other surgical procedures on adults and children alike, a formalwritten record of location, surgeon andanesthesiologist, type of anesthesia andoperative complications needs to be keptfor each circumcision procedure

5) The Israeli authorities should takesteps to monitor and report on the shortand longterm complications from malecircumcision; they should actively seek toinclude evidence from adult males whoare suffering the longterm complicationsof their infant circumcision

6) All Israeli children should be protected from all avoidable serious harmsuch as forced ritual genital cutting.

7) Suggested alternatives to childhood ritual circumcision are:

i) deferral of the procedure until the

boy reaches an appropriate age of medicalcompetence to give or withhold informedconsent, and

ii) that genital cutting be replaced bya symbolic ritual.

The UNCRC considered the submissions and included the following in theirfinal report published in July 2013:Harmful practices41. The Committee expresses concernabout reported short and longterm complications arising from some traditionalmale circumcision practices.42. The Committee recommends that theState party undertake a study on the shortand longterm complications of male circumcision.

The full report is available here:http://www2.ohchr.org/english/bodies/crc/docs/co/CRCCISRCO24.pdf

Predictably, Jewish leaders claimedthat Israel had been unfairly victimisedbut all countries in the world allow this tohappen.

It would be helpful for other NGOsand even some Governmental Organiza

tions to submit information to the committee on many other nations as theycome up for their cyclical review. Thedanger, otherwise, is that we might seeGovernments following Angela Merkel’slead. In Ms. Merkel’s desperation not toupset the Jewish community in Germanyshe missed the point that the applied lesson of the Holocaust in this case is thatgroups of stronger people should not beallowed to surgically impose their viewson the vulnerable who need protection.

The international language of childprotection is one route in which to engagepeople from within a wide variety ofcommunities and to help them understandthat child protection is not gender, race,religion or culturespecific and that all ofus would do well to examine how wetreat children.

And even the frustratingly smallsteps we’re witnessing help towards ending a practice that really would be inconceivable if only child protection were keptin focus at all times.

female hymen does for the infant vagina.On average this membrane lingers aroundfor 10 years. At that age, half of prepubescent boys – those left to mature naturally – are able to retract their foreskins tosee their entire glans. The other half willretain some lingering remnants of the infant membrane, and will be only partiallyretractable.

The timetable is different for eachboy, and there is no such thing as an ‘early’boy or a ‘late’ one, worthy of note, orworry. (One could, for instance, imagine aculture celebrating the natural appearanceof the glans into the open air as akin to thefirst menses of a young woman, a sign ofimpending adulthood. One could – but notin Englishlanguage cultures.)

PFFR (forcible retraction) is a folkloric fragment of a bizarre, totally invented, medical delusion. It is the stepchildof a pregerm diseasetheory (‘reflexneurosis’) which held that all disease results from the irritation of sensitive tissue,for instance, that caused by touching thegenitalia. Boys were suspected of beingdrawn to their genitals by decaying

smegma, the natural lubricant and immuneactive emollient both genders produce (see AAP 9/12 p.e763). And ofcourse, having touched themselves ‘downthere,’ these boys would soon develop,for instance, tuberculosis, or one of a litany of other silly but deadlyserious variationsonatheme: dim vision, hairypalms, insanity – notions that linger aslocker room jokes even today. Thus wasborn the zombie notion that boys needaggressive, systematic, internal genitalcleaning in infancy and childhood.

PFFR was also part of the ‘marketing’of circumcision in the midtolate 20thcentury. Better a single amputation, wentthe argument, than the melancholy andsexually yucky chore of constantly cleaning out the boy at each bath. It was a brilliant ploy, you have to admit. Also, (andperhaps I have had too much time to museover it) there is a certain retaliatory or retributive theme in play here, as if the modern parent, especially the mother, deservedan unpleasant task for not consenting to aconformist circumcision, ‘like everyoneelse.’ For his part, the boy needs to paysomething for ‘being lucky.’ Indeed, acommon way to chide a parent with a

child who needs the slightest medical attention to his intact penis is to suggest,“This all could have been avoided if onlyyou had...” We at D.O.C. think of PFFR asa ‘gateway drug’ for circumcision.

The need for cleaning – let alonepainful retraction – is bogus of course, asthe penis is selfcleaning and selfdefending in childhood. Were that not thecase, none of us would be here, as it isdoubtful our primate ancestors were sofastidious with their young. As I tell parents in lectures, ‘we are the evolutionarysurvivors of those whose children neverneeded such attention.’

Anglophone medicine has nurtured along tradition of aggressive cleaning of theintact boy, requiring the penis be forcedopen, destroying this membrane and artificially interrupting natural development,much like forcing open a rose bud to viewthe rose. It is a cruel and ignorant practice,uniquely painful, which risks infection,scarring, and much worse. But PFFR hasremarkable staying power in the folkloresphere of medicine (a larger body ofguesswork and ‘that’swhatwe’vealwaysdone’ than you might suppose).

A recent case, right in my bailiwick,

The Nether World of Premature, ForcibleForeskin Retractions...continued from p.1

20 Attorneys for the Rights of the Child Newsletter Volume 10, Issue 2will give you a flavor of the realworld,current legacy of this bizarre 19th centurydelusion:

In late August of 2013, an educated,articulate, distraught mother emailed mefrom Bellingham, Washington, a cityabout 90 minutes north of my Seattle office. She had taken her 10monthold infant to a clinic, expecting to see herregular doctor. But she was referred instead to an MD she did not know. The infant had a simple case of diaper rash, onethat did not respond to her home remedies. She just needed some prescriptionointment.

Instead of addressing the rash, thedoctor immediately positioned his palm atthe base of the child’s penis, right at thepubis, and began to press downward. Themother, realizing what might happen, immediately said, (and these are her words,not mine): “Please don’t do that. His regular doctor has never retracted my boy.Don’t do that! Stop right now!”

But the doctor continued, and forcedthe child’s glans to pop out fully, whichimmediately began to ooze blood. Hethen fumbled as he tried to put the foreskin back in place. While he fiddled, thedoctor said, “What are you worriedabout?” “All doctors do this to uncircumcised boys.” “You should have beencleaning him out all along.” The mothertells me she burst into tears, ‘was livid,’bundled up her boy and they both criedall the way home.

Prior to contacting D.O.C., she did agreat job of reporting this doctor toeveryone she could identify –the head ofpediatrics, risk management, section directors, etc., even the Joint Commission (abody that regulates and certifies hospitals). The hospital, Peace Health, a chainof Catholic hospitals stretching from Vancouver, BC to California, sent her whatthey imagined was a conciliatory letter,suggesting the doctor did what he wastrained to do, and what he had done for23 years, that he had two intact sons, andhe was sorry if she ‘reacted badly,’ suggesting she was alarmist and hysterical.

There was no discussion of whetherwhat occurred was – or was not – the bestmedical practice. (Including an omission,if you did not catch the detail, that parental consent for a medical procedure evaporates instantly when the parent objects,and must be reestablished before anyprocedure, no matter how benign, may re

commence. This alone was a legally actionable exhibition of pure arrogance.)

I gave her the standard optionsD.O.C. offers to parents:

1) Educate the doctor and the hospital with voluminous materials D.O.C.would provide.

2) Educate the doc, AND flood statemedical regulators with scholarshipD.O.C. would supply.

3) Consider a lawsuit (which werarely advise, as the costs and aggravationare horrific and the compensation exceedingly unlikely).

The mother chose the second option,to report the MD and the hospital to theWashington State medical licensing authorities.

In the ensuing weeks, I broadcast aparallel complaint letter to everyone Icould think of at the Peace Health system,stating that D.O.C. would assist the family. Recipients included the offendingphysician, the head of pediatrics, theCEO, CMO, risk manager, etc. My technique, ‘fishbowling,’ is intended to suggest the issue is all around and cannot beignored, shaming the hospital into reform.I have found this is the only techniquethat might work, since mere education ofthe individual offender has proved useless. For one thing, if one clinician, especially a preceptor, does this, acolytes willfollow suit.

In this case I even offered to drive toBellingham and present a live CME onthe subject for primary care providers,knowing that this was a ‘cheeky’ offerthat they would reject outofhand (JDsaddressing MDs? Hmmm).

Surprisingly, some cheery lower levelbureaucrat called me to say that the CMEthat I proposed was a great idea, and thatshe would get back to me with a date,mentioning that she would also have a pediatric urologist appear at the same timefor ‘balance.’ I said that was fine, a sort of“Bring ‘em on” bravado on my part.

Days later the senior VP for riskmanagement, an attorney, quashed heracceptance of my CME offer, claimedthat corresponding with his clients wasan ethical violation for an attorney, andthat D.O.C. was unduly cynical abouttheir physicians. (Hmmm, OK, no comment.)

In a followup, I sent a letter suggesting darkly, inter alia, and not so delicately, that perhaps this was a case of

systemic ICD9605 fraud, where themedical professional diagnoses the boywith a billable ‘birth defect’ for havingwhat the rest of the world understands asnormal anatomy. I suggested he checkwith his billing department to see if therewas a pattern.

There are lessons here, are there not?Let me make them overobvious for you:

Forcible retraction is distressinglycommonplace,

the offenders are completely refractory to reform, and,

with the aid of billing code ICD9605,

the practice ‘drops’ toddlers ontothe pediatrician/pediatricurologist circular conveyor belt, like a suitcase at theairport,

which involves multiple examinations, more retractions, more referrals,and,

finally, perhaps a postnatal circumcision to address what was iatrogenic(doctor caused) damage to begin with.

No one loses except the boy, his parents, the insurance company, and/orMedicaid.

In Anglophone medicine, the 19thcentury is not yet over, and the 21st century opportunities for using children as a‘profit center’ are nicely underway.

Consider one telling bit of evidencefrom the American Academy of Pediatrics’ (AAP’s) longawaited infomercialfor circumcision, released in September,2012. The AAP referred to the boy’s natural membrane like this: “Most adhesionspresent at birth spontaneously resolve byage 2 to 4 months.” Look it up; it’s atpage e763. This suggests to the 80,000pediatricians in the USA that an infantwho is ‘late’ needs medical attention,providing nifty legal cover. ALL boys willbe late using a timetable in error by tenyears or more. Was this comment merelystupid (it can’t be a typo; even ‘years’would have been wrong by a full sixyears)? Or is it devious? I wonder.


Council of Europe CondemnsMale CircumcisionOn October 1, 2013, under theleadership of German children’srights advocate Marlene

Rupprecht, the Council of Europe (CoE)passed a recommendation number 2023(by a vote of 78 in favor, 13 opposed, and15 abstaining) endorsing a child’s right tophysical integrity and a resolution number 1952 (by a similar vote of 77 for, 19against, and 12 abstaining) discussing theright to physical integrity in more detailand specifically supporting genitalautonomy for children by opposing several practices including male circumcision,female genital mutilation, and “early

childhood medical interventions in thecase of intersexual chldren.”

The recommendation and resolutionon “Children’s right to physical integrity”can be found athttp://www.assembly.coe.int/nw/xml/Xref/XrefDocDetailsEN.asp?FileID=20176&lang=EN.

The CoE’s resolution 1952 includesthe following statement in paragraph 2:The Parliamentary Assembly is particularly worried about a category of violation of the physical integrity of children,which supporters of the procedures tendto present as beneficial to the childrenthemselves despite clear evidence to thecontrary. This includes, amongst others,female genital mutilation, the circum

cision of young boys for religiousreasons, early childhood medical interventions in the case of intersexual children and the submission to or coercion ofchildren into piercings, tattoos or plasticsurgery.

Paragraph 7.5.2 of the resolutionstates that the CoE “calls on memberStates to... clearly define the medical,sanitary and other conditions to be ensured for practices which are todaywidely carried out in certain religiouscommunities, such as the nonmedicallyjustified circumcision of young boys...”

It’s been a truly remarkable week.Events are happening for which many ofus have been working for a long time.

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On Being an Intactivist MedicalStudentMatthew H. H. Young

M.D. Candidate, Harvard Medical SchoolAll students at Harvard MedicalSchool are required to take acomprehensive course on med

ical ethics entitled “Medical Ethics andProfessionalism.” As a capstone to thecourse, I researched and wrote about theissue of nontherapeutic neonatal malecircumcision. I interviewed both proponents and opponents, read online polemics and diatribes from both sides, butultimately tried to approach the issuefrom the four cardinal principles of medical ethics—beneficence, nonmaleficence, autonomy, and justice—as outlinedby Beauchamp and Childress (Principlesof Biomedical Ethics).

I found that nontherapeutic neonatalmale circumcision violates every principleof medical ethics. Unfortunately, this isnot clear to many individuals at HarvardMedical School. Harvard, like many medical schools, completely neglects circumcision in its medical curriculum.

The doctor I spoke to who routinely

performs circumcision was very polite,but it was somewhat of an awkward conversation. I did not feel comfortablepointing out to him that he had probablybecome inured to the ethical objectionsgiven that he performs the procedureevery day. One female medical studentsaid to me that “it’s just cleaner” to becircumcised.

When I broached the subject of circumcision as an ethical problem with

many of my classmates, they asked mewith confused looks, “What about it?”They were shockingly ignorant of howcircumcision is completely medically unnecessary and a violation of human rights.There have been positive interactions,though.

Our microbiology professor was lecturing on HIV/AIDS prevention with circumcision. I mentioned the ethical issuesto him and showed him the recent paperpublished by 37 European physicians andone Canadian ethicist arguing againstneonatal circumcision. He respondedreasonably by posting both the originalAAP report and the European rebuttal forstudents to read on our course website. Heis the only professor we have had whohas addressed (somewhat indirectly) theethical problems of circumcision.

