THECIRCUMCISIONREFERENCELIBRARY

MaleCircumcision:ALegalAffront
byChristopherPrice,M.A.(Oxon) [AsubmissioninDecember1996totheLawCommissionforEnglandandWalesinresponsetoConsultationPaperNumber139ConsentintheCriminalLaw]
CopyrightChristopherPrice1996

CONTENTS
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1.INTRODUCTION 1.1BurdenofProof 1.2Mutilation 1.3Hippocraticoath 2.THEPHYSICALEFFECTSOFCIRCUMCISION 2.1Pain 2.2Risks 2.3Dysfunction 3.CLAIMEDBENEFITS 3.1Hygiene 3.2Preventionofphimosisandparaphimosis 3.3Preventionofcervicalandpenilecancers. 3.4``Betterdoneatbirththanlater'' 3.5Preventionofsexuallytransmitteddiseases 3.6Preventionofurinarytractinfection 3.7``Benefits'':Conclusion 4.THESACRIFICIALORIGINOFCIRCUMCISION 5.JEWISHCIRCUMCISION 6.MUSLIMCIRCUMCISION 6.1Muslimcircumcisionprocedures. 7.AUSTRALIANABORIGINALCIRCUMCISION 8.THEORIGINSOFMODERNNONRITUALCIRCUMCISION 8.1Masturbationcure 8.2``HygieneandPrevention'' 8.3Moderncircumcisionaneyewitnessaccount 8.4SomequotesfromWarCries:It'saBoy 9.PSYCHOLOGICALMECHANISMS. 9.1ThePerpetrators 9.2TheVictims 10.FEMALECIRCUMCISION 11.CIRCUMCISIONANDTHECOMMONLAW 12.OFFENCESAGAINSTTHEPERSON:THECURRENTVIEW 12.1Rv.Brown 13.CHILDPROTECTION 13.1Paramouncyofwelfareofchild 13.2ChildrenAct1989 13.3Parentalconsent 13.3.1Medicaltreatmentgenerally 13.3.2TheAustralianview 13.3.3TheAmericanview 13.3.4ConsenttoTreatmentofChildreninEnglishLaw 13.3.5Discussion

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14.EUROPEANCHARTERFORCHILDRENINHOSPITAL 15.EUROPEANCONVENTIONONHUMANRIGHTS 16.THERELIGIOUSDEMANDS 17.THECULTURALCLAIM 18.THEREALITYOFMALECIRCUMCISIONANDTHECONSULTATIONPAPER'SPROPOSALS 18.1Commission'sproposals 18.2``Seriouslydisablinginjury'' 19.INTERNATIONALLAW 19.1UniversalDeclarationofHumanRights 19.2InternationalCovenantonCivilandPoliticalRights 19.3UNConventionontheRightsoftheChild1989 20.DISCRIMINATION 21.CONCLUSION REFERENCES

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1.Introduction
Thefunctionofthecriminallaw"istopreservepublicorderanddecency,toprotectthecitizenfromwhatisoffensiveorinjurious,andto providesufficientsafeguardsagainstexploitationandcorruptionofothers,particularlythosewhoarespeciallyvulnerablebecausethey areyoung,weakinbodyormind,inexperienced,orinastateofspecialphysical,officialoreconomicdependence"1 . `CircumcisionisnotanoperationtobeundertakenlightlyandifitistobeperformedinGreatBritainitisprobablybestperformedina hospitalenvironment,inanolderchildasageneralanaestheticdaycase' 2 . Thispaperintendstoexaminetheissueofnontherapeuticmalecircumcision,inthelightoftheLawCommission'sConsultationPaperNo 139(`TheConsultationPaper'),anditslawfulnessforritualandnontherapeuticreasons.By`nontherapeutic'ismeantanycircumcision whichisnottotreatanexistingdiseaseprocessorbodilyabnormalityacircumcisionisaformofproperprocedureonlywherethereisa diseaseprocessorabnormalityandtreatmentbyotherconservativemethodsis,orongenuinemedicalgroundsisconsideredtobe, medicallyinappropriateand/orlessinvasivetreatmentshavebeentriedbuthavefailed.[SeealsoinSecretary,Dept.ofHealthand CommunityServicesv.JWBandSMBper BrennanJ2A] ThispaperdoesnotseektocommentontheConsultationPapergenerallynordoesthepaperseektocommentonAppendixCofthe ConsultationPaper,whichdiscussescertainphilosophicalissues,exceptthatthecontinuinglackofarigorouslythoughtthrough philosophicalpositionisacleardefectintheConsultationPaper. Further,itwouldbeinappropriateforthispapertorehearseinanygreatdetailthereasonswhymalecircumcisionmedicallycannot properlyberegardedasharmlessthatisdealtwithfullybyotherselsewhere.Thispaperwillsimplyandbrieflydescribethe3areas wheremedicalstudieshavedemonstratedharm,givesomesamplereferencestomedicalpapersbywayofillustrationonlyandwill proceedonthebasisthatthecontentioninthepaperthatitis`generallyacceptedthattheremovaloftheforeskinofthepenishaslittle,if any,effectonaman'sabilitytoenjoysexualintercourse,andthisactisnot,therefore,regardedasmutilation'iswhollyfalse:andfrom thatposition,toexaminethelegalconsequencesthatflowtherefrom. Ithasbeenthoughtrighttotouchontheburdenofproofwhich,itissuggested,liesonthosewhowouldcontinuethisprocedureand,in viewofdisputeastowhetherornotcircumcisionisamutilationtogivesomeillustrativedefinitionsofthatword.Equally,becauseofthe antiquityofthepractice,thereligiousandtribalovertonestoit,andthemythsthathavegrownuparounditnotleastfromthe `masturbationphobia'ofthe19thcenturytothepseudoscienceofmorerecentyearsitseemsrighttodevotesomespaceinthispaper toanexaminationofthishistoryofthisprocedure.

1.1BurdenofProof
Thegeneralruleisthathewhoavers,proves. Circumcisioninvolvestheamputationofabodypartwhendoneforritual,culturalorsocialreasons,thepartamputatedishealthyflesh fromthehealthyorganofahealthymaleandthosewhosaythatitispropertodoit,andwoulddoittoanotherwithoutthatother's

consent,arerequiredtojustifytheallegedproprietyandtojustifythisinterferencewiththebodilyintegrityandfunctioningofthatother. Thespecificassertionsusuallymadearethat:
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Theforeskiniswithoutfunctionand/orvalue. Circumcisionispainlessininfancy. Circumcisionisaminorprocedureofno,orminimal,risk. Circumcisionisofnoilleffect. Circumcisionhaslittle,ifany,effectonaman'ssexualfunctionand/orpleasure. Circumcisionisnotmutilating. Circumcisioncanofferprophylacticbenefits. Nontherapeuticcircumcisionislawful

Itisnotforthosewhowouldhavechildrenleftintactanduncircumcisedtodemonstratethatcircumcisionisdamaging(andunless requiredforcleartherapeuticreasons,unjustifiable)although,wereittobewronglysuggestedthattheburdenweresolaidonthem,itis suggestedthatthispaperhasdischargedthatburden. Ratheritisclearlyforthecircumcisers,notleastinthelightofmainstreammedicalknowledgeandcurrentlegalconcepts,tomakegood theirgeneralandspecificassertions,bycarefulandrigorousevidence,argumentsandrefutationofthemedicalandlegalposition.Mere repetitionoftheseassertions,asintheConsultationPaper,particularlyinparagraphs9.1and9.2,arevalueless.Mereassertionthat ritualcircumcisionisseenasareligiousdutyisequallyvaluelessindischargingtheburdenofproof:itmayprovideareasonbutdoesnot provideajustification,orinotherwordsitmayexplainbutdoesnotexcuse.

