To whom it may concern: Male circumcision in Germany







I had been looking forward to attending the World Congress
in Psychiatric Genetics later this year. I had been looking forward to
presenting the results of my research investigating genetic factors
contributing to mental illness and to explaining the new methodologies I have been
developing which could assist others in the study of mental illness, dementia
and physical illnesses with a genetic basis. I had been looking forward to
hearing at first hand the latest advances in the field, which with recent
technological advances is entering a particularly exciting phase.





Today, I'm wondering whether I should be going at all.





I'm wondering how I can even consider setting foot in a
country which has just decided to ban the circumcision of male children for
religious reasons. And then to have what we would call the chutzpah to claim that this is not antisemitic.





It is absolutely antisemitic to fail to acknowledge the
significance of circumcision as having a central place in Jewish identity and
being a core religious practice and then to go on to connote it as a simple act
of physical violence against a child leading to permanent physical deformity.
I'm sure that it's also anti-islamic but I'll mostly stick with what I know.





What is being promoted is a simple, indeed simplistic,
liberal argument that a child should not be subjected to a medical procedure
having permanent consequences when they are too young to consent. It is not
hard to see the superficial appeal of this argument and it seems to have been
persuasive for the court in question. However it can be challenged on a number
of levels.





Firstly, it needs to be accepted that male circumcision is
not a physically harmful act. The least that can be said for it is that it is
neutral and there are good arguments for saying that it confers physical
benefits, for example in reducing the susceptibility to acquiring and spreading
HIV infection. The fact that it may be harmful to a small minority of people or
that some may resent having had it performed on them does not negate the fact
that it bestows overall benefit. (And where there are significant medical risks,
such as for haemophiliacs, the religious obligation is removed.) Identical
arguments could be made about immunisation, which undoubtedly causes severe and
permanent harm to a small number of children but which provides individual
benefit to the vast majority and which is overall hugely beneficial for society
as a whole.





Next, we can say that circumcision is not the only thing which we allow parents to do their children which has long-term
physical consequences. Alongside immunisation, we allow parents to arrange for
their children to have tattoos and piercings. Up to the age of 24 weeks or so
we allow them to terminate their existence. We allow them to encourage their
children to participate in athletic activities which are risky and dangerous as
well as those which are safe. And we allow them to provide their children with
large quantities of unhealthy food and drink which bestow on them lifelong
health problems.





As a psychiatrist I am especially aware that intellectual
and emotional consequences can be as important as physical ones. We allow
parents to indoctrinate their children in Judaism, Catholicism, Islam, humanism,
atheism, liberalism, Hinduism and Buddhism. We allow parents to force their
children to attend cheder, Sunday school and madrasas. We allow them to make
their children undergo christenings, baptisms, bar mitzvahs and confirmations. We
allow parents to teach their children Creationism and Darwinism. We allow
parents to teach their children what is morally right. Or not. We allow parents
to have their children watch too much television and to grow up with unsuitable
role models. In short, we allow children to be raised by their parents, not by
the state. Quite broad limits are set around how parents may treat their
children and we allow parents to do many things which we might not really
approve of.





Withholding circumcision from a Jewish boy is not a
neutral act. It is not adequate to simply say that he can decide for himself
when he is an adult. This is like saying that we should not provide him with
religious education because he can decide when he is an adult what religion to
pursue. Or we can hold off forcing him to learn to read or write because he can
decide when he is a grown up whether these are skills he would like to acquire.
A Jewish boy who is not circumcised will feel themselves to be deficient in their
identity and to be failing to fulfill what is expected of them. Of course there
are adults who will resent having been circumcised when they were younger but
this is a consideration which needs to be taken account of, not an overwhelming
and incontrovertible argument against the practice. An adult who abandons
Judaism is forced to bear a permanent reminder of their history. But each of us
has an awareness of our histories, some of which we may not be happy about,
whether or not we have a physical reminder. (Incidentally, it may need
clarifying here that it's not the circumcision which makes somebody Jewish,
it's the being Jewish which requires that one be circumcised.)





It will sound strange to hear, but from a Jewish point of
view the failure to perform circumcision would actually be a form of child
neglect.





It is difficult to convey to a non-Jew the absolutely
central place that circumcision has in religion, history and identity. I think
probably I shouldn't even try. I understand that there are people who think
that all religious belief and practice is primitive, irrational, harmful
nonsense. I have a good deal of sympathy with that position. But for those who have
the view that religion is something which should at least be tolerated then I
say that if they wish to pay more than lip service to this idea then they need
to hear Jews and Muslims when they say that this practice is key to their
religion and that parents need to be allowed to bring up their children in
accord with what their religion demands.





As I write this, I am sitting on a London underground
train. The man on my right is reading an article highlighting the worrying rise
in the number of violent children arriving at primary school. The man on my
left is looking at a Bible and making notes. He is studying the book of Maccabees.
Nowadays, we celebrate their rebellion against an occupying power which sought
to stifle religious expression with the festival of Chanucah. What every Jewish
child learns is how they won back the temple and relit the light which
symbolizes God's eternal presence and which is now seen in every synagogue.
Less well-known is that a key factor of the religious oppression which
triggered their revolt was the attempt to ban circumcision. 





I am shamefully ignorant of Jewish history and I may be
mistaken here but I know of no other time or place when a government has sought
to ban Jews from performing circumcision. Of course there have been plenty of
times when Judaism has been banned or Jews have been banned or Jews have been
killed. But never before have I heard of a society which tries to say,
"Yes, we accept Jews. But they must not circumcise their children."





I understand that liberal non-Jews probably feel a bit ambivalent
about this, as they do about the ritual methods used for animal slaughter and
the whole notion of animal sacrifice. However, they need to make a stand.
Either they truly defend the freedom to practice religion and they need to
vigorously contest this. Or they don't.