In sum, it disgusts me when intactivists are viewed as “fringe.” That’s why Iam writing. I hope that medical students,as the future physicians of America, canhelp our country end this terrible practicethat should have been eliminated bymodern medicine decades ago.

Matthew Young


Hamm Court Protects Right toBodily IntegrityFor the second time in a little more

than a year, a German court has ruled infavor of a child’s right to bodily integrityand against a parent’s right to have a malecircumcision performed on a child.

A translated press release from the courtregarding the case can be found below.

The actual court decision, in German,can be found here:

http://www.justiz.nrw.de/nrwe/olgs/hamm/j2013/3_UF_133_13_Beschluss_20130830.html

Below is a news article about the decision.

Court: Circumcision Too RiskyFor SixYearOldThe Local (Germany)

www.TheLocal.deSeptember 26, 2013A German court has forbidden a

woman from having her sixyearold son circumcised because of a

risk of psychological damage. The decisioncomes a year after a similar ruling sparked

an international outcry.Then a court in Cologne said religious

circumcision of male infants was tantamount to grievous bodily harm, a criminal act subject to prosecution – promptingfuror around the world. In response to theJuly 2012 ruling, German lawmakerspassed a law clearly stating that understrict conditions, circumcision was legal.

But now a court in Hamm in NorthRhineWestphalia has said a womancould not get doctors to perform the religious rite on her sixyearold child because she had not taken into account thepsychological damage it could cause him,newspaper the Westdeutsche Allgemeinenewspaper reported.

The unnamed woman fromDortmund, who is Germanborn but ofKenyan descent, wanted to have her soncircumcised before visiting Kenya, whereit is normal practice for boys when theyare very young babies.

More than 80 percent of the Kenyanadult male population is circumcised. Thewoman had worried her son would not beaccepted as a real man by his relativesthere unless he had the operation.

The court said the 31yearold mother was not fit to make the decision about

the operation because neither child normother were aware of the risks involvedin the procedure – including psychological harm, the newspaper reported.

“In this case there are substantialgrounds to suggest that the circumcisionsought by the child’s mother would damage the psychological wellbeing of thesixyearold,” wrote the higher regionalcourt in Hamm in a ruling from the end ofAugust that was published on Wednesday.

Potential harm could result from themother’s intention not to be present at theoperation, said the court and the fact thatthe child had already been christened.

Such “damage” was not necessaryand should not be allowed, particularly asboth mother and child lived in Germanyand only travelled to Kenya very rarely,the court said.

The decision upholds an earlier ruling by the family court in Dortmund suggesting the local youth welfare officeshould have the final say on the matter.

Last December, German lawmakerspassed a law stating circumcision waslegal as long as the child’s health was notput at risk, and that the practitioner carried out the rite in accordance with medical standards.

European Council Passes AntiRitual Circumcision ResolutionJewish Telegraphic Agency

www.JTA.orgOctober 2, 2013A resolution that calls male ritual

circumcision a “violation of thephysical integrity of children” was

passed overwhelmingly by the Parliamentary Assembly of the Council of Europe.

The council, a panEuropean intergovernmental organization, debated andpassed the resolution on Tuesday basedon a report by the Committee on SocialAffairs, Health and Sustainable Development led by German rapporteur MarleneRupprecht. The resolution passed by avote of 78 in favor and 13 against, with15 abstentions.

The resolution calls on states to“clearly define the medical, sanitary andother conditions to be ensured for practices such as the nonmedically justifiedcircumcision of young boys.”

It also calls on member states to

“initiate a public debate, including intercultural and interreligious dialogue,aimed at reaching a large consensus onthe rights of children to protectionagainst violations of their physical integrity according to human rights standards”and to “adopt specific legal provisions toensure that certain operations and practices will not be carried out before a childis old enough to be consulted.”

Practices covered by the resolutioninclude female genital mutilation, the circumcision of young boys for religiousreasons, early childhood medical interventions in the case of intersexual children, corporal punishment, and thesubmission to or coercion of children intopiercings, tattoos or plastic surgery.

Large majorities rejected five amendments that sought to remove or alter references to the circumcision of boys. Anamendment that removed a reference tothe “religious rights of parents and families” was supported by a large majority ofmembers.

“Although the adoption of this report

is nonbinding and does not represent anydirect threat to milah, we are troubled atthe readiness of the Parliamentary Assembly to dismiss the points made duringthe debate about religious freedom,” theMilah UK organization told JTA.

The ritual circumcision of boysyounger than 18 has come under attackincreasingly in Scandinavia and Germanspeaking European countries both by leftwing secularists and rightwingers whofear the influence of immigration fromMuslim countries. UPDATE: A team of Israeli diplomats hasgarnered signatures from enough Councilof Europe members to propose aresolution which would establish andprotect male circumcision as a religiousrite, reversing the resolution to protectchildren from male circumcision. See:www.jta.org/2013/12/20/newsopinion/world/councilofeuropemotionsubmittedinsupportofritualcircumcisionrights


Good News from Sweden:Officials Denounce MaleCircumcision, and BillIntroduced to Ban CircumcisionTwo separate pieces of good news

have come to us this week from Sweden.On September 24, Swedish legislat

ors introduced a bill that would outlawcircumcision of males younger than 18years of age for nonmedical reasons.

On September 28, Sweden’s Ombudsman for Children as well as representatives of four leading Swedishphysicians’ organizations declared that nomedical reason exists to circumcise boys,while the procedure causes a range ofproblems and violates human rights.

Below are articles on both developments.

Motion to Ban NonMedicalCircumcision Introducedin SwedenJewish Telegraphic Agency

www.JTA.orgSeptember 24, 2013A motion to ban the nonmedical

circumcision of males youngerthan 18 was presented to the

Swedish parliament.

Hamm Regional Appeals CourtDefines New CircumcisionRegulationHamm Regional Court Press Office

www.justiz.nrw.deSeptember 25, 2013A mother is prohibited from hav

ing her six year old son circumcised. This decision was made

by the Third Senate for family matters atthe Regional Appeals Court in Hamm byan order on August 30, 2013, which upholds the first instance decision of theDistrict Court – Family Court –Dortmund[, Germany] and therebydefines the statutory requirements of §1631 d Civil Code ( BGB ) for circumcision without a medical indication.

In the provisional order proceedingsthe child’s divorced parents fromDortmund dispute whether the child’smother from Kenya – at this time marriedto another man – is allowed to have their6 year old son circumcised. The childlives with the 31yearold mother whoalso has the right to sole custody. Thechild’s mother wants to circumcise theboy according to the cultural rites of herhome country, Kenya, so that during hisvisits in Kenya he would be regarded andrespected as a full man – especially byher relatives. She also regards circumcision as beneficial for hygiene reasons.

The third Senate for family mattersof the Hamm Regional Appeals Courtruled that currently, the child’s mothermay not let her son be be circumcised.The ruling further states that the power todecide on this question remains allocatedto the supplementary custodian fromchild protective services. It states that atthis time, the controversial issue betweenthe child’s parents regarding the boy’scircumcision cannot be resolved in favor

of the child’s mother. According to thenewly created provision of § 1631 BGBthe child’s mother, holding sole custody,has in principle the right to consent tomedicallyindicated circumcision for herson, as long as the boy cannot consenthimself. The legal requirements for informed consent by the custodial parent tocircumcision, however, are not present.Even if a six year old is not yet in a position to decide on his circumcision himself, the statutory provision requires ofthe custodial parent and – in the case ofchildren older than six months – even hisphysician to discuss the procedure withthe child in a manner appropriate to hisage and development and to respect thewishes of the child in the decision making. In the case at hand such an involvement of the child has not yet occurred.

The consent by the parent(s) entitledto custody is only effective if they hadbeen fully and properly informed priorlyabout the procedure. So far, acorresponding education of the child’smother has not been stated or shown.

In the present case it is seen asjustified to revoke the mother’s right toconsent to the child’s circumcision forthe time being. Currently, there exists ahigh probability of endangerment of thechild’s wellbeing if he underwent circumcision. This follows from the Senate’s evaluation of the particularcircumstances in this case. The motivesof the child’s mother for circumcisioncan in principle justify a nonmedicallyindicated circumcision. In the presentcase, however, they carry a lesser weightbecause the child’s mother has her permanent center of life in Germany, visitsto Kenya are rare, and the boy is raised asa baptized Protestant. Furthermore, it isnot evident that the boy’s intimate hygiene is at risk without circumcision. The

medical risk and possible pain associatedwith circumcision are not being considered in the decision, because thesecircumstances accompany any nonmedical circumcision. Yet, in the present case,substantial reasons indicate that circumcision at this time, induced by the child’smother, would negatively impact theboy’s emotional wellbeing, especiallybecause the mother does not see herselfable, according to her own statement, toaccompany her son to the procedure –even if he should reject it.

Legally binding decision by the ThirdSenate for family matters at the RegionalAppeal Court/ Hamm from 08.30.2013(3 UF 133/13)Christian Nubbemeyer, Press DepartmentHeadPress Office Notice:

The regulation § 1631 d BürgerlichesGesetzbuch, effective since December 18,2012 – Circumcison of the male childreads as follows:

Custody right includes the right toconsent to a nonmedically indicatedcircumcision of a male child, who is notable to decide and consent himself, aslong as it is performed lege artis [Editor’snote: according to proper medical practiceprotocols]. This does not apply, if bycircumcision, also considering itspurpose, the child’s wellbeing is beingendangered.

During the first six months after thebirth of the child, individuals appointedby religious communties to circumciseaccording to Section (1), are permitted toperform circumcisions, if they have beenspecially trained to do so without beingphysicians, comparable to a physician’sprocedure.


Swedish County Eyeing Ban onCircumcisionJewish Telegraphic Agency

www.JTA.orgDecember 19, 2013A county in Sweden is moving

ahead with plans to ban thenonmedical circumcision of

boys, its leading elected official said.PerOla Mattsson, the commissioner

of Blekinge County, said he will up bringup a ban on the practice with the county’s

health board in February, according to anarticle published Thursday by theSydostran Daily.

According to the Dagens Medicinmedical news site, Mattsson, who is alsochairman of the Public Health Board ofBlekinge, said he opposes the practicebecause minors “have no possibility tosay no to the surgery and therefore thecounty should not perform theseprocedures.”

Located in southern Sweden,Blekinge County has a population of

about 150,000.In Sweden, nonmedical and medical

circumcision may be performed only bylicensed professionals, as per legislationfrom 2001.

Under the legislation, Jewish ritualcircumcisers, or mohelim, in Swedenreceive their licenses from the country’shealth board, but a nurse or doctor muststill be present when they perform theprocedure. Representatives of the country’sJewish community told JTA they arepleased with the arrangement, as it does not

Circumcision Breaches HumanRights of the ChildThe Local (Sweden)

www.TheLocal.seSeptember 28, 2013There is no medical reason to cir

cumcise little boys; the procedureis painful, irreversible and can

cause complications, according toSweden’s children’s ombudsman and representatives for several healthcare organizations.

“To circumcise a child without medical reasons and without the child’s consent, runs contrary... to the child’s humanrights and the fundamental principles ofmedical ethics,” they write in a debatearticle in the Dagens Nyheter daily onSaturday.

The ombudsman Fredrik Malmberg,together with representatives from theSwedish Society of Medicine (SLS), theSwedish Society of Health Professionals(Vårdförbundet), the Swedish PaediatricSociety (BLF) and the Swedish Association of Pediatric Surgeons (SLF), arguesthat Swedish law requires that the child’swill be taken into account wherever possible.

Circumcision is a procedure which istypically carried out at a very young ageand it is this issue of consent which isparamount, they argue.

“We consider circumcision of boyswithout the child’s consent to be in contravention of article 12 of UN Conventionon the Rights of the Child (CRC) whichgives children the right to have an opinionin matters which concern them.”

They furthermore argue for a changein Swedish legislation in order to meet thehuman rights of the child and medicalethics.

The issue has become topical inSweden in recent weeks following thesubmission of a motion to parliamentfrom the Sweden Democrats calling foran outright ban on the procedure.

Furthermore on Monday September30th children’s ombudsmen from acrossScandinavia will meet together withprominent medical professionals in Osloto discuss the issue.

The Ombudsman for Children inSweden is a government agency whichrepresents the interests and rights on thebasis of the UN Convention on the Rightsof the Child (CRC).

Two lawmakers from the rightistSweden Democrats party, noting that female genital mutilation is illegal inSweden, submitted the motion to theRiksdag on Tuesday. A vote on the motion has not been set.

Bjorn Soder and Per Ramhorn wrotein the measure that “boys should have thesame right to avoid both complications ofreduced sensitivity in the genitals, painfulerections, increased risk of kidney damage and psychological distress by permanent removal, and the tremendousviolation of privacy that circumcision actually means.”

The motion proposes to scrap legislation from 2001 that says circumcision ofnewborns is permissible if it is performedby a “licensed professional.”

Jewish ritual circumcisers, or mohelim,

in Sweden receive their licenses from thecountry’s health board, but a nurse or doctor must still be present when they performthe procedure.

The antiimmigration Sweden Democrats party was established in 1988 butonly made it into parliament followingunprecedented gains in the 2010 elections, when it garnered 5.7 percent of thevotes, or 20 seats out of 349 in Sweden’sparliament. The opposition party is thesixth largest faction in the Riksdag.

Rabbi Pinchas Goldschmidt, presidentof the European Conference of Rabbis,said the proposal “betrays a dangerous ignorance of what is involved in the practiceof milah as compared with the abhorrentpractice of Female Genital Mutilation.”The motion’s authors “seem to have overlooked the fact that if circumcision were to

be banned, that would itself represent themost serious violation of human rights inrecent memory,” he added in a statement.