1.2Mutilation
Theuseoftheword`mutilate'or`mutilation'todescribecircumcisionishotlyopposedbythosewhocircumcisefornontherapeutic reasonshencealsothedefensive,medicallyrefutedandincorrectassertion(`incorrect'sinceittakesnoaccountofthefactsnorofthe definitionoftheword`mutilate')attheendofthesecondsentenceofparagraph9.2oftheConsultationPaper. "Languageoftenrevealsmoreaboutourselvesthanweintendandourchoiceofwordscanshowthewaywehumansidealisethingsthat wemightotherwiseseeinadifferentlight.ThestunteddeformedfeetthatresultedfromfootbindingofChinesegirlswerecalled `GoldenLotuses'andwereconsideredhighlyattractiveanddesirable.Theircounterpartnormalfeetwereseenasgrossandugly. Similarly,TheLayman'sGuidetotheCovenantofCircumcision [byRabbiJacobSchechet]callscircumcisionthe`GoldenCircle'" and"...arabbiwritingofhisownstrugglebetweenprotectiveparentalinstinctandtheculturalmandatetocircumcisehisnewbornson referstotheintactpeniswithitsforeskinasa`stoppedupdullness'"quotedbyBoyd 3 . Theuseoftheconceptofmutilate/mutilationinconnectionwithcircumcisionisresistedbothbythosewhowishtocontinuethepractice andbymanycircumcisedmen,forwhomtheprocessofdenialoftheirowndamageisfragile,soastocopewiththedestabilisingeffect onthemselvesandothersofadescriptionofsuchaccuracyanddirectness.Theresultingcontortionstoavoidsuchuncomfortablewords and/ortoredefinetheminanattempttoexcludecircumcisionareworthyofHumptyDumpty. Yettheword`mutilation'asdefinedinitsordinarysense,aswellasbymedicaldictionaries,iswhollyapttodescribetheresultofthis procedure.Thus: Mutilate `1.Todeprive(apersonoranimal)ofalimborsomeprincipalorganofthebodytocutofforotherwisedestroytheuseof(alimbor organ) `2.Torender(athing,esp.arecord,booketc.)imperfectbycuttingoffordestroyingapart.' OxfordEnglishDictionary OUP1971. `Injure,makeimperfectorinefficient,bydeprivingofapart.'ThePocketOxfordDictionary (4thEdition1942,revised1946) `Impliesthecuttingofforremovalofapartessentialtocompleteness,notonlyofapersonbutalsoofathing,andtohisoritsperfection, beauty,entiretyorfulfilmentoffunction.'Webster'sNewDictionaryofSynonyms:aDictionaryofDiscriminatedSynonymsand AnalogousandContrastedWords (1968) Mutilation `1.Theactionofdepriving(apersonoranimal)ofalimboroftheuseofalimbtheexcisionormaiming(ofalimborbodilyorgan). `2.Theactionofrendering(athing)imperfectbyexcisionordestructionofoneormoreofitsparts.'OxfordEnglishDictionary OUP 1971.

`Disfigurementorinjurybyremovalordestructionofanyconspicuousoressentialpartofthebody.'Stedman'sMedicalDictionary (26thEdition)1995 `Theactofdeprivinganindividualofalimb,member,oranyotherimportantpartdeprivalofanorganseveredisfigurement.'Dorland's IllustratedMedicalDictionary (28thEdition)1994 `Maimingtheactofremovingordestroyingaconspicuousoressentialpartororgan.' Taber'sCyclopedicMedicalDictionary (17th Edition)1993

1.3Hippocraticoath
Giventhatmanycircumcisionsareperformedbydoctorsandalsogiventhat,eventhoughtheOathmaynotnowbeformally administered,itspriciplesareasapplicabletodayasever,bothtodoctorsandallothersperformingsurgeryormedicaltreatmenton another,itisappropriatetociteanextractfromtheHippocraticOath 4 : "TheregimenIadoptshallbeforthebenefitofmypatientsaccordingtomyabilityandjudgement,andnotfortheirhurtorforany wrong....WhatsoeverhouseIenter,therewillIgoforthebenefitofthesick,refrainingfromallwrongdoingorcorruption."

2.ThePhysicalEffectsofCircumcision
Typicallyandincorrectly,malecircumcisionhasbeenseeninthepastbythelaypublic,as`aminorsnip',andsodescribedbymany especiallyinpopularmagazinestheforeskinisvariouslydescribedas`avestigialpieceofskin'or`redundant'. WhilstcircumcisionisnotnowroutinelycarriedoutinBritainfornonreligiousreasons,asitusedtobefromthe19thcenturyuntilcirca 1950,therearestillthosewhowishtoperformitontheirchildrenfornonritualreasonsandfromtimetotimetherearecallsforitswider use:thus,BethRaleighinYourSexOrgans,40FascinatingFacts (August1994SHE)whenshewrotethatneonatalcircumcision"can havehealthbenefits." OritisseenaprocedureconductedbyJewsonthe8thdayafterbirthorbyMuslimsandmembersofsomeotherreligions/ethnic groupsasaslightlyoddbutessentiallyharmlessritual. ItisdifficulttoobtainexactfiguresforthenumberofcircumcisionsperformedeachyearinBritain. GordonandCollin5 saythatnearly7%ofboysinBritainwillbecircumcisedbyage15,andtheysuggestthatthisnumberiswellin excessofthoseforwhommedicalreasonsdemandcircumcision(theysuggestthatthepropernumberwillbebetween1%and2%).By contrast,Finlandmanagestocircumciseonly6per100,000males(afigureof0.006%). AccordingtotheNHSExecutive6 ,thefiguresforoperationsontheprepuceare: 1991/92:36,644 1992/93:37,586 1993/94:36,403 Thesefigureswillhoweveronlyincludeprocedurescarriedoutinhospital,andwillexcludethoseperformedoutsidehospitaleither privatelyand/orbyGeneralPractitionerstheywillhoweverincludeanumberofcircumcisionsdoneforpurelyritualreasons. Accordingtoadiscussion,earlierthisyear,onBBC2'sNewsnightsome30,000ritualcircumcisionsaredoneeachyearwhilstsomeof thesewillbeincludedintheNHSfigures,somewillrepresentadditionalcircumcisions.Whatonecansay,withconfidence,isthatthe vastbulkofthecircumcisionswillbefornontherapeuticreasons(asdefined)andwillbewellinexcessof36,000andmayapproach 67,000eachyear. Whateverthereasonforitsbeingdone,itispopularlyseen(videthepopulistandunsupportedremarkinparagraph9.2ofthe ConsultationPaper)ashavingfewrisksorilleffectsforthemaleand,bysome,asofferingarangeofmedicalbenefits,thebreadthof whoseclaimsandwhosepersistenceinthefaceofmedicalrefutationisademonstrationthatstrongandhiddenforcesareatwork.That intheneonateitisusuallyperformedwithoutanaesthesiaraisesnoeyebrows,sincethetraditionalthinkingwas,andstillis,thatthe neonatedoesnotfeelpain. Circumcision,asisnowwellrecognisedbydoctors,hasthreemainareasofphysicalharm,which,inbriefare:

2.1Pain:
Circumcisionisverypainfulandincreasingly,despitetheinherentrisksofanyanaesthesia,doctorsperformingneonatalcircumcisionnow givesomeformofanaesthesiahowever,theJewishBrisMilahand,inmanycases,Muslimcircumcisionsarecarriedoutwithout anaesthesia. Formostofthiscentury,thebulkofmedicalliteraturestatedthatnewbornboyswereinsensitivetopainandwouldnot,therefore,need riskyanaesthesiaforcircumcision."Thismythwasbasedonthefactthatmuchoftheperipheralnervoussystemhasstilltodevelopthe myelinthatinsulatesthenervefibres,hencetheinabilityofnewbornstocoordinatemusclemovementetc.Withoutmyelin,thefibres concernedareunabletopassintegratedorhighlevelmessages.Itisextraordinarythatmedicallytrainedprofessionalscouldnotrecall

