Imposing choices

Barbara Kay argues badly in favour of infant circumcision:

Passing to the moral realm, the argument of “informed consent” is easily demolished by the fact that we routinely vaccinate our children against disease without their consent for their own good. Even before we knew of the HIV connection, amongst those circumcising their sons, health and hygiene were always the reason. STDs are much more common in uncircumcised men, and circumcision causes a 12-fold reduction in the incidence of urinary tract infections. Complications from circumcisions performed by experienced surgeons and mohels are as rare as those springing from dental procedures or vaccinations: that’s to say, statistically negligible.

On to the pernicious myth that male circumcision, a 30-second procedure, is a “mutilation” and the obscene canard that it is the equivalent of sexist FGM. FGM is a horribly protracted and painful cutting of girls under terrifying circumstances...

“Mutilation” is a disgusting word to apply to the excision of a non-essential bacteria trap, nearly painless and instantly forgotten (those who claim otherwise are fantasizing; no credible study demonstrates lasting effects)....

Set aside the rights-based rhetoric. It’s about sex: Circumcised men have greater pre-orgasmic endurance; non-circumcision permits more frequent ejaculations. What matters most to the anti-circumcision activists is their diminished pleasure with frequently changing sexual partners, as befits an era where the number of conquests is a more common metric of romantic success than long-term relationships. Our legislators have better things to worry about than this.

Let's construct a reasonable argument from the hash she's made of things above. But let's not avoid smacking Kay around a bit first. The vaccination analogy fails utterly as the main health benefits of circumcision come after the individual is old enough to make that choice himself. Second, in a counterfactual world in which female circumcision were done under medical anaesthetised conditions and offered minor health benefits (slightly reduced risk of various problems), would Kay recommend it? We can easily imagine a gender reversing of her final paragraph that would make its obnoxiousness a little clearer. Fewer utils is a cost, not a benefit.

Here's the more reasonable form of the argument. Medical procedure X correlates with certain health benefits but also with reduced capacity for enjoyment. If it's undertaken before the individual is capable of making choices, the short term costs of the procedure are relatively low; if it's done after the individual is capable of making choices, the short term costs are much higher (more traumatic, longer recovery time). The long term costs and benefits are identical. If the short term costs are high enough and if the parent thinks it likely that the child's eventual optimization would result in his choosing the procedure, it's best for the parent to impose X. So imagine that removing a kid's tonsils in infancy were simple and painless, that doing it after age 12 were horribly painful, and that half of all adults who hadn't had their tonsils removed would get a tonsil infection with high mortality rates. Would I impose a tonsillectomy on my kids in infancy? You betcha. And I'd expect them to thank me for it. Would I agree with a procedure that would dull the kids' enjoyment of food (say excising half the taste-buds) if it correlated with reduced obesity and diabetes rates? Hell no.

In the case of circumcision, if you lived in a country where HIV rates were very high, access to condoms were difficult, sanitation were a problem, urinary tract infections were dangerous, and medical progress that would either reduce disease burden or reduce the costs of an adult undertaking circumcision were unlikely, then imposing that choice on your child might be optimal. If you're in a country where HIV is relatively rare, access to condoms is relatively easy, urinary infections are easily prevented through sanitation and fairly minor if contracted, then you're really infringing on autonomy by imposing that choice.

Kay's arguing against a proposed Canadian ban on infant circumcision. I'd also side against a ban. But not because the procedure's a great and wonderful thing; rather, because there are bounds within which violations of parental autonomy are worse than violations of the child's. This one's getting close to the border though.

Previously: Western symbolic forms of female circumcision that may prevent worse outcomes.