Ritual circumcision of underage boysincreasingly has come under attack inScandinavia, both by leftwing secularistsas well as rightwingers who fear the influence of immigration from Muslimcountries.

The opposition follows a ruling lastyear by a German court in Cologne thatritual circumcision amounted to a criminal act. The ruling was overturned buttriggered temporary bans in Austria andSwitzerland.

Sweden has about 20,000 Jews and500,000 Muslims, according to a U.S.State Department report from 2011.


Five Nordic Children’sOmbudsmen Pass Resolutionto Work for Ban OnNonTherapeutic CircumcisionIn a meeting on September 29, 2013,

the children’s ombudsmen from the fiveNordic countries (Sweden, Norway, Finland, Denmark, and Iceland), and thechildren’s spokesperson from Greenland,in addition to representatives of associations of Nordic pediatricians and pediatric surgeons, have agreed to work withtheir respective national governments toachieve a ban on nontherapeutic circumcision of male minors.

Here is the announcement (in Norwegian) from Norwegian Children’s Ombudsman Anne Lindboe (see photograph):http://barneombudet.no/2013/09/29/aldersgrenseforomskjaeringavgutter/

Anne spoke at the recent conferencein Keele (see photograph at right).

Here is a discussion of pertinentevents in English by Dr. Morten Frisch,who attended the meeting and spoke tothe group about pain and complications.

Nordic Resolution onNonTherapeutic CircumcisionDr. Morten Frisch, MD, Ph.D.

Historic Day for Children’s Rights toBodily IntegrityOn September 29, 2013, at a meet

ing in Oslo, Norway, Nordic ombudsmen for children along with

Nordic children’s health professionals’ organizations (i.e. pediatricians’ and pediatric surgeons’) agreed on a resolutionurging their national governments to workfor a ban on nontherapeutic circumcisionof underage boys.

I was extremely pleased to be invitedto attend this meeting and give a talk onthe aspects of pain and complications inrelation to ritual circumcision and to takepart in the subsequent discussions leadingto the final text.

Anne Lindboe, Norwegian ombudsman for children should be warmly applauded for this great initiative! It is mystrong sense that the clear cut messagefrom today’s meeting will be a hard oneto escape for the Nordic governments in

their future dealing with the issue of nontherapeutic circumcision.

The resolution in Norwegian can beseen here. My unofficial translation of theresolution into English goes like this(written hastily in the flight back toCopenhagen tonight):Resolution: Let Boys Decide forThemselves Whether or Not They Wantto be Circumcised

Circumcision without a medical indication on a person unable to provideinformed consent conflicts with basicprinciples of medical ethics, particularlybecause the operation is irreversible,painful and may cause serious complications. There are no healthrelated reasonsto circumcise young boys in the Nordiccountries. Arguments that may argue infavor of circumcision in adult men are oflittle relevance to children in the Nordicarea. Boys can make up their own mindsabout the operation when they get oldenough to provide informed consent.

As ombudsmen for children and experts in children’s health we consider circumcision of underage boys without amedical indication to be in conflict withthe UN Convention of the Rights of theChild, article 12, about children’s right toexpress their views about their own matters, and article 24, pt. 3, which says thatchildren must be protected against traditional rituals that may be harmful to theirhealth. In 2013, the UN Human RightsCouncil has urged all states to end operations that compromise the integrity anddignity of children and are prejudicial tothe health of both girls and boys. Weconsider it central that parental rights inthis matter do not have precedence overchildren’s right to bodily integrity. Whatis in children’s best interest must alwayscome first, even if this may limit grownup persons’ right to carry out their religious or traditional rituals.

Anne Lindboe presenting regarding herwork as Norwegian Children's

Ombudsman, University of Keele,September 16, 2013

Dr. Morten Frisch, MD, Ph.D.

prevent them from performing the ritual.In recent years, Scandinavian

countries have seen an intensification ofefforts to ban ritual circumcision byactivists who say it violates children’srights and by antiimmigrationnationalists who seek to limit the effectthat Muslim presence is having onSwedish society. In September, the

rightist Sweden Democrats Partysubmitted a motion in parliament in favorof banning ritual circumcision.

In October, the children’sombudsmen of all Nordic countries —Finland, Iceland, Denmark, Sweden andNorway — released a joint declarationproposing a ban on circumcision.

Pinchas Goldschmidt, President of

the Conference of European Rabbis, toldJTA: “This latest proposal is yet anotheralarm bell for Jews across Europe and ourchallenge for 2014 is to do whatever wecan to ensure that other campaigners arenot emboldened to make similarpronouncements.”


Nordic Sexology AssociationUpholds Children's Right toBodily IntegrityOn October 10, The Nordic Associ

ation for Clinical Sexology (NACS) issued a press release titled, “Statement onNonTherapeutic Circumcision of Boys,”clearly upholding children’s right to bodily integrity and opposing male circumcision as impermissibly violating thatright.Here is the text of the press release:Helsinki, October 10, 2013

The following statement on nontherapeutic circumcision of boys wasagreed upon by the presidents of the sixnational member organizations of theNordic Association for Clinical Sexology(NACS) in connection with its annualmeeting in Aalborg, Denmark, on October36, 2013.

Statement on NonTherapeuticCircumcision of BoysThe penile foreskin is a natural andintegral part of the normal malegenitalia. The foreskin has a

number of important protective and sexual functions. It protects the penile glansagainst trauma and contributes to the natural functioning of the penis during sexual activity. Ancient historic accounts andrecent scientific evidence leave littledoubt that during sexual activity the foreskin is a functional and highly sensitive,erogenous structure, capable of providingpleasure to its owner and his potentialpartners.

As clinical sexologists, we are concerned about the human rights aspects associated with the practice ofnontherapeutic circumcision of youngboys. To cut off the penile foreskin in aboy with normal, healthy genitalia deprives him of his right to grow up andmake his own informed decision.

Unless there are compelling medicalreasons to operate before a boy reaches anage and a level of maturity at which he iscapable of providing informed consent,the decision to alter the appearance, sensitivity and functionality of the penisshould be left to its owner, thus upholdinghis fundamental rights to protection andbodily integrity.

Every person’s right to bodily integrity goes hand in hand with his or hersexual autonomy. By signing this statement we support the resolution ofSeptember 30, 2013, issued by the Nordicombudsmen for children, and the resolution of October 1, 2013, issued by theParliamentary Assembly of the Council ofEurope, in which governments are urgedto take the necessary measures to protectchildren’s bodily integrity with regard tonontherapeutic genital surgery.Helsinki, October 10th, 2013Maaret Kallio, President of the NordicAssociation for Clinical Sexology

In another positive development fromEurope, Norway’s Health Ministry isevaluating a proposal to regulate male circumcision. Here are two pertinent articles.

Norway May Ban NonMedicalCircumcision of BoysRT

www.RT.comNovember 13, 2013Norway’s Health Ministry is con

sidering a proposal on regulating the circumcision of boys.

Some political parties are calling on a

complete ban of the practice on minors, apossibility that would affect Jewish andMuslim communities.

Two years ago, the ministry wastasked with reviewing circumcision andhow it should be practiced in Norway. Itis yet to finalize its stance, but intendsto submit its legislative proposal beforeEaster next year, Health Minister BentHoie told Aftenposten, Norway’s largestnewspaper.

The issue was brought to public attention after the recent call by NorwayChildren’s Ombudswoman Anne Lindboe to ban circumcision of boys beforeage 16, unless the procedure is warranted

by medical needs.“This is not due to any lack of under

standing of minorities or religious traditions, but because the procedure isirreversible, painful and risky,” she argued.

Lindboe’s position is shared by somemembers of the Labor Party, which currently holds the largest share of 55 seatsin Norway’s 169strong legislature and isin opposition to the ruling ConservativeProgress coalition.

“As a modern society, we shouldwork to eliminate practices that exposechildren and people to unnecessary suffering,”said Labor’s Ruth Mari Grung,who is a member of the parliamentary

The Nordic ombudsmen for childrenand experts in children’s health thereforewant to work towards a situation, where acircumcision can only be performed, if aboy, who has reached the age and level ofmaturity required to understand necessarymedical information, consents to the operation. We wish a respectful dialogueamong all parties involved about how tobest ensure boys’ self determination withrespect to circumcision. We also urge ourgovernments to inform about children’s

rights and healthrelated risks and consequences of the operation. We ask theNordic governments to take the necessarysteps towards ensuring that boys get theright to decide for themselves whether ornot they want to be circumcised.

Oslo, 30th of September 2013Signed by:

Anne Lindboe, Norwegian ombudsman for children

Fredrik Malmberg, Swedish ombudsman for children

Maria Kaisa Aula, Finnish ombudsman for children

Per Larsen, Chairman of the DanishChildren’s Council

Margrét Maria Sigurdardóttir,Icelandic ombudsman for children

Anja Chemnitz Larsen, GreenlandicChildren’s spokespersonas well as by representatives of Nordicassociations of pediatricians and pediatricsurgeons.

Fall/Winter 2013 Attorneys for the Rights of the Child Newsletter 27Committee on Health and Care Services.

A ban is also supported by the CenterParty, which has 10 seats in the parliament.

Other parliamentary parties are yet toformulate their official position on the issue. Hoie, a Conservative member, whoused to chair the Health Committee before getting his ministerial appointment,voiced concerns that a ban would forcethe groups practicing ritual circumcisionunderground, where the procedure wouldbe performed by nonmedics and posegreater health risks to the children.

The Norwegian lawmakers also disagree on whether circumcision should becovered by the budget under the nationalhealthcare system. Some parties insistthat ritual circumcision should be paid forby parents.

According to the newspaper, an average of about 2,000 Muslim and sevenJewish newborns are circumcised in Norway each year.

Regulation of ritual circumcision inEurope made the headlines in June, whena German court ruled that the procedureconstitutes a minor bodily harm and outlawed performing it on minors. The de

cision sparked nationwide debate on theconflict between religious freedoms andprotection of children.

The issue was further stressed inearly October, when the Council ofEurope branded the practice “a violationof the physical integrity of children” andcalled on EU members to protect children. The latter should include a ban onperforming circumcision on those whocannot consent to it, the nonbinding resolution said.

Sweden, Finland, Denmark, Icelandand Greenland are among the Europeancountries where public debate on ritualcircumcision of boys is hotly debated.

Norway to ‘Control’Circumcision with Respect forJews and MuslimsJewish Press News Briefs

www.JewishPress.comNovember 12, 2013Norway appears to be on the way

to protect circumcision for Jewsand Muslims so long as they are

performed in hospitals.The ConservativeProgress govern

ment is considering suggesting regulations to control circumcisions but withtaking into account religious freedom, theNorwegian Foreigner newspaper reportedMonday.

A Conservative leader of the committee on health care said that a completeban on hospital circumcisions “will onlylead to this being carried out by nonprofessionals” with possible risks.

The government’s stand opposes arecommendation by Norway’s MedicalAssociation and the Children’s Ombudsman to ban circumcisions before the ageof 16.

Legislators from the oppositionLabor and center parties also oppose circumcisions, but Socialist Left Party leader Audun Lysbakken told the newspaperthat offering circumcision within thehealthcare system “will be the safestsolution for the children. He added thatreligious freedom must be taken account“since a ban would be perceived as a verynegative signal among both Jews andMuslims.”

Court: Circumcisions of MuslimBoys Not an OffenceKristiina Markkanen and Aleksi Teivainen

Helsinki Timeswww.helsinkitimes.fi

December 12, 2013The Helsinki Court of Appealrecommends that laws on male

circumcisions be drawn up.A person convicted for performingcircumcision on two Muslimboys has been acquitted of assault

charges by the Helsinki Court of Appeal.The court also acquitted the parents of theboys of incitement to assault.

With the appeals court ruling that thegrounds for the District Court ofHelsinki’s ruling in 2011 were incorrect,the decision marks a fundamental shift inFinnish judicial practice concerning theissue of boys’ circumcisions.

District prosecutor Eija Velitski hasvoiced her bemusement with the verdictand affirmed that she will seek leave toappeal with the Supreme Court. “Since all

the charges were rejected, I will naturallyseek leave to appeal,” she stated.

In 2011, the District Court ofHelsinki found an IranianTurkish personguilty of assault for performingcircumcisions on two schoolagedMuslim boys. In addition, the courtconvicted the boys’ parents of incitementto assault but, deeming the actforgiveable, opted not to impose penaltieson them.

The person who performed theoperations with a cautery in the homes ofthe boys has performed severalcircumcisions in both Turkey and Iran.The incision of one of the boys, however,became infected, forcing the boy to missschool and seek medical attention.

In 2008, the Supreme Court ruledthat, if performed in an appropriatemanner, a circumcision performed on aboy for religious reasons does notconstitute an offence. However, citing thesubsequent ratification of the Council ofEurope’s Convention on Human Rightsand Biomedicine as justification, thedistrict court deemed the circumcisions

unlawful.Both the prosecutor and the

defendants lodged an appeal against theruling – the defendants demanding thatthe charges be dismissed and theprosecutor that the practitioner andparents be sentenced to probation ordersfor aggravated assault.

In its ruling, the Helsinki Court ofAppeal then concluded that theconvention cited by the district court insentencing applies only to organtransplants, not to circumcisions. Theappeals court also referred to judicialpractices elsewhere in Europe, pointingout that boys’ circumcisions have notbeen banned by any European country ongrounds of the Convention on HumanRights and Biomedicine.

In addition, the court viewed thatFinnish laws do not prescribe thatcircumcisions must be performed bylicensed medical practitioners and that theperson who performed the operations hadacted with due diligence.