thatallpainmessagesarecarriedbythinunmyelinatedfibresofthepainandtemperaturetractsthatareunrelatedtothemyelinated motoranddiscriminatorysensationpathways.Farfrombeingincompleteintheirdevelopmentatbirth,thepainpathwaysareprobably themostdevelopedperipheralneuraltracts." 7 Remarkssuchas:`Hesleptthroughthewholething'areoftenused.Whatisseenas`sleepingthrough'theprocedureishoweveraform ofshockorsemicomafromthetrauma.DrJustinColl,infantpsychologistandProfessorinChiefofChildandAdolescentPsychology attheUniversityofCalifornia,isquotedinRombergCircumcision:ThePainfulDilemma ,assaying:thatinfantsbeingcircumcised `canlapseintoasemicoma'whichisan`abnormalstateinthenewborn'. Dalens8 writes:"Paininpaediatricshaslongbeenunderestimated.Thenumerousscientificstudiescarriedoutduringthelastdecade showthatitsexistencecannolongerbedoubted:infact,painalreadyexistsduringtheneonatalperiod,andprobablythroughoutthelast trimesterofgestationaswell.Painpathwaysmatureduringtheembryonicperiodandperipheralreceptorsdevelopbetweenthe7thand 20thweek[ofgestation].Spinalrootsandnervesarecompletelydifferentiatedbeforethesecondmonth[ofgestation].Assessingpain, alreadyadifficulttaskintheadult,isallthemoresoinchildrenbecauseoflesserverbalcommunicativecapabilities,difficultyinhandling abstractconcepts,lackofexperienceofpainfulstimulitomakecomparisons,andignoranceoftheirbodyimage.[Indiagnosingpain] behaviouraltestsremainthemainstayuntiltheprepubertalperiod." Becauseofthedangerofadministeringgeneralanaesthesiatobabiesunder6monthsofage,andthepainandrisksoftissuedamageof administeringlocalanaestheticstothepenis,circumcisionsinthisagegrouparestillmostlyperformedwithoutanyanaesthesiatothis day.Parentsarenotusuallytoldthattheirsonswillgothroughthisagony. "Thereisnodoubtthatcircumcisionsarepainfulforthebaby.Indeed,circumcisionhasbecomeamodelfortheanalysisofpainand stressresponsesinthenewborn.Notonlydoestheunanesthetizednewborncryvigorously,tremble,and,insomecases,becomemildly cyanoticbecauseofprolongedcrying,butotherstressrelatedphysiologicalreactionshavealsobeendemonstrated,includingdramatic changesinheartandrespiratoryratesandintranscutaneousoxygenandplasmacortisollevels.":H.J.Stang etal 9 . Taddio etal .10 studiedtheeffectsofneonatalcircumcisionpainonlatersensitivitytopain.Theyfoundthattheeffectsofthispainwere detectableinlaterchildhoodbutthenarrivedattheincorrectconclusionthat,insteadofnotcircumcising,thereshouldbepainrelief givenforcircumcisions. DrRVanHowewrites: 11
"TheworkofGunnar, Marshall ,andothers, showthatthebehaviourandphysiologicresponsestoneonatal 15 circumcisionhavebeenwellestablished.AlthoughafewphysicianssuchasWeiss claimthenewborndoesnot experiencepain,mostinformedphysiciansnowagreethatneonatalcircumcisionispainfulandrecommendlocalanesthetic fortheprocedure.Performingthisextremelypainfulprocedurewithoutanesthetichasallowedresearcherstostudythe parametersofextremepaininexperimentsthatwouldnothavebeenallowedonlaboratoryanimals. "Usingroutine,unanesthetizedcircumcisionasamodelofstress,Porteretal.wereabletoexaminetherelationbetweencry acousticsandvagaltonein49(32experimental17control)1to2dayold,fulltermnormal,healthynewbornsduringthe preoperative,surgical,andpostoperativeperiods.Vagaltonewassignificantlyreducedduringtheseverestressof circumcision.Thesereductionswereparalleledbysignificantincreasesinthepitchoftheinfants'cries. Inaddition,individualdifferencesinvagaltonemeasuredpriortocircumcisionsurgerywerepredictiveofthephysiological 16 andacousticreactivitytosubsequentstress. "TwostudiesbyMarchette'sgrouplookedatnonmedicalnursinginterventionstoalleviatethepainassociatedwith circumcision.Inthefirst,neonateswererandomlyassignedtooneofthreeinterventiongroups:18infantsreceivedroutine care,15infantshadmusicplayed,and15infantshadatapeofintrauterinesoundsplayed.Duringcircumcision,monitors measuredcardiacrate,rhythm,bloodpressure,andtranscutaneousoxygen.Painwasmeasuredbyanalysisofvideotaped facialexpressions.Themeanheartratewasabovenormallimitsduringallstepsofthecircumcisionforthecontrolgroup andduringsomeofthestepsfortheothertwogroups.Analysisofthefacialexpressionsshowedthatallthreegroups expressedpainmuchmorethananyotheremotionduringtheprocedure.Unfortunately,thetwointerventionswereunable 17 tooffsettheeffectsofcircumcisionpain. "Thesecondstudyassessedtheeffectivenessofsomenoninvasivepainreductioninterventionsin121neonates undergoingunanesthetizedcircumcision.Subjectswererandomlyassignedtooneofsixgroups:classicalmusic, intrauterinesounds,pacifier,musicandpacifier,intrauterinesoundsandpacifier,ornointerventionsusedwhileheartrate, rhythm,dysrhythmias,bloodpressure,transcutaneousoxygen,ratepressureproduct,andbehavioralstateweremeasured during14circumcisionsteps.Overthe14steps,42%oftheheartrates,78%ofthesystolicbloodpressures,30%ofthe diastolicbloodpressures,and81%ofthetranscutaneouspO 2pressureswereabnormal.Again,fewsignificantdifferences 18 werefoundamonganyofthesteps." Circumcisionhasbeendescribedas"amongthemostpainful[procedures]performedinneonatalmedicine" andthepain 20 21 therefromas"severeandpersistent" andofalevelwhich"wouldnotbetoleratedbyolderpatients"
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Walcoetal.write22 :
"Manymythsaboutpaininchildrenhavebeendiscredited.Onemythwasthebeliefthatveryyounginfantsdonothave theneurologiccapacitytoexperiencepain.Neuroanatomicalstudies,however,haveshownthatby29weeksofgestation, painpathwaysandthecorticalandsubcorticalcentersinvolvedintheperceptionofpainarewelldeveloped,asarethe 23 2425 26 neurologicsystemsforthetransmissionandmodulationofpainfulsensations .Behavioral andphysiologic studies haveshownthatevenveryyounginfantsrespondtopainfulstimuli.Prematureinfantsundergoingsurgerywithminimal anesthesia,whichwasoncestandardpractice,havesignificantlyhigherstressresponses(byhormonalandmetabolic 2728 measures)andsignificantlyhigherratesofcomplicationsandmortalitythanthosegivendeeperanesthesia. "Arelatedmisunderstandingisthebeliefthatevenifveryyoungchildrenexperiencepain,theyhavenomemoryofit,and

thereforeithasnolastingeffect.However,recentstudieshaveconcludedthatpainanddistress,suchasthoseassociated withcircumcision,canendureinmemory,resulting,forexample,indisturbancesoffeeding,sleeping,andthestabilityofthe 29 stateofarousal .Preliminarydataevensuggestthatearlyexperiencesofpainmayproducepermanentstructuraland 30 functionalreorganizationofdevelopingnociceptiveneuralpathways,whichinturnmayaffectfutureexperiencesofpain . "Anotherbeliefthathasbeendispelledisthatchildren'spaincannotbemeasuredaccurately.Paininchildrencanbe 31 assessedthroughphysiologicindicators,systematicobservationofbehavior,andreportsbythechildrenthemselves ."

2.2Risks:
Circumcisionisaprocedurewhichcarriesriskswhichhavebeendescribedashighassome50%ofcourse,iftheinevitablediminution ofsexualfunctioniscountedasacomplication(aswouldseemtobewhollysensibleacourse),thenthecomplicationrateis100%.Itis farfromeasytoobtaindefinitivefiguresfortherateofcomplicationsasconventionallydefined. WhentheUnitedKingdommedicalprofessionandtheNHSdecidedtoabolishroutinecircumcisionafterthepublicationofGairdner's landmarkpaperin1949[op.cit.atn78],oneofthereasonscitedwasthehighdeathrate:thisrangedfrom1019perannumnationally incircumcisedboysunder5yearsofageinacountrythatdidnotperformwholesalecircumcision(e.g.duringthesameperiodasthese deathratefigures,onerepresentativecityhadacircumcisionrateofonly58%).Becausemostofthedeathsfollowingcircumcision resultfromconditionssecondarytothesurgery(e.g.infectionorhaemorrhage)therecordskepthaveusuallyshowntheactualmortal conditionratherthantheprimarymedicaleventthatinducedit.Soitisnotsurprisingthatanumberofreviewsoftheprocedurehave remarkedonthedifficultyinobtainingrealisticmortalityrates. AsGellis32 hasmorerecentlyobserved:
"Itisanincontestablefactatthispointthattherearemoredeathseachyearfromcomplicationsofcircumcisionthanfrom cancerofthepenis."

