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To cut or not to cut? That is the circumcision question roiling Europe

- The Washington Times - Tuesday, January 28, 2014

The political battle over circumcision is intensifying in Europe, as medical professionals and their allies have renewed a push to curb the procedure for infants and young boys.

But in a debate being closely watched by U.S. doctors and health care officials, governments across the European Union appear to be backing away from outright legal bans in the face of powerful opposition from medical supporters of the practice and faith leaders who say religiously observant parents should have the right to have their sons circumcised without social objection.

In the United States, newborn circumcision remains popular — although rates are slowly declining — and there is talk that male circumcision could be promoted in the U.S. as an HIV-prevention policy as it is in African countries.

A committee of the European Parliament met Tuesday to discuss the topic once again. The Council of Europe, the continent's biggest human rights organization, passed a resolution in October calling for a critical look at "nontherapeutic circumcisions."

Children's rights are human rights, and one of those rights is "physical integrity," Marlene Rupprecht, former lead researcher on the issue for the council, said Tuesday. The issue "has a lot of baggage," she said, but argued that the rights of the child must be distinguished from the rights of parents.

Circumcision is widely practiced in Jewish and Muslim communities. In Judaism, an infant boy is to be circumcised by the eighth day of life as part of Abraham's covenant with God. In Islam, boys are circumcised, often by age 10, as part of a celebration of their faith.

No European country bans circumcision of infants and boys, and some analysts predict that efforts to outlaw the practice altogether will simply force circumcision underground.

But efforts to curtail circumcision are growing. The Council of Europe's resolution is nonbinding, but could be used one day as the basis of law in some of the council's 47 member states.

European leaders also are working on a strategy to promote the rights of the child by 2015, and one of the main objectives is to end "all forms of violence against children."

Circumcision has been identified as a concern because it is painful, not medically justified and an irreversible procedure to which newborns and boys cannot consent.

In September, the national ombudsmen for children in six Nordic countries — Denmark, Norway, Sweden, Iceland, Greenland and Finland — said nontherapeutic circumcision performed on a child who cannot consent "violates fundamental medical-ethical principles." Moreover, the critics said, such circumcisions conflict with the United Nations Convention on the Rights of the Child, which says children have a right to express their views on all matters that concern them and must be protected against "traditional practices that may be prejudicial to their health."

In Tuesday's session in Strasbourg, Dr. Wolfram Hartmann said he and other German pediatricians have concluded that circumcision is not harmless nor pain-free, and parents cannot consent to such a procedure for their boys.

Boston psychologist Ronald Goldman said he wished in particular to address his fellow Jews: "Circumcision is a trauma," he said. Some infants go into shock because of the pain, and some men experience long-term physical and psychological problems.

United Kingdom film producer Victor Schonfeld, whose anti-circumcision documentary, "It's a Boy," was shown prior to the council session, noted that if circumcision were as revered as others say, men would have the procedure as adults. Instead, it is forced on children who cannot resist, said Mr. Schonfeld, who has publicly regretted that he, as a Jewish father, put his newborn son through circumcision.

Religious resistance

But religious leaders and their allies are rallying in defense of the practice and reminding their audiences that circumcision is has deep historical roots, rarely causes harm and is protected by freedom of religion — which means objections amount to an attack of faith.

Circumcision has "obvious and clear benefits," Istanbul pediatric urologist Dr. Mesrur Selcuk Silay told the Strasbourg meeting, citing data on preventing sexual disease, including work conducted by the American Academy of Pediatrics.

Dr. Bernard Lobel, a French urologist and surgeon who has seen "1,000 penises a year" in his professional practice, rejected the idea that circumcision deforms the male organ. How can people say circumcision for religious reasons is mutilation, but circumcision for medical reasons is not? he asked. It is "not a question of mutilation."

A second film shown before the meeting was produced by the Israeli government, which has observer status at the Council of Europe. The film showed how circumcision is an integral part of religious life for Jews and how it has little or no medical disadvantages when performed by experienced people.

Other circumcision supporters at the meeting said complaints about the procedure were rare from adults, that children do not have a say in other procedures, such as getting their tonsils removed, and that respect for diverse cultural and religious traditions was important.

Legal, medical issues

To date, circumcision proponents have prevailed, notably in Germany.

In June 2012, a German court in Cologne made news when it ruled that circumcision did "bodily harm" to boys and infringed on a child's "fundamental right" to "bodily integrity."

The court acquitted a doctor after the Muslim boy he circumcised had to be hospitalized for heavy bleeding, on the grounds that he had not broken any law. But the court also concluded that circumcision of minors for religious reasons should be outlawed and that neither parental consent nor religious freedom justified the procedure. It ruled that doctors who carry out circumcisions in the future should be punished.

Jewish and Muslim leaders and their allies quickly denounced the ruling.

By December, German lawmakers enacted a law permitting male infant circumcisions for nonmedical purposes, but only under certain circumstances: Both parents had to consent to the procedure; it could be performed only with anesthesia on a healthy child; qualified religious leaders could circumcise newborns, but infants 6 months or older could be circumcised only by a doctor.

In the United States, a clear majority of newborn boys are circumcised, although rates have fallen. In 1981, about 65 percent of boys were circumcised; in 2010, it was 58 percent, according to the Centers for Disease Control and Prevention. The highest circumcision rates in 2010 were in the Midwest, with about 70 percent of boys undergoing the procedure, compared with about 40 percent of boys born in the West.

Circumcision opponents typically reject the idea that adult circumcision is an effective HIV-prevention procedure.

The United States is spending millions of dollars to promote voluntary male circumcision in Africa because studies show that circumcised men have a significantly lower risk of acquiring HIV from infected women. Global public health officials have set a goal of 20 million voluntary circumcisions by 2015.

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