The surgical site infection in one ofthe boys, the court elaborated, had been


The National Post PublishesARC ArticleThe National Post, one of Canada’s

major newspapers, published an articlethat Steven Svoboda was invited to writeafter submitting a letter in response to theNational Post’s reprinting on September19 of Mark Joseph Stern’s article, “’Intactivists’ Against Circumcision,” which originally appeared in Slate on September 18.

Below is the text of the article aspublished today by the National Post.They did a nice job with the presentationincluding graphics.

Thanks to several helpful folks whoreviewed drafts of this piece and madeuseful comments.

The Perils of CircumcisionJ. Steven SvobodaThe National Post

www.NationalPost.comApril 10, 2013Last month, the National Post pub

lished Mark Joseph Stern’s article(“’Intactivists’ against circum

cision, Sept. 19) criticizing anticircumcision activists, whom Mr. Stern dismissedas “fringe,” “paranoid” and “bizarre.”

But individuals committed to safeguarding children from unnecessary surgical interference include leadingscientists, pediatricians, public health researchers, bioethicists, medical historians,and human rights advocates from countries around the world.

Mr. Stern makes much of the socalled“health benefits” of circumcision, but hecompletely ignores the scientific controversy surrounding their very existence – asdetailed by Brian D. Earp of the University

of Oxford in a pointbypoint rebuttal ofMr. Stern’s intemperate polemic.

Indeed, as a team of 37 European experts (along with the eminent Canadian pediatrician Noni MacDonald) recently wrote,infant circumcision cannot be justified as a“medical procedure” on nonconsenting patients. The only health concern of even theoretical relevance to uncircumcised infantsis the existence of urinary tract infections(UTIs), which are not only rare for boys,but can be effectively treated with antibiotics rather than preemptive surgery — justas they are for girls.

“The other claimed health benefits,” these authors write, “including protection against HIV/AIDS, genital herpes,genital warts, and penile cancer, are questionable, weak, and likely to have littlepublic health relevance in a Western context, and they do not represent compellingreasons for surgery before boys are oldenough to decide for themselves.

Since Mr. Stern cites only studiesshowing potential benefits for circumcision, and fails to cite any studies showing drawbacks (such as pain and loss of50% of the penile covering) or the manypotential complications, his objectivitymust be questioned.

Legal authorities in the United Statesand elsewhere have questioned eventhe basic legality of nontherapeutic circumcision of children. Two Germancourts and one Dutch court have endorsedthe principle of delaying circumcision until a boy is old enough to make his owndecision. In Australia, a comprehensivereport on the ethical and legal status ofcircumcision recommended that it be prohibited except for conscientious adherentsof religions and cultures that practice it asa traditional rite.

Stern derides the suggestion that circumcision has an adverse impact on sexualsatisfaction, yet a recent paper in the International Journal of Epidemiology foundthat “circumcision was associated with

frequent orgasm difficulties in Danish menand with a range of frequent sexual difficulties in women.” While the foreskindoes not have “mythical powers” (as Mr.Stern sarcastically puts it), it is a complexgenital structure consisting of sensitive, erogenous tissue, and is an integralpart of the penis; its permanent removal,therefore, is not the “simple snip” belovedof headlines. Countless men are unhappy that they were deprived of such anintimate part of their body without havinghad any say in the matter.

The strictly monetary costs of circumcision include not only the immediatefees, but also the cost to repair complications, and sometimes legal expenses. Themakers of the Mogen circumcision devicewere the target of so many successful actions for botches that they were driven outof business. A recent study in the CanadianUrological Association Journal found:“Most physicians performing neonatalcircumcisions in our community have received informal and unstructured training,[leading to] unsatisfactory results [being]witnessed in our pediatric urology practice. Many practitioners are not aware ofthe contraindications to neonatal circumcision and most nonsurgeons perform theprocedure without being able to handlecommon postsurgical complications.”

Far from being the concern of some“vitriolic mob,” circumcision has caughtthe attention of highly respected moralphilosophers. The Journal of Medical Ethics recently published a special issue oncircumcision that included several articlesvoicing strong opposition to the removalof healthy tissue from children’s genitals.

Moreover, several recent landmarkevents have confirmed the “mainstream”nature of concerns about circumcision. OnSeptember 24, Sweden’s Ombudsman forChildren as well as representatives of fourleading Swedish physicians’ organizations declared that no medical reason existsto circumcise boys, and that the procedure

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caused by insufficient aftercare ratherthan the operation. The person whoperformed the circumcision used surgicalgloves, sterilised the instrument used,applied local anaesthesia and providedthe parents with instructions for aftercare, the court added. Accordingly, inaddition to acquitting them of charges, the

appeals court relieved the person whoperformed the circumcision from liabilityfor damages. Similarly, the briefcase andinstrument used in the operation werereturned to the defendant.

Finally, the court recommended thatlaws on male circumcisions be drawn upto eradicate any judicial ambiguities.

Despite having mulled over suchlegislative revisions for some time, theMinistry of Social Affairs and Healthstated earlier this autumn that norevisions are likely to be adopted in thenear future.


ARC Letter to JAMA CritiquingSugerman ArticleWe submitted the below letter to theJournal of the American MedicalAssociation (JAMA) on September 9,2013, in response to its recent onepageprocircumcision article by DeborahTolmach Sugerman titled, “Male InfantCircumcision.”

Questions to Ask RegardingInfant CircumcisionBy J. Steven Svoboda, M.A., J.D.

Attorneys for the Rights of the ChildDeborah Tolmach Sugerman1seems to take for granted theAmerican Academy of

Pediatrics’ (AAP’s) claim that the“benefits” of infant circumcision exceedthe associated “risks.” Unfortunately, shedoes not seem to be aware of severalmajor critiques of the AAP’s findings thathave been published in recent months.These critiques, including one by 38 ofEurope’s most distinguished medical andethical authorities, substantially underminethe credibility of the AAP report.

Among other problems, the AAPfails to include in its risk/benefit calculusany consideration of the sexual,protective, and immunological functions

of the foreskin, all of which are lost tocircumcision. The AAP alsoacknowledges that it cannot quantify therisks and complications of circumcision,thereby conceding the impossibility of ameaningful risk/benefit calculation. Itsconclusion, therefore, is based on a mere“feeling”, as it admits in the Journal ofMedical Ethics (JME): “These benefitswere felt to outweigh the risks of theprocedure.”2

Sugerman poses eight “questions toask when deciding about circumcision.” Wepose eight “questions to ask when readingSugerman’s defense of circumcision”:

1. Why are the AAP and JAMApromoting a practice that is no longercommon anywhere else in the developedworld?

2. Why do the AAP and JAMA saynothing regarding medical ethics? (It hasbeen argued that male circumcisionviolates core ethical principles endorsedby the American Medical Association.)

3. Why do the AAP and JAMA saynothing regarding challenges that havebeen raised as to the very legality ofinfant male circumcision, given thethreats it poses to bodily integrity andselfdetermination?3

4. Why do the AAP and JAMA saynothing regarding concerns that infantcircumcision may violate the humanrights of the child?

5. To what other cosmetic surgicalprocedures on children are the “personalpreferences and feelings” of the parentsconsidered relevant?

6. To what other surgical procedureson children are the parents’ “religious andcultural beliefs” considered relevant?

7. How can the benefits be greaterthan the risks when the AAP itself admitsthat it does not know what the incidenceof risks are?

8. When will we focus on providingneeded medical services to improve thehealth of all people rather thansquandering our resources on anoutmoded procedure that medicalassociations around the world agree atbest cannot be positively recommended,4and may be actually harmful?5

1. Sugerman DT. Male infantcircumcision. JAMA. 2013;310(7):759.

2. AAP Task Force on Circumcision2012. The AAP Task Force on NeonatalCircumcision: a call to respectful dialogue. JMed Ethics;39(7):4423.

3. Adler P. Is Circumcision Legal?Richmond J Law Public Interest 16(3):439483.

4. Royal Australasian College ofPhysicians. Circumcision of male infants.Sydney: Royal Australasian College ofPhysicians, 2010.

5. Royal Dutch Medical Association.Nontherapeutic circumcision of male minors.KNMG, 2010.

Steven Svoboda’s and Bob VanHowe’s Journal of MedicalEthics AAP Paper Attacked byBrian Morris in JMEBrian Morris and colleagues havepublished in the Journal ofMedical Ethics (JME) a paper

attacking the paper published earlier thisyear in the JME by Steven Svoboda andBob Van Howe, which critically analyzedthe American Academy of Pediatrics’

(AAP’s) 2012 position statement andtechnical report regarding neonatalcircumcision. The publication in the JMEof the SvobodaVan Howe paper wasaccompanied by the concurrent publicationof a response by the AAP that attempted tosuggest bias on behalf of me and Bobwithout being able to point to a singlespecific error anywhere in our article.

Morris’ paper, entitled “Veracity andrhetoric in paediatric medicine: a critiqueof Svoboda and Van Howe’s response to

the AAP policy on infant malecircumcision,” is available on our website,www.arclaw.org, as well as the originalpaper by Van Howe and Svoboda thatMorris is attacking. It is interesting tonote, however, that Morris seems evenmore upset with the AAP for not forcefullyrecommending universal neonatalcircumcision than he is with us. Ourresponse is currently being prepared.

causes a range of problems and violates human rights. On September 27, the children’sombudsmen from the five Nordic countries,along with associations of Nordic pediatricians and pediatric surgeons, agreed towork with their respective national governments to achieve a ban on nontherapeutic

circumcision of male minors. And onSeptember 28, Swedish legislators introduced a bill that would outlaw circumcisionof males younger than 18 years of age fornonmedical reasons.

Mr Stern did get one thing right:“intactivists” certainly are winning this

battle for children’s rights. More andmore people are discovering the truthabout circumcision for themselves, andare coming to realize that a preEnlightenment ritual has no business masquerading as medical treatment in the 21stCentury.


ARC’s Steven Svoboda Appearson Los Angeles Radio ShowOverviewing Recent ImportantEvents in IntactivismOn Wednesday, June 12, 2013,Steven Svoboda appeared onMaria Sanchez’ hourlong show,

“The Maria Sanchez Show,” on LosAngelesbased Internet radio stationLATalkRadio.com. Maria is a longtimefriend of ARC and of intactivism and we

are glad to see that she has returned toactive media work.

Svoboda and Ms. Sanchez discussed(1) several important legal developmentsincluding the recent $1.3 million award inan infant circumcision case in the Chicago area as well as circumcisionrelatedlawsuits in Queens and in South Africaand a lawsuit filed by the SouthernPoverty Law Center over the genital mutilation of an intersex child; (2) recentnews of and some of the larger issues

raised by the development of a new circumcision device (the PrePex) that is endorsed by the World Health Organizationand is intended to help promote the practice in third world countries as an assertedpreventive of HIV and AIDS; and (3) anoverview of the continually increasingsuccess of intactivism and the work ofAttorneys for the Rights of the Child including the excellent achievements byLegal Advisor Peter Adler and by webmaster Jonathan Friedman.

Maria Sanchez Show Appearanceby Steven Svoboda OverviewsState of Intactivism, ARCOn September 12, 2013, StevenSvoboda appeared on the “MariaSanchez Show.” Maria is a long

time friend of ARC and intactivism;Svoboda did their first show together wayback in the year 2000. In this 40minute

long show (available on our website atwww.arclaw.org or athttp://mariasanchezshow.com/stevensvoboda) they discussed some recent andupcoming events relating to intactivismand of the work of Attorneys for theRights of the Child (ARC):

1) The 2012 German court caseupholding a right to genital integrity andthe subsequent legislation purporting tooverturn the legal case, both of which I

will be discussing on September 17 at aconference organized by GenitalAutonomy at the University of Keele, UK.

2) The debate to take place betweenSvoboda and AAP representative MichaelBrady, M.D. at the twentieth annualThomas A. Pitts Lectureship in MedicalEthics, a conference on “Ethical andLegal Issues in Pediatrics” taking place atthe Medical University of South Carolinain Charleston on October 1819. The top

WBAI “Walden’s Pond”Appearance by Steven SvobodaOverviews State of Intactivism,ARCSteven Svoboda's appearance onShelton Walden’s longtime“Walden’s Pond” radio show on

September 8, 2013 went extremely wellthanks to Shelton’s skills as a journalist andhis broad knowledge of the issues. In thishourlong show, aired on New York City’spublic radio station, WBAI, they were ableto provide a brief overview of the currentstate of intactivism and of the work of Attorneys for the Rights of the Child (ARC).

Svoboda led off this particular showby congratulating Shelton for his trulyawesome, longtime work on many phasesof this issue, as an activist, a journalist,and a human rights advocate. Shelton andSvoboda discussed the generally positivetrend by which more and more people arecoming to question circumcision, whetherit be in the form of blogs or peerreviewed articles that are being publishedby authors with all backgrounds fromthroughout the globe, or whether it be a

mother who refuses to take a knife to herchild without a solid medical reason to doso, which even the American Academy ofPediatrics (AAP) finds itself forced to admit is lacking with infant male circumcision. We also overviewed several recentdevelopments and upcoming events:

1) The 2012 German court caseupholding a right to genital integrity andthe subsequent legislation purporting tooverturn the legal case, both of whichSvoboda will be discussing on September17 at a conference organized by Genital

Autonomy at the University of Keele, UK.2) The debate scheduled between

Svoboda and AAP representative MichaelBrady, M.D. at the twentieth annualThomas A. Pitts Lectureship in MedicalEthics, a conference on “Ethical and LegalIssues in Pediatrics” taking place at theMedical University of South Carolina inCharleston on October 1819. The topicassigned by the organizers for the paperand talk, which are being prepared withthe collaboration of ARC Legal AdvisorPeter Adler and Robert S. Van Howe,M.D., is, “Newborn Male Circumcision isUnethical and Should be Illegal.”

3) The recent study supporting thegeneral trend of declining circumcisionrates in the United States.