Illingworthinhisstandardtextbookhasnoted: 33
"Mostpractisingpaediatricianshaveseenunfortunateconsequencesfromtheoperationofcircumcision,andseenor personallyheardofdeathdirectlyresultingfromit."

TheJournalofUrology(Baltimore)putsthefigurefortheriskofcomplicationsat1.5%to15%. 34 WilliamsandKapila35 offera`realisticfigureof2%to10%'.However,theyalsocommentthattheincidenceofmeatalulceration followingcircumcisionisfrom8%to20%whichwouldseemtosuggestthattheirrateofcomplicationsisonthelowside.Theywrite: "Meatalstenosisisgenerallyadirectconsequenceofcircumcisionthatisseldomencounteredinuncircumcisedmenmeatalcalibreis knowntobegreaterinuncircumcisedindividuals.Theincidenceofmeatalulcerationisfrom8to20percent....Meatalstenosisfollowing circumcisionhasbeenadvancedasacauseofrecurrentpyelonephritisandobstructiveuropathy,forwhichmeatotomyiscurative." 36 . Patel's37 istheonlylongitudinalstudybeyondthefirstfewmonthswhichstudiedthetrueextentofcomplicationsasmanyofthe complicationsariseinlateryears,hisarethemostreliableasshownbythehighfiguresheobtained.Hereportedarateof24%of seriouscomplications. Apartfromtheproblemsofdifferingandvaryingdiagnosticcriteriaemployed,thereareindicationsthatcomplicationsandmishapsare beingmisreportedornotreportedatall.TheEditorialcomment 38 in1996 BritishJournalofUrology ,commentingonacasereportby Neulanderandothers,whichdescribesanamputationofthedistalpenileglansfollowingritualcircumcisionasa`rarecomplication', observes:"Theauthorsreportwhattheydescribeasararecomplication....Fistulaformation,lymphoedemaandiatrogenichypospadias haveallbeenreported.Mostamputationsarealmostcertainlynotreported.Ihaveseenhalfapenisamputatedina4yearoldboy duringaritualMuslimcircumcision.ThepeniswasleftbytheGeneralPractitionersurgeoninthewastepaperbasketofhissurgery." DrVanHowe 39 summarisesthefollowingcomplicationsashavingbeenreportedinthemedicalliterature:acuteobstructiveuropathy 40 andacuterenalfailure, 41 penileischemia,42 necrosis, 43 buriedpenis, 44 penileandglansamputation,45 iatrogenichypospadias, 46 severe hemorrhage,47 totaldenudationofthepenis, 48 infectionsincludingStaphylococcusaureus, 49 Escherichiacoli,50 meningitis,51 staphylococcalscaldedskinsyndrome, 52 GroupBhemolyticStreptococcussepsis, 53 erysipelas, 54 impetigo,55 neonatalsepticemia, 56 tuberculosis,57 scrotalabscess, 58 death, 59 meatalstenosis, 60 abdominaldistension,61 adhesionsandpreputialskinbridging,62 penile tourniquetsyndrome,63 methemoglobinemia,64 gangreneofthepenis 65 andscrotum(Fournier'ssyndrome),pneumothorax,Plastibell retention,urethralfistula,meatalulceration,keloidformation,rupturedbladder,gastricrupture,urethralstricturesandstenosis, tachycardiaandheartfailure,myocardialinjury,acuteurinaryretention,iatrogenicburns,pulmonaryembolism,impotence(inadultmen), chilling,phimosis,unilaterallegcyanosis,andcosmeticresultnotachievedandrecircumcisionrequested..

2.3Dysfunction:
Thevictim(tousetheCommission'sownword,whichhereseemswhollyapposite)willsufferfrominevitabledeficits,viz: 2.3.1 Removaloftheprepuceremovesspecialisedtissueandnervesdesignedforsexualpleasure.Tayloretal.66 write:
"clearly,thepenisisacomplexorganwithmanydifferentparts,eachspecializedforaspecificrole.Theprepuceprovidesa largeandimportantplatformforseveralnervesandnerveendings.Theinnervationoftheouterskinoftheprepuceis 67 impressive itssensitivitytolighttouchandpainaresimilartothatoftheskinofthepenisasawhole.Theglans.by 68 69 contrast,isinsensitivetolighttouch,heat,cold and,asfarastheauthorsareaware,topinprick.LeGrosClark noted

thattheglanspenisisoneofthefewareasonthebodythatenjoysnothingbeyondprimitivesensorymodalities."

Thisinsensitivityelicitedthecomment70 "thattheglanspenishasbeendocumentedtohaveunusuallylow(emphasisadded)sensitivity (highthreshold)tomechanicalstimulation.VonFrey 71 foundthattheonlytheportionofhumanskinlesssensitivetomechanical stimulationwasacallusonthesoleofthefoot. 2.3.2 Thelossofsomeonethird(oranareaintheadultofsome15squareinches)ofpenileskin,removestheskinwithinwhichthepenis shouldmoveduringintercourseandmasturbation,producingafeelingof`tightness'duringanerection.

"LikemanyboysofmygenerationinBritain,Iwascircumcisedininfancybyadoctor.Igrewupknowingthatsomething hadbeenremovedfrommypenisasmyolderbrotherwasintact,butwastoldthatthisdidnotmatter.Theglanswasalways uncomfortablewhenrubbedbyclothingthroughoutchildhoodandonintoadultlife,sothatIalwayslookedfortight supportiveunderweartominimisefriction.Thediscomfortwaspoorlylocalised,anditisonlyrecentlythatIhaverealised thatmyintoleranceofboxershortswasthedirectresultofcircumcision. "Theshaftskinwasverytightduringerection,thoughIneverthoughtofthisasabnormalasIhadnothingtocompare with.Masturbationwasoftenaccompaniedbylacerationoftheskin,sothatIlearnttomasturbatewearingacondom.I married25yearsagoandatfirsttherewereproblemsofdyspareuniafromtimetotimewhichweattributedtovaginal dryness,asIconsideredmyselfnormal.Weovercamethisbyuseofartificiallubricants.Astimewentonweexploredways ofmaximisingoursexualenjoyment.Iobservedthattherewasremarkablylittlesensitivityintheglans,theskinofwhich seemedtothickenwithadvancingyears.Iremarkedonthistomywife,whothoughtitstrange.ItwaswhenIobservedthat themostsensitivepartofmypeniswastheskinbetweenthecircumcisionscarandtheglans,thatIbegantorealiseforthe firsttimehowmuchIhadbeenharmedbycircumcision.Thisskinwastheremnantoftheinnerliningoftheforeskin,the remainderofwhichhadofcoursebeenamputated.Iassumedtherewasnothingwhatevertobedoneaboutthistragedy, 72 andIresolvedtomakethemostofwhatwasleft" .