So, what now?





To the Jews of Germany, who would in some ways ironically
be better treated in Iran or Syria than where they are now, I say that travel
and employment in Europe is unrestricted and that although the weather in
Britain is not all that great it's probably not much worse than what you have
there. And that the social, political and cultural climate certainly seems far
more accommodating. I extend the same invitation to Muslims of Germany and France.





To the organisers of the Congress I say, what actions are
you taking to protest this decision? To the doctors of Germany I say, what
actions are you taking to defend the rights of your patients to be able to have
this procedure performed legally by somebody who is medically qualified rather
than for it to be driven underground? To the politicians, lawyers and citizens
of Germany I say, where do you stand on this issue? 
Please make your thoughts
known. The world is watching you.

Comments

  1. (tried to leave a longer comment, but it didn't post); very minor - I'm also not an expert on the subject, but the ban is by no means unique in history: http://en.wikipedia.org/wiki/Circumcision_and_law

    ReplyDelete
  2. Hi.

    Lovely to see the head of your medical association taking such a brave, principled stand. I hope you're proud of him:

    "The head of the German Medical Association, Frank Ulrich Montgomery, said the ban meant there was "an increased risk of this task being performed by lay people which, because of poor hygiene conditions, could lead to serious complications".
    But Montgomery said he sadly had to advise his colleagues to refrain from performing the operation until the legal situation had been clarified, "otherwise they could face prosecution"."
    http://www.reuters.com/article/2012/07/12/us-germany-circumcision-idUSBRE86B0XF20120712

    Please direct me to the link where it says that thousands of German doctors are standing up for the rights of their jewish and muslim patients and colleagues to practise their religion.

    Best wishes

    - Dave

    From: "Prof. Dr. med. Markus M. Nöthen" [mailto:markus.noethen@uni-bonn.de]
    Sent: 29 June 2012 15:40
    To: Curtis David (EAST LONDON NHS FOUNDATION TRUST)
    Cc: Lyn Sholl; Marcella.Rietschel
    Subject: Re: Response of WCPG organisers to Germany's ban on circumcision for religious reasons?

    Dear David,
    I can only say, that what is reported in your country seems not in any way reflect the depth of public discussion that is taking place here in Germany,
    Best wishes,
    Markus



    Am 29.06.2012 um 16:25 schrieb Curtis David (EAST LONDON NHS FOUNDATION TRUST):

    Hi.

    Thanks. I fully appreciate that there's controversy in Germany and I welcome this. However what is being reported here is that it is at present illegal for a doctor to perform religious circumcisions and that this decision is supported by the majority of German people.

    Of course it's not at all a criticism of the Congress. But it is the case that I personally would feel uncomfortable about visiting Germany in this situation.

    I will see how things develop.

    Best wishes

    - Dave

    ReplyDelete
  3. OK, I've decided not to go. I don't feel comfortable visiting Germany at the moment.

    Merkel has managed to get a resolution passed by the German parliament to have the law reviewed but till then it stands. So for me one question is how Germany managed to arrive at this situation in the first place. It demonstrates a lack of concern for religious freedom in society when a local court can make a decision which has such a profound and pervasive effect across the country.

    Secondly, I'm unimpressed by the attitude of German doctors. Their association has meekly advised them not to perform circumcision because it has been deemed to be illegal. This is in spite of the fact that the doctor in the original case was acquitted. In fact, it's precisely because he was acquitted that no appeal could be lodged in order for a higher court to consider the situation. In these circumstances, it would be appropriate for German doctors to make a stand and publicly declare that they would continue to perform circumcision. If one were charged and convicted then so much the better because then an appeal could be lodged where doubtless the conviction would be overturned and a new precedent could be set.

    As I say, I'll see how things develop but it's clear that there won't be any movement till after the conference so I'll have to miss it.

    ReplyDelete
  4. Dear David, I must respectfully point something out.
    In another of your articles you chastise a media producer for causing harm with unscientific nonsense. Good on you :) Unfortunately I must now level the same criticism at you. You stated that circumcision reduces the susceptibility to acquiring and spreading HIV infection. The three African studies that are the source of this misinformation are completely bunk. Bad science at it's worst. The trials suffered a number of serious confounding problems including problematic randomisation and selection bias, inadequate blinding, lack of placebo-control (male circumcision could not be concealed), inadequate equipoise, experimenter bias, attrition (673 drop-outs in female-to-male trials), not investigating male circumcision as a vector for HIV transmission, not investigating non-sexual HIV transmission, as well as lead-time bias, supportive bias (circumcised men received additional counselling sessions), participant expectation bias, and time-out discrepancy (restraint from sexual activity only by circumcised men).
    Circumcision/HIV data has been collected in the U.S. for 30 years – during the peak of the HIV epidemic, 85% of men in the U.S. were circumcised, and yet it didn't stop the spread of HIV. In Europe the circumcision rates are very low, yet they do not have higher HIV rates. Why do we not see the purported “protective effect of circumcision” outside of those three Africa studies? Maybe because it doesn't exist.

    ReplyDelete
  5. It's really not a huge deal whether or not circumcision is actively beneficial from a medical point of view. Expert opinion says that on balance it is, but that's by no means central to my argument. Using a comparison of US/European HIV rates as evidence against is unconvincing - there's a plethora of other explanations for the difference. I haven't looked at the African studies in detail but I doubt that dismissing them as "completely bunk" represents a fair appraisal of them.

    Here again is what I originally wrote on this: "The least that can be said for it is that it is neutral and there are good arguments for saying that it confers physical benefits, for example in reducing the susceptibility to acquiring and spreading HIV infection." That does seem to be a pretty fair account of current opinion.

    ReplyDelete

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