4) Activism by some of ARC’s valued collaborators including ARC LegalAdvisor Peter Adler and ARC WebmasterJonathan Friedman.

The show included several interesting phone calls from callers with a broadrange of backgrounds and perspectives onthis topic. As always, it was a greatpleasure to revisit “Walden’s Pond.”

The show is already available on ourwebsite (www.arclaw.org) or atwww.wbai.org/serverarchive.html.

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Intactivist radio show hostShelton Walden


In Search of FatherhoodMagazine Again Reprints StevenSvoboda’s WorkWe are pleased to report thatIn Search of Fatherhoodmagazine is again featuring

in their soon to be published Summer2013 issue a reprint of part three ofSteven Svoboda’s article, “The Limits

of the Law: Comparative Analysis ofLegal and Extralegal Methods to Control Child Body Mutilation Practices.”While Svoboda was interviewed by themagazine for a 2009 cover article,more recently they have issued a pressrelease regarding our work and havepublished reprints of Svoboda’s articlesin each of their last six issues.

We are grateful to the magazine

(http://globalfatherhooddialogue.blogspot.com) and to its editor Diane A. Sears fortheir longstanding commitment to creating a better world and to promoting workin a number of different fields relating tothe wellbeing of children and families.Anyone interested in a sample copy or asubscription to In Search of Fatherhoodcan contact editor Diane A. Sears [email protected].

Steven Svoboda DiscussesCharleston and KeeleConferences, European GoodNews on Maria Sanchez ShowOn November 22, 2013, StevenSvoboda appeared on the “MariaSanchez Show.” Maria is a long

time friend of ARC and intactivism; theydid their first show together way back inthe year 2000. In this halfhourlongshow, released by Maria on November 25and now available as a downloadablepodcast athttp://mariasanchezshow.com, they discussed some recent landmark events:

1) Pediatrics Ethics Conference inCharleston: On October 1819, Svobodaparticipated in the Twentieth AnnualThomas A. Pitts Lectureship in MedicalEthics, held at the Medical University ofSouth Carolina pursuant to a conferencetitled, “Ethical and Legal Issues in Pediatrics.” Svoboda was the only nonphysician invited, and debated the AAP’s Dr.Michael Brady in a talk entitled, “Newborn Male Circumcision–Is It Ethical; IsIt Legal?” Svoboda also appeared in a“Seminar on Pediatric Controversies” opposite Brady and Douglas Diekema, alsoan AAP Circumcision Task Force member. As they each personally told Svoboda

later, two (!) of the five physicianpresenters who are not AAP Task Forcemembers were completely convinced byour arguments and went from being prettystrongly procircumcision prior to theevent to coming to oppose the procedurebased on our arguments. This was a trueteam victory, with coauthor, ARC LegalAdvisor Peter Adler, Aubrey Taylor, andAngel Alonso Terron providing awesomesupport and asking some hard questionsthe AAP Task Force members simplycould not answer.

2) On September 16, Svoboda spokeat the University of Keele in the UK,analyzing the 2012 Cologne court caseholding that male circumcision violateshuman rights and the law and the Germanlegislation attempting to overturn thatcourt case. Svoboda discussed four distinct reasons the legislation is invalid andthe earlier court decision is soundlybased in medical ethics, law, and humanrights. The talk went very well and thequestions afterwards were quite perceptive. Awesome presentations were givenby a number of others including AntonyLempert, James Chegwidden, AnneLindboe, and Lena Nyhus.

3) In early October, the National Post,one of Canada’s major newspapers, published an article that Svoboda was invited

to write after submitting a letter in response to the National Post’s reprinting ofMark Joseph Stern’s article, “’Intactivists’Against Circumcision.”

4) Even since Svoboda's last appearance on this show in early September,we are seeing a consensus continuing toemerge in Europe among medical associations, legislators, courts, and similarbodies that circumcision violates therights of the child and should be illegal.Recent declarations have been issued bySweden’s Ombudsman for Children andrepresentatives of four leading Swedishphysicians’ organizations, by the children’s ombudsmen from the five Nordiccountries, by the Council of Europe, andeven by the United Nations. In lateSeptember, while Svoboda was on theplane home from the UK (!), anotherGerman court held that a Germanbornwoman of Kenyan descent could not authorize doctors to circumcise a sixyearold child of whom she had custody, because she had not taken into account thepsychological damage it could cause him.To all our USbased readers, we wish thehappiest of Thanksgiving holidays. Wetruly all have much for which to bethankful.

ic assigned by the organizers for the paperand talk, which are being prepared withthe collaboration of ARC Legal AdvisorPeter Adler and Robert S. Van Howe,M.D., is “Newborn Male Circumcision isUnethical and Should be Illegal.”

3) Brian Morris and colleagues havegone on the rampage again lately with aslew of articles attempting to attack intactivist scholars, which we believe evid

ence the increasingly beleaguered,embattled situation in which apologistsfor circumcision are finding themselves.

4) The recent study supporting thegeneral trend of declining circumcisionrates in the United States.

Steven Svoboda appears next onThe Maria Sanchez Show onJanuary 8, 2014.

Maria Sanchez


San Francisco Pride 2013James LoewenEvery year Pride celebrations at the

end of June draw people to SanFrancisco to celebrate sexual

freedom and human rights. Attendees tothe parade now number more than onemillion people from all over the world.The parade has grown so large that it begins at 10:30 AM and continues well intomid afternoon.

Intactivists marching in the Prideparade brought a beautiful and diversevisibility to the issue of genital integrityfor all children, male, female and intersex.

I’ve marched with Bay Area Intactivists (BAI) several times, documentingthe BAI contingent and the responses ofthe public. It’s a curious sensation observing the people flanking the paraderoute and seeing and hearing their immediate responses to the issue of circumcision when it’s suddenly brought intotheir focus.

Elwyn Moir, who had travelled fromAustralia to march with the Bay Area Intactivists, described the emotions whilemarching as “intense.”

This year I noticed a difference inaudience response compared with twoyears previously. More people were nodding, giving thumbs up, and expressinginformed support.

“Isn’t this wonderful,” said MarilynMilos, marching in the parade for the firsttime, “So many people are getting ourmessage.”

A phenomenon of the genitalautonomy movement is that when wemake the issue publicly visible it encourages others to share their personal experiences related to circumcision, whichpreviously had usually been kept underwraps. Many visitors to the BAI boothduring the twoday Pride Festival told oftheir experiences with circumcision, somevery tragic.

Bay Area Intactivists exemplifieshow a small group of dedicated and veryhardworking individuals can produce acohesive and sustained message, not onlyat this high profile event but also at manyothers throughout the year.

You can view several videos coveringthe Bay Area Intactivists at SF Pride onmy YouTube channel, Bonobo3D:www.youtube.com/Bonobo3D.

GGrraassssrroooottss IInnttaaccttiivviissmm

Bay Area Intactivists contingent in San Francisco Pride, June 6, 2013

Bay Area Intactivists booth at San Francisco Pride Festival, June 6, 2013

Bay Area Intactivists contingent marching in San Francisco Pride, June 6, 2013


On August 13, 2013 ARC boardmember Marc Angelucci participated in an intactivist rally at

City Hall in downtown Los Angeles.Many of the ralliers wore the Bloodstained suits. Brother K led the ralliers tomarch in the street holding signs in frontof cars that were stopped at red lights.There were occasional honks of support.

“Los Angeles Will Hear Us”ProtestMarc Angelucci

ARC Board Member

Orlando AAP Experience ProtestOctober 2628, 2013, intactivistsdemonstrated at the AAP AnnualConvention in Orlando, Florida.

Photos reprinted with permission fromSavings Our Sons (www.savingsons.org).

Intactivist table outside the AAPConvention, Orlando, Fl, August 26, 2013

(l. to r.) Colleen C., Danelle Frisbie, Allison H,AAP Convention, October 26, 2013(l. to r.) Jason Fairfield, Brother K, Danelle Frisbee, Jim Tidwell,

Nick Kustrius, Kevin R., AAP Convention, October 29, 2013

Group photo on the steps of Los Angeles City Hall, August 13, 2013

Bloodstained Men & Their Friends intersection action, Los Angeles, August 13, 2013

34 Attorneys for the Rights of the Child Newsletter Volume 10, Issue 2Cincinnati Demonstration

Jeff CowsertOn the morning of Thursday, October 3, 2013, I met with a largegroup of intactivists in front of

Good Samaritan Hospital in Cincinnati,Ohio to protest a circumcision experiment. The group included representativesfrom NOCIRC, Intact America andBloodstained Men & Their Friends,totaling at least 40 intactivists (possibly50 including children).

We gathered to raise public awareness of, and demand an end to, the circumcision research study that is beingforced onto male infants at the hospital.The study’s purpose is to compare theMogen vs Gomco devices during forcedgenital mutilation, to observe and document the level of pain the infant expresseson their faces, the amount of bleeding, theneed for followup surgeries and overallpatient satisfaction.

Routine infant circumcision is childabuse–a federal crime as outlined in theChild Protection and Treatment Act–because it disfigures, removes sexual functions, leaves a scar, alters normalaesthetics and causes pain. There are risksof infection, bleeding and even death.Adults have also indicated physical andemotional harm from circumcision.

The inclusion criteria for “participation” in the study are healthy childrenwho are not in need of medical intervention. Since children cannot consent totheir “participation” and they aren’t inneed of surgery, then this amounts tonothing more than child abuse.

Doctors are sworn to an oath of “firstdo no harm.” Doctors performing the circumcision study are breaking their oath,violating a fundamental ethical principle.Circumcision also violates the equal protection clause of the 14th Amendment ofthe US Constitution. Since girls are protected from any cut to their genitals underfederal law, boys should also be.

Prior to the protest, many of us sentletters to the hospital and to healthcareagencies requesting a halt to the studybased on these grounds, but nothing positive has resulted from these efforts.

The police authorities were veryfriendly and the hospital security weretolerant – we had no issues from either.The traffic never let up the entire day andwe must have grabbed the attention of

thousands. We were also blocks awayfrom the University of Cincinnati, whichcertainly spread awareness to the soontobeparents as well as medical students.Two local TV news stations were presentfor the press conference and the hospitalissued a statement to reporters in supportof the study.

The day started with a heavy rain,but not one of us left. We received considerable support throughout the day. Itwas difficult to gauge the reaction from

many. I think this is because the majorityof the onlookers were shocked, surprised,caught offguard or simply new to theidea of revolting against such a widelyaccepted practice in a region of the USthat has the highest cutting rates. MarilynMilos (NOCIRC Founder) pointed outthat she could not recall a time when aprotest has ever been organized against acircumcision experiment. We have placeda bookmark in history.

Group photo at Good Samaritan Hospital, Cincinnati, OH, October 3, 2013

Intactivist moms and children at Good Samaritan Hospital, Cincinnati, OH, October 3, 2013

Fall/Winter 2013 Attorneys for the Rights of the Child Newsletter 35Baltimore Demonstration

Devon OselI t’s crazy to think people have tostand on street corners to tell peoplenot to cut children’s genitals. Kari

said that as we talked about the demonstration on the way home. I have to agree.

There were some nice folks whoasked questions, others who said theyagreed and were glad we were there. Manyothers honked in response to a sign askingfor such, gave us the thumbs up... but therewas also a man who rolled down his window to say, “I’m circumcised and I love it.You people need to get a clue!” Then added, “And my son is circumcised too!”

And a woman who repeated “Mothers should get to decide.” Over and over.“It violates all medical ethics.”“Mothers should get to decide.”

“It violates all medical ethics,” wassomething I said a lot. There weren’t anyanswers to that. Instead, things like “Uncut dicks stink.” or “Can’t you peoplefind something more important to worryabout?” were typical responses. (There isno rational answer to the question of ethics, which is precisely why the AmericanAcademy of Pediatrics avoided any discussion of ethics in its 2012 statement.Doctors who cut the genitals of childrenwithout medical IMPERATIVE are colossal failures at ethics and in advocacyof their PATIENTS’ needs and rights.)

“It’s a sexual assault on children, Ithink that’s pretty important. It violatesall medical ethics.”

“You don’t know anything about themedical benefits!”

“Even if all the claims were true, itstill isn’t ethical. It still isn’t ‘medicine’ aspracticed on other body parts. There is nodiagnosis of injury, disease, or malformation requiring immediate amputation.”

For all the smug avoidance, andadults snickering and seeking validationfrom each other like middleschoolers,there were good stories from the day:There were people taking photos, posingin photos with the signs, young peopleasking for more information, a taxi driverwho left his cab to come talk to us because of a documentary he’d seen inwhich a doctor said that genital cutting ofchildren, whether female or male, was ahuman rights violation and unnecessary.

There was a young woman whose friendwas clearly uncomfortable with her interest... she walked by once, but thencame back to talk while her friend stayedacross the street.

There’s a reason I spend so muchtime on ethics (or lack thereof): Circumcision proponents have studies; we havestudies (and realworld data which debunks the claims of benefit). They haveanecdotes; we have anecdotes. They argue rights; we argue rights (of the personwho will have to live with the parentdesired amputation for a lifetime).

They CANNOT argue ethics. To do sowould be to expose their fatal flaw, theirabsurd advocacy of the importance of anamputation to please parents as more important than actual medicine and the mostbasic of human rights to the individual.

Slowly but surely, we will changepublic perception. Already the circumcision advocates are reeling. They writeabsurd articles which ignore the key issues, argue a parent’s right to alter an infant’s penis to suit their preference, relyon logical fallacies. They will lose... butthey will collect human casualties whilewe battle.

As a man who is resigned to a lifewithout ever knowing full enjoyment ofmy body, I have only one goal in the human rights work of intactivism—to spareas many childrentobecomemen as I canfrom this wicked, insidious, body ANDmindaltering poison.