Alltoooften,however,considerablymoreskinthanthatisremovedandlossesof60%+ofthetotalpenileskinarefarfromuncommon. 2.3.3 Theglansisexposedtodailyassaultsandtraumafrominfections,urineandfaecesinthenappiesandtolifelongabrasionfromclothing andbecomesdry,wrinkledandcoveredwithalayerofkeratin(or,assomehavedescribedit,becomes`cornified')andinsensitiveand abletotoleratetouchwhichanintactmancannot.Assuchitiswhollyunliketheglansofanintactmanwhoseglansissmooth,glistening andsensitivetotouch.WarrenandBigelow 73 write:

"BigelowTheJoyofUncircumcising reportsthattheprepucehasfourfunctions.Firstly,itisitselfsensitiveduetothe nerveendingsonitsinnersurface,whichbecomeexposedduringsexualarousal.Secondly,itprotectstheglans. "Theprotectedglansremainssoft,moistandsensitivethroughoutlife,buttheexposedglansofthecircumcisedmale becomesincreasinglythickenedanddesensitised.Werethisnotsoitwouldbeimpossibleforacircumcisedmantotolerate theabrasionofclothingontheexposedglans.Thirdly,themobilesheathofskinontheintactpenisallowstheprepuceto slidebackandforthovertheglansduringforeplayandintercourse.Rittercallsthisaction`thepleasuredynamic'.Fourthly, itprovidesslackskinontheshaftoftheerectpenisallowingittoglidewithinitsownsheathofskinduringintercourse. Thisprovidesformoreenjoyableintercourseforbothpartnersandavoidsproblemswithvaginaldryness."
74

Otherstoohaveearlierdescribedtheprepuceasoneofthemostsensitivepartsofthepenisanditspotentialforenhancingsensation duringsexualintercourseandthedevelopmentontheexposedglansofdermallayersupto12timestheskinthickness,whichhasbeen describedastheformationofacornifiedlayeranadditionaloutercoveringofcompresseddeadcellswhichasaresultofthis `scarification'processmayrenderthepenislesssensitive.75 Alltoooften,onehearssupportersofcircumcisionclaimingthattheyhavenotbeenharmed,thattheirsexuallifeisunimpairedand,even, thatthey`couldnotcopewithanymoresensitivity'.Noonewouldclaimthatcircumcisionrendersthemanincapableofprocreation. Rathertheanalogyisofapersonblindedatbirthinoneeye:hecanstillseeandinmostrespectslead,withhisremainingvision,auseful andfunctionallifebutwhathecannotknow,andcanneverexperience,isthefunctionandqualityoflifewithbinocularvisionthoseof uswithfullvisioncanonlyfeelpity,andsorrow,forhislossevenwhilstwemightcommendhisabilitytocopewithhisdisability.Further, thatsomecircumcisedmen,beingunawareofthediminutionofsexualpleasurewhichtheyhavesuffered,arecontentwiththewhat remainsoftheirsexualpleasureisneitherconvincingastotherebeingnolosses,noranargumentforimposingthoseonanother. DouglasGairdner76 wroteofthefunctionoftheprepuce:
"Itisoftenstatedthattheprepuceisavestigialstructuredevoidoffunction.However,itseemstobenoaccidentthat duringtheyearswhenthechildisincontinenttheglansiscompletelyclothedbytheprepuce,for,deprivedofthis protection,theglansbecomessusceptibletoinjuryfromcontactwithsoddenclothesornapkin.Meatalulcerisalmost confinedtocircumcisedmaleinfants,andisonlyoccasionallyseenintheuncircumcisedchildwhentheprepucehappens tobeunusuallylaxandtheglansconsequentlyexposed(Freud,1947). "Thereremainanumberofmoreorlesstrivialfactorswhicharesometimesmentionedasreasonswhyinfantcircumcisionis desirable:difficultiesinkeepingtheuncircumcisedpartsclean,orthesupposedaestheticoreroticsuperiorityoftheshorn member.Inordertofulfiltheintentionofthispaperaninquiryonthesepointsshouldhavebeenmadeamongstagroupof uncircumcisedmen.Thiswasnotattempted,althoughwithregardtothelasttwoofthefactorsmentioneditshouldbe statedthatwheneverthesubjecthasbeenbroachedinmalecompanythosestillinpossessionoftheirforeskinhavebeen forwardintheirinsistencethatanydifferenceswhichmayexistinsuchmattersoperateemphaticallytotheirown advantage. "Moreover,ifthereweresensibledisadvantagesinbeinguncircumcised,onewouldexpectthatthefathersofcandidates forcircumcisionwouldsometimesregistertheirfeelingsinthematter.Yetininterviewingtheparentsofseveralhundred infantsreferredforcircumcisionIhavemetbutonefatherwhowishedhissoncircumcisedbecauseofhisdisagreeable

experienceoftheuncircumcisedstate.Therestofthefatherswereequallyindifferentaboutthematterwhetherthey themselveshadbeencircumcisedornot.Indeed,solittledidthefather'spersonalexperienceseemimportantthatone quarterofthemothersdidnotevenknowwhethertheirhusbandswereorwerenotcircumcised.Thesefactsprovidesome evidencethatfewuncircumcisedmenhavecausetoregrettheirstate."

Seealso,foranotherviewfromthisperiod,DanielWhiddon77 :
"Theglansbelongstothegroupofspecialsenseorgans.Itisalmostinsensitivetolighttouch,hasnoappreciationofheat andcold,andinterpretspainfulstimuli(suchasapinprick)onlyasavaguelyunpleasantcontact.....Thepreservation, undulledandundiminished,ofthisspecialsensethattheglanscanreceivesomesexualsensations],andtheguardingof themucousmembraneinwhichitresidesfromconstantexposureandadullingofitssensibility,isofparamount importance.....Asecondlessimportantfunctionisintheactofcoitusitself.Theerectuncircumcisedpenisentersthe vaginawithouteffortoratanyratewithoutfriction,theprepuceunfoldingasthepenisadvancesandeachpartofit remainingincontactwithsuccessiveareasofthevaginalwalls,tillfinallytheuncoveredglansliesatthecervix.The circumcisedpenis,deprivedofthisselftrackingmechanism,isintroducedtotheaccompanimentoffrictionbetweenpenile skinandvaginalmucousmembrane.itisthedifferencebetweenslippingthefootintoasockthathasbeenrolledupand onethatisheldopenbythetop.Thehumanforeskin,then,isneithervestigialnoruseless.Itispartofthenormal mechanismofreproduction,andwithoutitsexualdesireistosomeextentblunted,andtheperformanceofthesexualactat anyratethefirstactofcoitusbetweenthevirginmaleandthevirginfemalemademoredifficult......Apartfromthoseevil resultswhichareduetoimperfectworkmanship,therearethefairlycommonminortroublesthatfollowbecauseastupidand unnecessaryoperationhasbeendone,anormalmechanismhasbeendestroyed,andadelicatesurfacehasbeenexposedto theairandtofriction4or5yearsbeforeitshouldbeexposed.Eczemaoftheglansandmeatusisnotrareinthenewly circumcisedinfantitneedscarefultreatmentwithointmentandsometimesleadstoscarringandnarrowingofthemeatus. Thesearethefacts....themedicineofthejungleandthewitchdoctor,theteachingoftheBibleandtheKoran,thetraditional scienceofthemidwife,thehealthvisitor,andtheHomeMedicalDictionary,areallagainstus....Nonetheless,letuskeepour ownsanity.Whenwemeetthosewhoadvocatethismutilation,letusaskthemwhytheydoitandagainwhy:theyhave seldomaskedthemselves.Whenwemeetayoungmotherwhosemindisherownandnotsomeoneelse'sgramophone record,letusaskherifshethinksitlikelythatNaturewouldbring1000Englishchildrenintotheworldeveryday,well formedinallrespectsexceptthisoneifitisnotmorelikelythatNatureisrightandthefolkmedicinethattriestoimprove onheriswrong......letusnotcommitthesinagainsttheHolyGhostbyconcealingfromourselvesthatitisfoolish..Daniel Whiddon."

3.ClaimedBenefits
Evendiscountingthe`antimasturbatory'reason,discussedbelow,forcircumcision(andthesocalledhygienegrounds,whichforthe Victorianscarriedthemessageofmoralcleanliness)andwhichbecamedisprovedbycircumcisedboyswhostillmasturbated,theclaims forbenefitsforcircumcisionotherthanasareligiousorritualobservanceareasmyriadastheyarediscredited.Thus,forexample,the claimofhygieneinthesensethatthewordisunderstoodtodayasreferringtobodilycleanlinessandcitedbytheCommission,is disprovedevenbytheprocircumcisionbiasedTaskForceoncircumcisionoftheAmericanAcademyofPediatricsin1989.78 Theclaimsstilloften(indeed,onemightalmostsayinvariably)madebycircumcisersasbenefit(s)flowingfromcircumcisionincludethe following: Hygiene. Preventionofphimosisandparaphimosis Preventionofbalanoposthitisandbalanitis). Preventionofcervicalandpenilecancers. `Betterdoneatbirththanlater'

3.1Hygiene
ThisisstillthemostpersistentofthemythsthatsurroundcircumcisionindeeditistheprimereasonwhyMuslimsfeelcompelledto circumcise.YettheAmericanAcademyofPediatrics'ownTaskForceoncircumcision(op.cit.)has,notwithstandingaprocircumcision bias,concludedthatordinaryandregularwashingservesjustaswellascircumcision.Thus:"Itisparticularlyimportantthat uncircumcisedboysbetaughtcarefulpenilecleansing.Astheboygrows,cleansingofthedistalportionofthepenisisfacilitatedby gently,neverforcibly,retractingtheforeskinonlytothepointwhereresistanceismet.Fullretractionmaynotbeachieveduntilage3 yearsorolder." DrTerryRussell79 ,anAustraliangeneralpractitioner,istypicalofthemuddled,emotive,unresearchedandwhollyunthoughtout advocateofcircumcisionfor`hygiene'reasons:"Whatmanafteranightofpassionisgoingtoperformpenilehygienebeforerollingover andsnoringthenightaway(withpathogenicorganismsmultiplyinginthewarmmoistenvironmentundertheprepuce)":towhichonecan onlysaythatthereisnoevidenceeducedof`pathogenicorganisms'andthatthewoman,whoisjustaslikelyto`rolloverandsnorethe nightaway'willhaveher,muchmoreconvoluted,internalandthusretentive,genitalsbathedinherandherpartner'sfluids.Further,the argumentfortheeaseofcleaningclaimedformalecircumcisionhasnotleadtodemandsinanycivilisedcountryforexcisionofthe clitoralhoodandthelabiaininfantgirls(who,despitealsoproducingsmegma)arereliedupontowash. VanHowe(op.cit.atn8)observes:
"Ifleftalone,themicroenvironmentofthepreputialspacemaintainsadelicatepHandbacterialbalance.Ifdisturbed throughretractionor`cleaning',friendlybacteriaarekilled,andmoreaggressivepathogensarefreetocolonizemucosal tearsand,potentially,theurinarytractitself.Ithasalsobeenestablishedthatsoapwilldryoutthepreputialmucosaleading 80 toinflammationandinfectionssuchasbalanoposthitisandrecurrentbalanitis ."Healsoobserves:"Theimportanceofthis advice[againstforcibleretractionbyparentsanddoctors]cannotbeoveremphasized.Theexperienceoftheauthorhas
81

beenthesameasWatson's, namely,everyintactboythatIhaveseenwithcomplications(i.e.phimosis,urinarytract infection,balantitis)haveallhadtheirforeskinsprematurelyandforciblyretractedbyaphysicianorhadtheparents forciblyretractthechild'sforeskinatthephysician'sinsistence."

Kayabaetal. 82 foundthesame:infectionoforundertheprepucewasnotafunctionofunretractabilityoftheprepuce,butratherofpoor hygiene.Theyfoundinastudyof608boysthatnoneweretypeVundertheageof1andthatthenumbersofaTypeVprepuce increasedwithagetheincidenceofbalanoposthitiswasonly1.5%and7boyswereaged1to5years(andtheinfection,they suggested,owedmoretopoorpenilehygienethanaforeskin).

3.2Preventionofphimosisandparaphimosis
Ofcourse,withoutaforeskinthechancesofphimosis(anarrowingorstenosisoftheforeskinwhichpreventsfullretractionofthe foreskin)areeitherreduced(vanHowehasdescribedfindingphimosisincircumcisedboys)oreliminated:onemightequallysaythat amputationofthetoeswilleliminatethechancesofathlete'sfootyetnooneseriouslywouldproposethatasamethodofprevention andtreatmentisbylessinvasivemeanswhenandasneeded.Yetwhatisclearisthat,particularlyintheUnitedStatesbutalsoinBritain, phimosisis`diagnosed'whenitissimplynotpresent:Thepenisdevelopswiththeglans`fused'totheforeskinandfewboyswillhavea freeandretractileforeskinatbirth:separationoccursoverthefollowingyears,butwhilstmanywillhaveachievedthisbyage5,some willnotuntilaslateasage17.Itisamisdiagnosis,suggestiveofafundamentalignoranceofthebasicanatomy,anddevelopment.ofthe boy'spenistodiagnosephimosisinayoungchildyettheusual`justification'intheUnitedStatesfor,andthereasongivenforaclaimon healthinsurers,routineneonatalcircumcisionisphimosis(usuallycoupledwiththecomment`redundantforeskin').ster'sobservations 83 forolderboysinaDanishpopulation,wherecircumcisionisrarelypractised,showedthatnonretractabilityisfoundin8%of67year olds,in6%between8and11years,3%at1213,andonly1%atage1417.Healsoshowedthatpreputialadhesionsdecreasedwith advancingageintheboysinthestudy,sothatthesewerepresentin63%of67yearolds,butonly3%of1617yearolds.More recentlyKayabaetal.(op.cit.)havefoundthesameandtheyconcludethat:"WeagreewithWallersteinthatintheabsenceof emergencymedicalproblemstheprepuceofinfantsshouldremainuncircumcised.CONCLUSIONSInmostmaleindividualspreputial separationcontinuesuntiladolescence,presumablytoprotecttheimmatureglanspenis.Physiciansaswellasparentsshouldbefamiliar withthebiologicalroleandnaturaldevelopmentoftheprepuce.Whilstsurgerymustbeconsideredinthepresenceofparaphimosisor dysuriaassociatedwithphimosis,fewboysrequirecircumcisionuntiladolescencewhentheonlyreasonforthisprocedureispoor preputialretractability." Wherethereisgenuinephimosisorparaphimosis,thenrecentworkhasindicatedthattreatmentwithsteroidcreamsorpreputioplasty cantreattheprobleminthebulkofcases,thussavingtheforeskinwithitsnervesandotherfunctions 84 apartfromboyssufferingfrom therareconditionofbalanitisxeroticaobliterans,theprepuceisusuallysaveable.

3.3Preventionofcervicalandpenilecancers.
Theclaimsofareduction,orevenhintsoftheelimination,ofcancersofthecervixandpenis(adiseaseofatinynumberofelderlymen) havebeendiscreditedDenmarkandJapan,mainlyuncircumcisedcountries,havealowerratethantheUnitedStatesand,toputthe diseaseinperspective,some9,600mendieannuallyinBritainofcanceroftheprostate.Inviewofthecontinuation,despiteclear refutationinthemedicalliterature,astotheseclaims,itisworthquotingfromalettertoDrPeterRappo,oftheAmericanAcademyof Pediatrics,dated16Feb1996andfromDrsHughSingletonandClarkHeath,theNationalVicePresidentandVicePresident,ofthe AmericanCancerSociety:
"...wewouldliketodiscouragetheAmericanAcademyofPediatricsfrompromotingroutinecircumcisionasapreventative measureforpenileandcervicalcancer.Researchsuggestingapatterninthecircumcisionstatusofpartnersofwomenwith cervicalcancerismethodologicallyflawed,outdated,andhasnotbeentakenseriouslyinthemedicalcommunityfor decades.PenilecancerratesincountrieswhichdonotpracticecircumcisionarelowerthanthosefoundintheUnited States.Fatalitiescausedbycircumcisionaccidentsmayapproximatethemortalityratefrompenilecancer."