Recently married: (l. to r.)Katie Marie Osel and Devon Osel

(l. to r.) Katie Marie Osel and Devon Osel Linn Tilley and her son Sandy Conway and her son

36 Attorneys for the Rights of the Child Newsletter Volume 10, Issue 2Circumcision Crisis NortheastMarathon

Jonathan FriedmanNovember 1625, 2013This past November, Brother K and

I met to do a tendayCircumcision Crisis Northeast

Marathon. Previously Brother K had donea Circumcision Crisis Midwest Marathonin October, visiting different cities in theMidwest to hold rallies promoting genitalintegrity. I had joined in for part of it. Ithought we were done until the New Year,but unexpectedly Brother K contacted mewith the desire to do a NortheastMarathon with me right beforeThanksgiving.

To give a littlebackground, I firstmet Brother K atGIAW 2013, buthave heard abouthim onlinethrough Facebookbefore then. He’s alegend, a trueoriginal. Hedemonstrated in1980, formed a group called CARV –Citizens Against Ritual Violence, andwrote a manuscript called, “TheCircumcision Instinct.” Brother K is oneof the most dedicated individuals I know,ready to take to the streets at a moment’snotice. I’m always amazed watching himsuit up and march unabashedly into theintersections with his signs held highabove his head.

Brother K and I were the first ones toreach Times Square around 10AM onSaturday, November 16. We donned ourbloodstained suits and immediately thetourists’ cameras came out to snap photosof us. Rik Przybanowski from Chicago

joined us and was also wearing abloodstained suit. I had just met Rik forthe first time in Cincinnati at the GoodSamaritan Circumcision ExperimentDemonstration, and was excited to see adedicated newcomer turn pro. Rik waswith us the whole way.

A lot of wonderful intactivists camefrom all over to join us. Frank McGuinessfrom Bay Area Intactivists flew in fromSan Francisco. Cynthia Maloney, a birthprofessional, drove down from the Bostonarea. There were also a lot of NYCintactivists, including a couple fromManhattan, Angelica Padilla and MichaelRivera, who brought their three youngchildren.

Times Square has an interesting mix oftourists – foreigners and Americans. Scoresof people showed us their support. Theconstant flow of people taking photos wasamazing. I talked with several people whoapproached me. A nurse. An anthropologist.Women who regretted circumcising theirsons. Circumcised men who wanted toknow what they were missing. SometimesI got emotional and told people about mysuffering when they asked me why I’magainst circumcision. Some people wereapparently offended by that.

Protesting circumcision in public,especially in Times Square, can be a verydaunting task. I watched as my closefriend Opal communicated how she feltabout circumcision to a man who listenedto her but responded (somewhatsarcastically) with the classic procircretorts for everything. We didn’t evenrealize until afterwards that his familywas on the corner waiting for him(impatiently) during their fiveminutelong interaction. Opal kept him engagedand opened his mind to new facts and tochallenging the myths.

As we planned to demonstrate from10am to 3pm each day, Brother K and Ipacked up and left shortly after 3PM. Agroup of intactivists stayed beyond thatpoint and held down Times Square for alittle while longer, as Brother K and I leftNew York City with a rental car justbefore rush hour traffic began. Our nextdemonstration was to be held inProvidence, Rhode Island, so we had along drive ahead of us.

During the ride, we shared ourperspectives and theories aboutcircumcision and about the world. Oneobservation that I shared with Brother K

that he found particularly interesting isthat men who are circumcised may carryan unconscious rage within themselvesbecause they know that sex will never beas pleasurable as it should be for them butthey don’t know why. This rage is oftendirected at women because women areseen as responsible for delivering the fullsexual pleasure that is forever lost tocircumcision. As children, boys deservemotherly love and protection from harm.The circumcised man’s mother tragicallyfailed to provide this essential love andprotection. Some believe thatcircumcision harms the love bondbetween boys and their mothers,potentially impacting future intimaterelationships.

In my view, neglecting love and carecan be child abuse. Abuse is oftencyclical, frequently selfperpetuating, andcommonly is difficult to stop. Intactivismis more than just about foreskins.Children who are abused or simplydenied physical pleasure and bondingmay be more likely to become abusers.

Brother K and I checked into a motelin Mystic, Connecticut for the night, feelingoutraged yet enthusiastic about the tour.

As promised, Rik appeared inProvidence and we set up at theintersection of Hope and Thayer streets. Wemet Michelle Meritt and Amber Showalter,two moms with Intact Rhode Island. Theywere incredibly friendly and shared theirstories with us. Cynthia Maloney joined inagain for another actionpacked day. Tensof people in cars drove by and gave uspositive responses. The intersection gave uswide visibility and was perfect for usingthe huge signs that Rik borrowed from RonLow in Chicago.

After the wife of Steve Ahlquist, ahumanist blogger, saw us demonstrating,Steve rode over on his bicycle. Steve was

Jonathan FriedmanARC webmaster and

newsletter editor

(l. to r.) Rik Przybranowski, FrankMcGuiness, Brother K, Franny Max, andNicholas Socha protest in Times Square,

NYC, November 16, 2013

(l. to r.) Amber Showalter and Erin R.,Codirectors of Intact Rhode Island,Providence, RI, November 17, 2013

Fall/Winter 2013 Attorneys for the Rights of the Child Newsletter 37excited that we were there and was evenmore excited when we told him about thetour. Steve interviewed us extensively andpublished a favorable news article on hiswebsite, www.rifuture.org.

After a short while, we decided tohead downtown near the mall. Along theway, we had numerous photos taken.When we reached the intersection ofFrancis St. and Memorial Blvd, Brother Kposted himself on the median, holding hissigns high above his head, Rik posted upon a corner opposite him with a hugebanner, while the rest of us worked theopposite corner and handed out info cardsto passerby. Throngs of people and tonsof cars passed through the intersection.There was a conference nearby withmany young students in attendance.

And then it started to rain. Wedecided to call it a day around 2pm, saidour good byes, and disbanded.

Our next stop was in Boston. CynthiaMaloney put Brother K and me up for thenight. The next morning we rolled intoBoston on a beautiful, sunny day. We setup right in front of the State House,adjacent to the Boston Commons. Throngsof people passed by us. I was excitedwhen a man named Kenneth Thomasarrived after reading an email about ourdemonstration. He had been againstcircumcision for over 20 years, but had noidea that there was an intactivistmovement. The Boston demonstration wasa cosmic relief for Kenneth. He finally feltempowered being out in public againstcircumcision, and I’m glad to have been apart of that moment.

Cynthia arrived for her third andfinal day with her baby granddaughterand two more women, Mary Bristol andWendy Weinbeck Grenier, arrived withtheir children. It’s really empoweringhaving women demonstrate with us.When women demonstrate againstcircumcision, nobody thinks it’s a joke.

Towards the end we decided to moveto another corner where the metro entrancewas. A police officer ran over to pose withus in a photo. Then a Jewish man cameover to me and started arguing with me.For some reason I kept engaging with him,not realizing that he wasn’t listening, thathe was trying to get me to feel upset. Idon’t think I won that religious debate, butI definitely realized that I wasn’t out thereto debate. I was there to use my voice, tobe heard, and vowed not to engage with

people who are trying to hurt us orotherwise drag us down.

Then, realizing that the bloodstainedmen were already in the intersection, Istepped off into the street to join them.There’s something really powerful abouthaving four or more bloodstained menand their friends all lined up. Every headturned towards us. Cameras come out. It’slike intactivism on steroids.

Again at 3pm, we packed up andcalled it a day, and drove on to our nextdestination, Hartford, CT. Brother K and Istayed with a friend of a friend of mine,and we got some much needed rest.

The demonstration in Hartford wasagain groundbreaking. We stood in frontof the State House at the intersection ofCapitol Ave. and Lafayette Street. At firstit was just the three of us, Rik, Brother Kand I. Another activist named Asa Rubincame a little while later. We receivedhonk after honk of support. It felt likeecstasy being out there. And then thecounterdemonstrators showed up.

Apparently people had heard aboutour tour and two Jewish men decided tocome out and protest our “antiSemitism.” One of their signs saidsomething about how circumcision wasprotected by religious freedom. The otherone sang Hanukkah songs in Hebrew andcompared us to Antiochus, the Greekruler who banned circumcision (amongother things) in ancient Judea. Then,suddenly, one of their signs was ripped inhalf by the wind. They left shortly afterthat. I think it’s safe to say that theircounterdemonstration was a failure. Oneguy even came back for more, but gaveup again after witnessing how successfulwe were. Still, it gave all of us a lot toreflect upon.

A few cars drove up to us andstopped to take literature. We decided totry and go to the downtown area, but itwas so windy and cold that weimmediately rushed back to the StateHouse. Another day with thousands morereached, with thousands more awakenedto the reality of circumcision.

The next stop was Trenton, NewJersey. I was a little worried aboutTrenton being a dud because of itsreputation of being desolate. In the end, itwasn’t that bad, in fact it was so good thatBrother K and I labeled the day “TheBattle of Trenton,” after a famousrevolutionary war battle that took place

there. Which reminds me of the fact that‘our forefathers had foreskin!’

In Trenton, we were four total: Rik,Brother K, myself and Craig Adams,whom we last saw in Times Square.Shortly after setting up, a police sergeantdrove by and gave us the thumbs up.More and more cars gave us the thumbsup and honked. The Taxation Buildingwas right on the corner of our intersectionand was filled with office workers. Wecreated a buzz in the building. By thetime lunch rolled around, people werestreaming out to take our photos. A lot ofpeople even posed with us.

Our next stop was Baltimore,Maryland. Brother K and I spent the nightat my roommate’s friends’ house. One ofthem was working on a sex ed pamphletfor teens, and will be emailing me thedraft when its near completion. He wantsto make sure that he gets the parts correctabout intact and circumcised penises.They were all really happy to host us andwished us the best.

The protest location was a shortdriving distance from where we spent thenight. Brother K and I met Rik, and we allsuited up and prepared our signs. I’malways amazed at Brother K’s resolve,

(l. to r.) Cynthia Maloney, Wendy WeinbeckGrenier, Jonathan Friedman, Mary Bristol,

Boston, MA, November 18, 2013

(l. to r.) Rik Przybranowski, KennethThomas, Brother K, Jonathan Friedman

in front of State House, Boston, MA,November 18, 2013


stepping off the curb into the crosswalk inhis bloodstained suit.

More intactivists began to arrive.Mothers from Intact Maryland. DevonOsel and his nowwife Katie [Editor’snote: Devon’s Baltimore report appearson p. 35]. Kenneth Nero arrived with 25color copies of my pamphlet, “GenitalAutonomy: Why Circumcision Must BeStopped.” He’s a librarian and alwaysensures that it’s in stock. The protest wasextremely successful as we received anoutstanding welcome.

Next stop, Philadelphia. As soon asBrother K and I stepped onto the cornerof Chestnut and South Sixth St., a stone’sthrow from the Liberty Bell, we wereapproached by a private security agenthired by the federal government whopromptly told us, “Move or else you’ll bemoved.”

Our options were now reduced totwo possible corners. Shortly after we hadmoved, a man came out of a building andtold us that his corner was privateproperty and that we had to move again.He threatened to call the police if werefused. I invited him to do so, and gotback to protesting while Brother K calledon the federal parks police to ask for help.Brother K quoted the “under 25 law,”which states that a group under 25members does not require a protest permitfor federal parks.

The Philadelphia police sergeantarrived, an intelligent man, reaffirmed ourright to protest anywhere, and asked uswhy we were out there. We explained tohim, and he listened and acknowledgedhow bizarre circumcision was.

During this time, hundreds of carsand hundreds of tourists, many of themhigh schoolers, read our signs and tookphotos of us. It was an iconic moment forall of us to have the chance to pose infront of Independence Hall, where theDeclaration of Independence was signed,and where the Liberty Bell originallyhung. Jake Van der Vliet showed up witha sign that read “Circumcision is aHuman Rights Violation.” We walked upand down the lawn and did someintersection actions. Again, I felt like theday was extremely successful.

Now we were on the home stretchback to New York City. I was excited toget back home to see my friends and to domore protesting on home turf.

On Saturday morning we headedback to Times Square where veteranintactivist Laurie Evans (Steven Svobodadid some speaking events with her in thenineties as some of his first activities) andPulley de Pereda (a European intactivistwho marched in NYC Pride 2013) joinedus. While Brother K was filming aninterview with Pulley, a group of ultraOrthodox Jewish men were also filming acomic promo for “Thanksgivukkah” (amerging of Thanksgiving and Hanukkah)and interrupted Brother K’s interview.The man dressed in a pilgrim outfit said,“Sure, we might have gotten the short endof the stick, but we’re all right,” inreference to circumcision. Brother Kpolitely cut them off and got back to hisinterview, at which point the ultraOrthodox Jews promptly left.

It was brutally cold so we decided tocall off the demonstration at 2pm to saveourselves for the next day.

Union Square on Sunday, November24 turned out to be by far our best day.There was nothing like it. The day startedout slow as we set up on the corner of E14th St. and Broadway, just outside of theUnion Square Winter Market. Peoplegave us tons of positive feedback,honking their horns, giving us the thumbsup, and asking to take our photos. We didget a few naysayers who ridiculed us.Some even spouted angry statements atus, such as: “You should be ashamed ofyourselves!”

As Brother K says, it is a shame thatwe have to do this, a shame that doctorsare sitting on their hands, a shame thatgrown men are on street corners talkingabout penises.

As the morning turned into theafternoon, hordes and hordes of peoplewere moving through that intersection, andat one point there was a constant stream ofphotos being taken of us, a constant streamof heads turned towards us. It was like wehad discovered a magical formula with thebloodstained suits.