3.4`Betterdoneatbirththanlater'
Theincidenceofproblemsinvolvingtheprepuceislow:ashasbeendiscussed,theincidenceoftruephimosisis low,andcertainlyunder2%andprobablyoftheorderof1%orless:Finlandcircumcisesattherateof6per100,000(or 0.00006%) 85 .Anadult,orevenanolderboywillbeabletounderstandwhy,assumingthatmoreconservativeandlessinvasively mutilatingtreatmentshavenotworked,itisnecessarytosufferthishewillbeoldenough(inhisadolescenceorolder)tohave anaesthesiaandpostoperativeanalgesiahissynechiawillbewhollyorlargelydissolved(thusavoidingthestrippingofthemwithtrauma andsubsequentscarringoftheglansandresultingfurtherlossofsensitivity)andhispeniswillbegrownenoughforacarefuland calculatedamputationtobemadethusavoidingextradisfigurement,ratherthantheguessworkforaninfantpenisandhealingisusually uneventful.Theclaimsthatcircumcision"hurtsmoreinlaterlife"aremade,usually,bythosecircumcisedrituallyatbirthorearly childhoodwhothereforedonotknowfrompersonalexperiencewhattheyaretalkingaboutandwhooffer,asusual,notonescrapof evidenceinsupportoftheirclaims. Tothe`traditional'andwelldebunkedclaims,thefollowing`new',andequallyunscientific,candidateshaverecentlyemerged:

3.5Preventionofsexuallytransmitteddiseases
Now,perhapsasameasureofthedesperationofcircumcision'ssupporterstofindareasontocontinue,itissuggestedasapreventive againstUTIs,AIDSandothersexuallytransmitteddiseases(onthebasis,accordingtosomeUSdoctors,86 thatthekeratinisedlayeron theglansactedasaformofcondom!).IfthatwereindeedsothenonewouldnotexpecttofindratesofHIVinfectionintheUSA,a mainlycircumcisedpopulation,some8timesthatofBritainandtherestofmainlyuncircumcisedEurope,andonalevelwithSub SaharanAfrica. 87

The`best'thattheAmericanAcademyofPediatricscouldcomeupwithintheirTaskForcereport(op.cit.)was:
"Evidenceregardingtherelationshipofcircumcisiontosexuallytransmitteddiseasesisconflicting.Earlyseriesindicateda higherriskofgonococcalandnonspecificurethritisinuncircumcisedmen,whereasonerecentstudyshowsnodifferencein theincidenceofgonorrhoeaandahigherincidenceofnonspecificurethritisincircumcisedmen.Althoughpublished reportssuggestthatchancroid,syphilis,humanpapillomavirus,andherpessimplexvirustype2infectionaremorefrequent inuncircumcisedmen,methodologicproblemsrenderthesereportsinconclusive."

VanHowe(op.cit.atn8)concludes,afteranexhaustivereviewoftheliterature:
"Thereisnocompellingevidencethatcircumcisionprotectsanindividualfromsexuallytransmitteddiseases,especiallyina developednationsetting,andtodependoncircumcisiontoprotectanindividualfromcontractingtheseillnesseswouldbe naiveandfoolhardy.Thenonmedicalfactorsthatareusedtoreachadecisionconcerningneonatalcircumcisionare probablymoreimportantafactorindevelopingsexuallytransmitteddiseasesthanthepresenceoftheforeskin.Atthis point,untilstudiesproveotherwise,circumcisioncannotberecommendedasapreventativemeasureagainstsexually transmitteddiseases."

Indeed,ithasbeensuggestedbysomethatthecircumcisedmale,lackingthenaturalmobilityofskinaffordedbytheforeskinandlacking thesensitivitybothofwhichmakesintercoursesuchalabourforthecircumcised,mightbemorevulnerabletotearsinthepenileskin thantheuncircumcisedthusgivingareadieraccesstotheHIVvirusandotherpathogensbutnorealresearchseemstohavebeen conductedtotestthistheory.

3.6Preventionofurinarytractinfections
Theworkrelieduponforthislatest`scaretactic'bycircumcisersisthatofWiswell,aUSArmydoctor.YettheAmericanAcademyof Pediatrics'TaskForceconcluded: 88

"Inanotherarmyhospitalstudy,infantswereexaminedinthefirstmonthoflifeanditwasconcludedthatthehigh incidenceofurinarytractinfectioninuncircumcisedboyswasaccompaniedbyasimilarlyincreasedincidenceofother significantinfection,includingbacteremiaandmeningitishowever,theauthorsofthatstudydidnotdistinguishbetween bacteriuriasecondarytosepticemiaandprimaryurinarytractinfection.Stillanotherrecentarmyhospitalstudylends supporttoa1986hypothesisthatcircumcisionpreventspreputialbacterialcolonizationandthusprotectsmaleinfants againsturinarytractinfection. Itshouldbenotedthatthesestudiesinarmyhospitalsareretrospectiveindesignandmay havemethodologicflaws.Forexample,theydonotincludeallboysborninanysinglecohortorthosetreatedas outpatients,sothestudypopulationmayhavebeeninfluencedbyselectionbias ."[emphasisadded].

Wiswell'sworkhasbeenthesubjectoftrenchantcriticismbyothers,suchasAltschul89 andbyvanHowe(op.cit.atn8).Kayabaetal. (op.cit.)foundnotasinglecaseofurinarytractinfectionandconcludethatreductionofurinarytractinfection(andthereisdoubtasto theefficacyofcircumcisiontoachievethisanyway)"isnotadecisivereasonforjustifyingindiscriminateneonatalcircumcision"Drvan Howecommentsonthisinaprivatecommunication:"Thefactthatnourinarytractinfectionswereseenisextremelyimportant.When comparedtoWiswell'sstudiesthereisasignificantlylowerincidenceofUTIinthisstudy(Fisher'sexacttestrangesbetween0.001to 0.000000031dependingonwhichWiswellstudyislookedat).ThisstudyisanotherinalonglinethathasfailedtoconfirmWiswell's dramaticandunreproduciblefinding.Addingtotheimportanceofthisfindingisthatthisstudywasprospectivewhichismuchmore powerfulthanWiswell'scursorychartreviews.....actuallyWiswellcouldn'tevenreproducehisownresults.TherateofUTI'sinhisfirst tworeportsdifferedsignificantlywiththefirststudyhavingahigherrate(oddsratio=2.34,95%confidenceinterval=1.045.26)."

3.7`Benefits':Conclusion
Itisunnecessaryhere,giventhattheCommissiondonotofferitasareasonforproposingthatritualcircumcisionberegularisedand giventhatthemedicalconsensusinBritainandtherestofthenoncircumcisingworld(some85%oftheworld'smenareblissfully uncircumcised)isthattherearenorealbenefitstoroutineneonatalcircumcision,torefutethoseclaimsatanygreatlength:thosewho requirefurtherdetailaredirected,asastartpoint,totheworkofDrRVanHowe(op.cit.atn8)andtothepaperbyWilliamsand Kapila(op.cit.atn32)andthepaperstherecited.

4.Thesacrificialoriginofcircumcision
Initiationrites,usuallyinvolvingtheinflictionofpainandthescarifyingofthebody,orthedeformationofbodypartsortheexcisionof fleshwere,andremain,notuncommoninprimitivesocieties.Itwouldnotbeunreasonabletoseethemasamark,andatest,bothofthe victim'sabilitytowithstandpain(andthusprovehimselfasastaunchwarrior)and/orasamethodwherebythetribeasserteditselfandits powersovertheindividual.Itisinappropriateheretoexamineindetailthemotivationforsuchpracticesbutitiswhollyappropriateto bearthenatureandhistoryofsuchmutilationsinmindwhenconsideringthelegalityofcircumcision,especiallyinthelastyearsofthe 20thcentury. J.HenryC.Simes 90 wrotein1890:
"Themutilationofthegenitalsamongthevarioussavagetribesoftheworldpresentsastrangeandunaccountablepractice ofhumanideas,whichoneisnotabletoreconcilewithanyreasoningpower.Whysuchcustomsshouldbeinvoguenone cantellatthepresenttimebutwemustsupposethatatsomeperiodtheyhadtheirsignificance,whichinthecourseof ageshasbeenlost,andthepracticehasbeenhandeddownfromgenerationtogeneration."

WarrenandBigelowwrite91 today:
"Theoriginsofcircumcisionarelostinantiquity.MalecircumcisionisdepictedinEgyptiantombs5,000yearsago,while Gairdner(op.cit.atn78)referstoevidencethatithasitsoriginslongbeforethisinprehistoryupto15,000yearsago.