NYU Journalism student MelanièBouché, a friend of a friend, came to filmus. She was amazed at the positiveresponses that we received.

We kept going way past 3pm, buteventually we called it a day to preparefor the early morning Financial Districtdemonstration, the grand finale.

The Financial District protest thatconcluded our tour on Monday, November25 went far better than I had expected. Weset up at Zuccotti Park—the iconic“Liberty Square” that two years earlierhosted Occupy Wall Street. Immediatelyafter Rik set up his “Honk to StopCircumcision” sign, an NYPD squad carrolled by and honked at us and the twocops inside both gave us the thumbs up.

After a little while, Brother K and Imarched down to Wall Street, passed theStock Exchange, and stood on the steps ofFederal Hall, where George Washingtonwas sworn in as the first president of theUnited States of America. We hastilyposed in front of the statue before afederal parks officer came out andinformed us that we had to be on thestairs, and not on the statue. Lots oftourists took our photos.

We walked back to Zuccotti Park andBilly Eliot, a local artist who’s wife is aDoula, joined us. We also met a respectedwriter and father of an intact son whowrote a paper on circumcision years agobut couldn’t get it published. TwoOrthodox men who passed by us hit

(l. to r.) Jonathan Friedman and AsaRubin in front of the State House,Hartford, CT, November 19, 2013

(l. to r.) Jonathan Friedman, supporter,Brother K, Rob Jap Tsvetkov, UnionSquare, NYC, November 23, 2013


On the Water: Circumcision isSadism, Not CultureNeels Blom

Business Day Live (South Africa)www.bdlive.co.za

July 15, 2013Every year, untold numbers of boysenter rural initiation schools.Most survive to return as men;

many are badly injured, some die. All aresexually mutilated. That is how it goes.There is no point to an odyssey if it is notan ordeal, is there?

The idea of initiation is as old as humanity. Its philosophical underpinning iswhat Joseph Campbell describes as thehero’s journey. Its purpose is to gain entryinto the adult world.

It is a monomyth because it occurs inevery society in one form or another; it isas necessary to a cooperative society asthe rule of law. Campbell’s quote is apposite: “A hero ventures … into a region ofsupernatural wonder: fabulous forces are

there encountered and a decisive victory iswon: the hero comes back from this mysterious adventure with the power to bestowboons on his fellow man.”

Parents may not necessarily acceptinitiation schools as the best way to introduce youths to adulthood, but they knowintuitively that their children will not attain social maturity until they have shownthemselves worthy. Arnold von Gennep’sdescription as a general theory of socialisation describes the process as a rite ofpassage, in which three steps must occur:separation, transition, and reincorporation.

In South Africa, the isolation at initiation schools represents separation, andwhat happens at the school is meant to beinstructive to the youth so that he mayundergo a transition that would renderhim acceptable to adults for reincorporation into society — as an adult. But that isno more than form.

What we have for content in SouthAfrica is the fabulously toxic mix of sex,religion and money. Sex because it is aprivilege of adulthood, religion becausethe forces of change are occult and sex ismysterious, money because it is possible.The upshot, however, is the sadistic ex

pression of sexually repressed adults inwhich the boys are partly emasculated asa form of discipline that would permitthem entry into a society of equally partlyemasculated men. Who needs that?

Rites of passage are essential, but thereis no reason to permit the sexual mutilationof circumcision. Circumcisions for purposesother than surgical intervention (rarely necessary) are unnecessary. They serve nofunction in hygiene (read the medical literature), rob the victims of sexual pleasure(also in the literature), do not prevent thetransmission of HIV (the evidence is overwhelming, despite the Department ofHealth’s assertions) and are associated witha list of lifethreatening complications aslong as the arms of the brutes who favourthis atavistic act of sadism.

The cultural value of initiation is indisputable if the content is applicable tothe society we wish to build. Our children’s development is about the future,not some misguided past. We do want ourchildren to overcome challenges, to gainselfknowledge, to belong to a cohort ofpeers, but sexual mutilation has no function in this. It is up to parents to disruptthis cycle of violence.

NNeewwss,, VViieewwss && RReevviieewwss

themselves on the head, evidently tosymbolize how they thought we werecrazy, and one muttered, “Stupid!”Several more people stopped to thank usand took our photo.

The protest tour was an amazingopportunity. It showed tens, maybehundreds of thousands of people, thatintactivism is on the rise, and encouragedmore people to join our movement.There’s no way that people could havedone this ten years ago. Facebook and theprevalence of smart phones have beenessential tools in organizing andspreading our message. It makes me sadto think what it was like for all of thepeople who started before me, coming outagainst circumcision when it was anunquestioned norm. Times have reallychanged, in large part due to the work ofintactivists in previous decades. Not onlydid I meet firsttime mothers with intactsons, but I also met mothers whoregrettably circumcised their sons andbravely left their future sons intact.Intactivism is growing so rapidly that Ican’t keep up with all the newcomers.

The American people are finallybecoming receptive to hearing us, and I’mgrateful to be able to play a positive rolein all this.

I’m so glad that I got the opportunityto connect with everyone throughout this

tour, and I look forward to joiningeveryone at the Circumcision CrisisSouthwest Marathon in February. 2014 isgoing to be another groundbreaking year,you can count on that.

(l. to r.) Brother K, Jonathan Friedman stand iat the statue of George Washington beingsworn in as first President of the United States at Federal Hall on Wall St., NYC,

November 26, 2013

40 Attorneys for the Rights of the Child Newsletter Volume 10, Issue 2Review: The Business of Baby

Review by J. Steven Svoboda

The Business of Baby: What DoctorsDon’t Tell You, What Corporations Try toSell You, and How to Put YourPregnancy, Childbirth, and Baby BeforeTheir Bottom Line. By Jennifer Margulis.New York: Scribner, 2013. 344 pages.www.simonandschuster.com. Review by J.Steven SvobodaAwardwinning journalist Jennifer

Margulis, who is also the motherof four children, has written a

book that has much to say about the interface of capitalism and our deeply flawedmedical system with pregnancy, childbirth, and raising a baby. Surely TheBusiness of Baby, which was famouslypanned by the New York Times, is not aperfect book. Margulis seems less than aperfectly judicious and objective author,probably likely to favor anything alternative and a sure bet to find fault with mostanything that is sold by big corporationsthat relating to pregnancy or raising ayoung child.

That is just fine by me. While I wasinitially skeptical, this book eventuallyconverted me to a view more or lessaligned with that of the author. Margulisis an excellent writer, opening her bookwith two compellingly contrasting storiesof prospective mothers, 1) a Serbianbornwoman, Marijana, living in London whoupon becoming pregnant for the first time,moves back home with her husband; and2) a New Jersey elementary school teacher, Melissa Farah, having her first child atthe same hospital as a close girlfriend,

Valerie Scythes, who became pregnant atmore or less the same time. The author’strenchant question: “Which young womanwould be better off, the one in a smallBalkan country still recovering from abrutal civil war, or the mom in the richestand most powerful country in the worldwith stateoftheart medical equipmentand knowhow?” The answer of course,is that statistically, Marijana is better off,and in fact, both Melissa and Valerie diedin childbirth.

In terms of infant mortality, no fewerthan fortyeight (!) countries are saferthan the United States, which has one ofthe highest death rates in the industrialized world. An American child is morethan twice as likely as a child in Finlandor even Singapore to die before his or herfifth birthday.

Meticulously, painstakingly, in manydifferent contexts, the author shows usthat “time and time again corporateprofits and private interests trump what isbest for mom and babies.” Ultrasound isbadly overused and doesn’t necessarilyprovide any clinically useful information,at least not enough to justify the inherentrisks of the procedure, but it does contribute to obstetric intervention, which cansometimes even prove fatal. It also maybe causing autism.

The author comes up with lots ofshocking facts. It is more dangerous tohave a baby in the US in the twentyfirstcentury than it was two or three decadesago. Margulis builds a convincing casethat Caesarean sections are often performed for the convenience of the doctor.

Margulis includes a chapter on circumcision and the title alludes to the saleof foreskins for high profits. She discussesalterations in baby’s brain chemistry thatresponse from painful stimuli, and the needto respect each person’s genital integrity,all the more so with procedures that are irreversible and not medically necessary.The author discusses evidence from ARCBoard Member David Llewellyn thatbotched [Editor’s Note: socalled as everycircumcision may be considered a botch]circumcisions are much more commonthan is believed and reported.

Another shocking topic is the medicalestablishment’s continued hostility tobreastfeeding mothers. The US was foundto rank last (thirtysixth out of thirtysix)in a recent “assessment of how wellwealthy countries support breastfeeding

moms.” The cluelessness of physiciansand nurses in believing that a healthy babywould be “choking” on breast milk orwould be at risk for “convulsions” withoutformula supplementation again reminds usof ignorance such as that of Dr. Brady’scomment to me in our October 2013 debate in South Carolina, “No one knowsthe functions of the foreskin.” Doctorsdon’t receive adequate training in medicalschool on either breastfeeding or the intactpenis’ functions. Formula, Margulisshows us, is literally killing babies in theUS. In Norway, a baby has half thechance to die in infancy relative to here,and one main reason for that is thatbreastfeeding rates in Norway are amongthe highest in the world.

Analogies applicable to intactivismrepeatedly crop up in discussions of othertopics. Caesarean sections seem to bedone so frequently at least in part becausethey are more lucrative for doctors thannormal deliveries. Ultrasound, like circumcision, has come to be routinely performed while incurring significant riskswithout clearly providing any benefit.Babies are kept in neonatal intensive careunits longer than they need to be therebecause this practice is lucrative, just asfinancial incentives have similarly helpedperpetuate circumcision.

Margulis’ later chapters are lesscompelling than the early ones. The lastone, on the lack of need for wellbabycare, is probably the least convincing ofall. Before that, the author lost me a bitwith her chapter about corporate profitsshaping the desire to potty train childrenat ostensibly premature ages. There maybe something to this but it just doesn’tstrike me as of a piece with the earlierchapters. And I frankly find it hard tobelieve, as Margulis claims, that “kindergarten teachers now report having tospend up to one third of their time dealingwith urinary and fecal accidents in theclassroom.” I volunteered in both mykids’ kindergarten classes and I don’t remember a single such incident occurringthroughout two entire school years. I doagree that it is a bit creepy that Procter &Gamble is evidently extremely reluctantto reveal the ingredients in their diapers!

As the husband of a pediatrician anda firm believer in vaccination, which hassaved many lives, I also can’t fully embrace Margulis’ chapter on vaccinations.Still, as with the chapter on potty training,


South African CircumcisionResults in $215,000 AwardThe South African lawsuit resulting fromthe botched circumcision of a fiveyearold boy has been decided in favor of theplaintiffs for R2.2 million or approximately US $215,000.R3m Claim for Six ‘Botched’Circumcisions

Amanda KhozaIndependent Online (South Africa)

www.iol.co.zaOctober 20, 2013The parents of six boys from Dassen

hoek who were allegedly circumcised without consent are suing

New Start clinic for R3 million in damages.The clinic, which is managed by So

ciety for Family Health and ThatendaHealth Care, is a partnership with the Department of Health. It runs six male circumcision centres in KwaZuluNatal,Gauteng and Mpumalanga.

In May, the Sunday Tribune reportedthat parents of 19 boys, aged 11 to 19,from Dassenhoek, near Mariannhill, laidcharges against New Start over circumcisions.

Some of the boys experienced postoperative complications, swelling orbleeding of the penis or infected wounds.A case of assault with grievous bodilyharm was opened.

Police spokesman Captain ThulaniZwane confirmed the docket had beentaken to the National Prosecuting Authority for a decision.

The boys were picked up in groupsby a man in a vehicle bearing the New

Start logo from April to May.Victor Makhunga’s 13yearold son’s

foreskin was removed at the Umlazi clinic. Makhunga, 46, had wanted to bury thetissue in the yard next to his son’s umbilical cord for cultural reasons. He is one ofsix parents claiming R500 000 each.

“New Start must tell the truth, wewant the matter to go to court because wewant to hear what happened. Too muchdamage has been done,” said Makhunga.

Busisiwe Ntiga, 29, was at workwhen her 11yearson was circumcised.She alleges the KZN Department ofHealth offered them money for their silence.

“One official told us we can be paidbefore the matter goes any further. Theytried to silence us with money but we refused,” said Ntiga.

The KZN Department of Health hasfailed to respond.

Attorney Naheem Rehman, for theparents, said: “In terms of the Children’sAct, consent is required by a health practitioner before undertaking any procedure.Circumcision of children under the age of16 is strictly prohibited unless it is donefor medical or religious purposes. Anyone who contravenes this law faces a 10year jail sentence or will be fined.”

He said the Society for FamilyHealth had until this week to respond tothe letter of demand or summons wouldbe issued.

Director of the society’s South African branch, Scott Billy, said the organisation had not received the letter and theywere not aware of the claim.

However, the Sunday Tribune hasseen a copy of a registered letter signedon behalf of New Start clinic acknow

ledging the letter of demand.“An investigation about the incident

at the Umlazi site found that we did nothing wrong. The KZN Department ofHealth reacted immediately to the reports,conducted an audit and investigation andfound that our site had done nothingwrong,” said Billy.

He said the NGO, which gets aidfrom the South African, US and Dutchgovernments, as well as the UN, uses theforceps method for circumcision.

The July edition of the KZN HealthBulletin boasted more than 239 000 KZNmen had been successfully circumcisedsince 2010, with not a single death orbotched procedure – even though theSunday Tribune highlighted the case ofthe Dassenhoek boys.

KZN Health MEC Dr SibongiseniDhlomo acknowledged New Start amongother NGOs for “assisting with the expansion” of the circumcision programme.

Meanwhile, Wentzell Ngidi, 26, thefast food employee from Umlazi whoseentire skin was removed from his penisduring a botched circumcision onSeptember 21, is recovering at St Aidan’sHospital and awaiting plastic surgery.

“I am still in a lot of pain,” saidNgidi this week. He said he has not seenor heard from Dr S’bu Ndlovu, who performed the circumcision.

The Sunday Tribune tracked Dr Ndlovu down at KwaDabeka CommunityHealth Centre, east of Pinetown, where hewas working the late shift.

When asked to explain what happenedthat day, Ndlovu said: “I really can’t talkabout what happened because it’s a subjectof an internal investigation.”

no doubt grounds exist for some suspicion of the medical stories we are fed andthe author is to be commended for questioning them. Certainly we may be givenpause by the counterintuitive finding ofone recent study that nations that requiremore vaccines tend to have higher infantmortality. And I can certainly embrace the

author’s argument that current vaccineschedules may be driven by capitalismrather than by babies’ best interests, giventhat breastfeeding rates and general infanthealth are much higher in Norway andIceland, where children receive no vaccines before they are three months old.

Jennifer Margulis has written an

important and thoughtprovoking book,the sort of work that it is difficult to getexactly right in every detail, yet exactlythe sort of book we need in this day andage. Much can be learned from it aboutilluminating analogies between othermedical practices and male circumcision. I highly recommend it.

42 Attorneys for the Rights of the Child Newsletter Volume 10, Issue 2Mother Upset Over BotchedCircumcision

Ernie FreemanMyFox Memphis

www.MyFoxMemphis.comNovember 8, 2013I t doesn’t happen often, but when a

doctor botches a child’s circumcision, it's heartbreaking.Maggie Rhodes is dealing with that

heartbreak right now, after a catastrophicmistake on the operating table.

Removal of the foreskin from achild's penis is rooted in concerns abouthealth, hygiene and religion. But somequestion the necessity of the procedure.

Rhodes is sorry she ever took heryoung son to get circumcised.

“After I went home and I discoveredthat my son’s penis was not there, I immediately froze, like, oh my God,”Rhodes recalls.

The mother said she couldn’t believewhat happened when she took her threemonthold son Ashton to Christ Community Health Center on Broad Avenue

for a circumcision in August. She saysdoctors told her the procedure would takeabout 20 minutes.

But after a couple hours, Ashton wasstill in surgery.

“It took them about three hours to dothe circumcision and so my babyscreamed the whole three hours, like thewhole process,” Rhodes said. “Then evenwhen she gave him back to us, he wasstill screaming.”

Rhodes said the doctor performingthe surgery obviously botched the procedure. But when it was over, she says theysimply returned her screaming son to her,never telling her about the devastatingmistake that had happened in the operating room.

“I should have been notified thatsomething went wrong in this room withyour baby,” she said. “I wasn’t notified.They gave me back my baby like nothingwas wrong. They said, ‘here go yourson.’Yeah, something went wrong in thatroom.”

It’s something Rhodes said she didn’tfind out about until she went home with a

still screaming son, and a diaper filledwith blood.

She said her curious sister finallydiscovered Ashton’s mutilated penis.“When my sister pulled the cloth back, itwas covered in blood and it was no penisthere,” Rhodes said.

All that was left was a partial penisand his tiny testicles. Rhodes said Ashtonurinates through a hole in his penis. Shesays she can’t imagine what she’ll say toher son, when he's old enough to understand what happened to him.

“Like, ‘Momma like, how could thishappen to me? How could this happento me?,’” she said. “How could you explain that to your child that you don'thave a penis that they have to reconstructone or you probably have might not neverbe able to have kids? That don't sit wellwith me at all.”

Rhodes has hired an attorney and ispursuing a medical malpractice suitagainst Christ Community Health Centers.

As for little Ashton, a reconstructivesurgery planned for October has beenrescheduled for early next year.

Circumcision Does Not PreventSexually Transmitted InfectionsJonathan Friedman

IntactNewsIntactNews.org

October 11, 2013A new study* by urologists showsno link between circumcision andsexuallytransmitted infections

Researchers performing a clinicalstudy on over 800 African American menfound that circumcision does not preventSTIs (sexually transmitted infections).The most important factor was thenumber of sexual partners.

Researchers say their results throwinto question commonly held beliefsabout the connection betweencircumcision and STIs, which they sayare largely based on extrapolations fromstudies performed on men in Africa.These African studies and their policyimplications, which includes the recent

reversal of the American Academy ofPediatrics' circumcision policy statement,were widely criticized by a consortium ofdoctors and human rights organizations.

The latest American study wasperformed by urologists from theUniversity of Michigan, Ann Arbor, theUniversity of Illinois, Chicago, andMount Sinai Hospital in New York.

Researchers did not test for HIV inthis study. *J.R. Gonzalez, J. Hotaling, R. Dunn, N.BarChama, A.V. SarmaA populationbased study of circumcisionand nonHIV sexually transmittedinfections in a contemporary group ofAfrican American men: the flint men'shealth studyFertility and Sterility September 2013(Vol. 100, Issue 3, Supplement, PageS220)www.fertstert.org

Woman Fined $140 a Day forRefusing to Circumcise SonDimi Reider972mag.com

+972 MagazineNovember 25, 2013Rabbinical judges in the case said

they fear the effect thatallowing Israeli Jews to freely

decide on the ritual circumcision of theirown children might have on the globaldebate over the issue.

An Israeli woman is being fined NIS500 ($140) every day for refusing tocircumcise her oneyearoldson, Israel’sChannel 2 reported today. There is nosweeping legal requirement for Jews inIsrael to circumcise their children, but thewoman is undergoing a divorce process atthe Haifa Rabbinical Court, and her husbandhas appealed to the court to pressure thewoman into circumcising the son.

“I’ve been exposed to a lot ofinformation about circumcision anddecided not to proceed with thecircumcision,” the woman told Channel2. “I have no right to cut at his genitalsand to maim him, and the court has no


Ethical Issues in Israel’s BizarreCircumcision CaseRebecca Wald

Beyond the Briswww.BeyondTheBris.com

December 18, 2013An Israeli mother ordered to circumcise her elevenmontholdson, or face a daily accruing fine,

has today taken her case to the High Courtof Justice, the court of last resort in thatcountry. The strange case stems from a divorce proceeding. When it comes to matters of divorce, the Israeli judicial systemis very different from the American system, as this case illustrates. In Israel thereis no civil marriage and rabbinical courtshave jurisdiction over Jewish divorce. Sowhen the father in this case demanded thathis son undergo brit milah—religious circumcision—during a divorcerelatedhearing, the court cited the importance ofupholding the biblical covenant. Elinor,the mother, was ordered to pay whatamounts in U.S. currency to a $140perday fine until the boy undergoes brit milah. Elinor (who is among the approximately 40 percent of Israeli Jews that aren’treligious) says she doesn’t want to circumcise her son at all, that he is fine justthe way he is. She says medical reasonsprevented him from being circumcised ateight days old in keeping with the Jewishtradition, and that as time went on and shelearned more about the procedure she decided against it. The boy’s father originally agreed but then made a surprisingaboutface in court, she says. I wanted toget the scoop on what kind of chance

Elinor’s plea would have on appeal—aswell as some of the ethical issues involved, so I spoke to a prominent Israelilawyer and ethicist, a bioethicist in theU.S., and a political scientist in Londonwith an expertise in circumcision.

“The is a really bizarre case, the firstof its kind,” said Carmel Shalev, an Israeliethicist and human rights lawyer whoteaches at Haifa University Faculty ofLaw. She told me she thinks the HighCourt of Justice will likely rule that therabbinical court doesn’t have the authority to force anybody to perform circumcision. In Israel, where there is no civilmarriage, Orthodox rabbis, applying Orthodox religious law, are the only oneswho may grant a divorce. It certainlyseems like an odd system for those of usin the U.S. where church and state areseparate. “They aren’t lawyers, theyaren’t professional judges,” Shalev pointed out to me, adding that their powers arelimited. She said in this case they are exceeding their authority. “There is no dutyunder Israeli law to perform male circumcision,” she said. The rabbinical courtsystem, where women don’t have thesame right as men to obtain a divorce,was inherited from the time of the Ottoman Empire and is part of the early politics of the State of Israel. “People mostlyaccept the tradition and don’t make a bigfuss about it,” said Shalev. According toU.S. ethicist Ruth Macklin, the main issuefor her is one of religious freedom. “Fining people for failing to adhere to a religious law is not religious freedom. Thisshould not be the case in a democracy,”she told me. Macklin is a professor in the

Department of Epidemiology & Population Health at Albert Einstein College ofMedicine of Yeshiva University and a Dr.Shoshanah Trachtenberg Frackman Faculty Scholar in Biomedical Ethics.

“It’s patently unfair to women—straightforward sexism—that awoman does not have an equal right to adivorce,” Macklin added. However,Macklin said she doesn’t feel that a parental decision about whether to circumcise is an ethical issue. She pointed outthat parents make all kinds of decisionsfor their kids, including ones that havelasting consequences, including whetherto even bring their children up in a particular religion.

Rebecca Steinfeld, a political scientist at SOAS, University of London, whohas written and broadcast on the historyand ethics of circumcision, told me shesees it another way. “If the rabbinicaljudges coerce Elinor into circumcisingher son, her right to freedom of conscience would be violated,” she said. “Bycompelling her to irreversibly remove ahealthy part of her son’s genitals withouthis consent, the rabbinical judges wouldalso undermine her son’s rights to bodilyintegrity—a cornerstone of postHolocaust human rights law—and an open future, since he would have to live foreverwith his father’s and the judges’ choice.”

Steinfeld points out that “most criticisms of the rabbinical judgment focussolely on the violation of the mother’srights, but it is important to remember thatthe child’s rights would also be undermined if Israel’s High Court of Justice failsto overturn this unprecedented ruling.”

authority to force me to.” Her lawyer alsosaid the rabbinical court does not have theauthority to enforce the procedure, but thesecular family court would. The womanwent on to add she was unemployed, andcannot afford to pay the fine, whichalready adds up to NIS 2,500 ($700). Shesaid her husband originally had noobjections to avoiding circumcision whenthe child was born, but changed his mindduring the divorce process.

The rabbinical judges in the case saidin their decision the woman was opposingthe circumcision as a means to bringing

her husband back to her. They alsoreferred explicitly to the growing debatearound ritual male circumcisionelsewhere in the world, and voiced theirfear of the precedent that could be createdby a Jewish Israeli woman allowed not tocircumcise her son.

“We have witnessed for some timenow public and legal struggles against thebrit milah in many countries in Europeand in the United States,” the judgeswrote. “The public in Israel has stood asone man [sic] against these trends, seeingthem as yet another aspect of displays of

antiSemitism that must be combatted.How will the world react if even here theissue of circumcision is given to thediscretion of any person, according totheir own beliefs?”

Religious courts in Israel holdcomplete sway over all matrimonialissues, including divorce. An appeal tothe Haifa District Court by the womanwas turned down, and the woman said theonly resort left now is an appeal to theSupreme Court.

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Rabbi Sued After Baby InjuredDuring CircumcisionKDKA

pittsburgh.cbslocal.comDecember 27, 2013A local rabbi is being sued after al

legedly botching a bris, the traditional Jewish circumcision ritual,

and severing a newborn boy’s penis.The incident detailed in the lawsuit

happened at the Tree of Life Synagoguein Squirrel Hill within the last year.

The Jewish circumcision ceremonywas performed by Pittsburgh Rabbi Mordechai Rosenberg – who is also a mohel.

Sometime during the bris, accordingto the lawsuit, Rosenberg severed thebaby boy’s penis.

The baby was rushed to Children’sHospital, where doctors performed emergency microsurgery.

“If your finger, your thumb was cutoff and was put back on, that is pretty exciting,” said renowned UPMC plastic surgeon Dr. Joe Losee.

Dr. Losee was not involved in theboy’s treatment and he can’t talk specifics.

But our sources say it took eighthours. The baby needed six blood transfusions and was hospitalized for nearly twomonths. Sources describe the reattachment procedure as successful.

Dr. Losee says microsurgery advances every day, but it’s risky.

“Sometimes, it doesn’t alwayswork,” he says. “When you’re reattachinga portion where you include nerves,sometimes the nerves don’t heal wellbeyond where you reattached it. So thereare limitations for sure.”

On his website, Rabbi Rosenbergsays he is recognized as a “certified mohel by the American Board of Ritual Circumcision.” His site also says “a doctor’smedical circumcision, usually performedin the hospital, is not considered valid according to Jewish law.”

“That is extraordinarily serious and isextraordinarily rare,” said attorney DavidLlewellyn.

Llewellyn handles cases involvinginjury during circumcision – injurybrought on by both doctors in the hospitaland mohels in religious ceremonies.

“Your average pediatric urologist

probably spends about 20 percent of hisor her time repairing children who havebeen circumcised,” Llewellyn says.

According to the American Academyof Pediatrics, one in every 500 newbornboys experience significant acute complications as a result of circumcision.

“This is pretty much unregulated,”Llewellyn said.

He says there is no regulated standard for training or certification of mohels,or any place for reporting injuries fromcircumcision.

“There’s virtually no regulation ofthis any place in the United States that Iknow of,” Llewellyn said. “I think thegovernment probably should require somesort of training if this is going to be done.”

Rabbi Rosenberg told KDKA “I amtrained in this.” He also called the case a“tragic accident” and a “horrible situation.” But also said he continues to perform circumcisions.

Sources close to the case say, whilethe baby is recovering, there’s no way toknow if he’ll make a complete recovery.The incident happened about eightmonths ago.

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