"Wedonotknowwithcertaintywhythisprocedurewascarriedout,butmanywritershavesuggestedthatitwasa sacrificialrite.Nodoubthumansacrificewaswidespread,anditseemslikelythatsubstitutesforthispracticeincludedthe sacrificeofdomesticanimalsandmutilationsofthehumanbody,ofwhichcircumcisionisjustoneexample.Circumcision wouldusuallyhavebeencarriedoutasaninitiationordealataboutthetimeofpuberty,buttherewasatendencyforthe ageatwhichitwasperformedtoshiftearlier,sothatJewishritualcircumcisionhasbeencarriedoutontheeighthdayoflife sincebiblicaltimes. "Ritualcircumcisionisparticularlypopularandwidespreadgeographically.Animportantaspectofsacrificeistheshedding ofblood,andcircumcisionisanotoriouslybloodyoperation,andeveninmodernsurgicalconditionshaemorrhagecanbea 92 93 problem.Arateofupto2%isreportedbyDenton ,sometimesrequiringbloodtransfusion.Gellis reportedthatthere weremoredeathsintheUSAfromthecomplicationsofcircumcisionthanfromcarcinomaofthepenis.Onecanonlyguess whatthemortalityfromhaemorrhageandinfectionsmightbeinprimitiveorancientcommunities. "Anotheraspectofsacrificeisthattheobjectwhichisforfeitedshouldbevaluable.Thegreaterthevalueoftheobject sacrificed,themoreworthythesacrifice.Thisshouldmakeuswonderwhatarethevalueandfunctionoftheprepuce.Ifit werejustauselessflapofskin,itwouldnotbemuchofasacrifice,andonemightjustaswellshaveoffone'sbeardorcut one'stoenails.Theprepuceplaysamajorroleinensuringthesensitivityofthepenisduringsexualactsandcircumcision greatlyreducesthepossibilitiesofpleasurablesensations.Thismakesitanidealsacrificialobject,asthecircumcisedmale isabletofunctionnormallyinsocietyandtoprocreate,butsufferspermanentimpairmentofsexualenjoymentandbearsa visible,lifelongreminderofhissacrifice."

AccordingtoPhilocircumcisionwasfor
"theexcisionofpassions,whichbindthemind.Forsinceamongallpassionsthatofintercoursebetweenmanandwomanis thegreatest,thelawgivershavecommended[sic]thattheinstrument,whichservesthisintercoursebemutilated,pointing out,thatthesepowerfulpassionsmustbebridled,andthinkingnotonlythis,butallpassionswouldbecontrolledthrough thisone."

Indeed,afterthepassageinGenesisChapter17astocircumcision,thereisthenthepassageinGenesisChapter22ofthesacrifice demandedbyGod,eventhoughthenstayed,ofIsaactheconnectionbetweenthesetworequests,andthevalueofthatwhichwas requiredtobesacrificed,isclear. Hosken 94 writes:

"Someanthropologistsalsospeculatehoworifthetraditionofmalecircumcision,theremovaloftheprepuce,isrelatedto thecuttingofftheentirepeniswhichwasofferedasasacrificetothegods...Circumcisionofbothboysandgirlscameinto fashionlongbeforeIslam,andwaspractisedinmanydifferentareasinAfrica....TheCoptsinEgyptandtheAbyssians (Ethiopians)havepractisedcircumcisionofboysandgirls(atamuchyoungeragethanthetypicalpubertyritesofSub SaharanAfricans)fromprehistorictimes....ItisstatedthatboththeJewsandtheArabslearnedcircumcisioninEgypt, ratherthanviceversa.TheruleintheMiddleEast,aswellasinSub SaharanAfrica,isthataboycannotgetmarriedunless heis...circumcised...excision[infemales]...ispractisedtoaffirmthesexoftheindividualbecauseitisbelievedthatthe clitorisrepresentsamaleelementinafemale,andthattheprepuceofthepenisrepresentsfemininityinaboy.Hence,the girlsareexcisedandtheboyscircumcisedinordertoestablishtheirsexinsociety."

5.Jewishcircumcision
InGenesisChapter17,verses10to14,GodissaidtohavecommandedAbrahamtocircumcisehimselfandallmalesinhishousehold asasignofthecovenantbetweenhimandGod.InLeviticusChapter12verse3,itiswritten:
"Andintheeighthdaythefleshofhisforeskinshallbecircumcised."

SeealsoISam18:25foranother,undeniablyprimitive,reasonforcircumcision,quotedbySzasz 95 . Szaszalso(op.cit.)observes:
"TherootsofbothRNC[`RoutineNeonatalCircumcision']andantimasturbatorymeasureslieinJewishlaw,which recognisesthelegitimacyoferoticpleasureassociatedwithsexualintercourse,providedthattheactismarital genital congressbetweenaJewishmanandaJewishwoman.Everyothersexualactisstrictlyprohibited.Masturbationis condemnedunequivocallybothintheTalmudandinextraTalmudicliterature.TheZohar(anauthoritativecommentaryon thePentateuch)callsmasturbation`asinmoreseriousthanallthesinsoftheTorah'(FeldmanDM:1968: BirthControlin JewishLaw:MaritalRelations,Contraception,andAbortionasSetForthintheClassicalTextsofJewishLaw p114)....Recognisingtheobviousconnectionsbetweentouchingthepenisandsexualarousal,Jewishlaw`definitely prohibitstouchingone'sgenitalstheunmarriedmannever,andthemarriedmanonlyinconnectionwithurination'(Epstein LM:1967 SexLawsandCustomsinJudaism p137)WhenanOrthodoxJewishfatherbladdertrainshisson,headmonishes him:`Withouthands!Betterabadaimthanabadhabit.'"

TheformofthecircumcisionoriginallypractisedbyJewswasamuchlessinvasiveprocedurethantheBris(orBrit)Milahoftoday, which(initsradicalexcisionofthepenileskin)istheformalsoadoptedbycircumcisionsperformedbydoctors:onlytheverytipofthe prepucewasremoved,thuspreservingthefrenulumandmostoftheprepucewithitsnervesanditscoverageofmuchoftheglans indeeditseemspossiblethatinsomeinstancesonlyatoken`cut'ordrawingofbloodwasdeemednecessary.Withsuch`minor' excisionitwasnotdifficultforamancircumcisedinthiswaytopullandretaintheremnantsofhisprepuceovertheglanssoastoappear tobeuncircumcised.SincetheancientGreeks(whowerenakedforsportingactivitiesandexercise)foundthesightoftheuncovered glanstobeoffensiveandobsceneduringexercise,JewswhowantedtotakepartinsportswithuncircumcisedGreeksadoptedthis methodof`uncircumcision'andthismethodcouldbeusedinanysituationwheretheJewishmanwishedtoconcealthephysicalmarkof hisJewishness.ItisamethodadoptedbyJewswhenevertheyhavewishedtoconcealtheirJewishness,asforexampleduringthe Holocaust(powerfullydemonstratedinthefilmEuropaEuropa)andbroadlyspeakingitisthefoundationofthenonsurgicalmethodof foreskinrestorationdescribedbyBigelowinhisbook,TheJoyofUncircumcising (op.cit.).Theneedformanymentoday,someof whomarecircumcisedJews,tofollowthelengthyandoftenuncomfortabletechniquetorestorejustatinybitofthefunctionofthe

foreskinlostincircumcisionisevidenceoftheirrealisationofthedamagecausedbytheircircumcision. Inorabout140AD,themoreradicalformofcircumcision,thepariah(orperiah)wasintroduced:itsradicaltearingofftheliningofthe prepuceoftheglansand,withasharpenedfingernailorthumbnail,theremovalofallthemucoustissuethatcomprisestheinnerliningof theprepuceandamputationofthewholeprepucemadeitimpossibleforamanthuscircumcisedtorecoverhisglans,sincetherewas insufficientpenileskinleft.ItisthisformwhichhasbeenusedsincethenbyJewsandisthemodelforthemodernnonritualcircumcision whichalsoinvolvesradicalamputationaftertheforciblebreakingdownofthesynechiabetweenprepuceandglanspenis. Thelossofsexualpleasureofthecircumcisedmanandthemeasureofthesacrificeimposedontherituallycircumcisedboyhasbeen wellknownformanycenturies(albeitthattherecenttrendisforcircumciserstofeelimpelledtodenythatlossinordertodefendtheir behaviour). Thus,MosesMaimonides(11351204AD.),anotedJewishrabbi,sageanddoctorofhistime,wrote: 96
"Asregardscircumcision,Ithinkthatoneofitsobjectsistolimitsexualintercourse,andtoweakentheorganofgeneration asfaraspossible,andthuscausemantobemoderate.Somepeoplebelievethatcircumcisionistoremoveadefectinman's formationbuteveryonecaneasilyreply:Howcanproductsofnaturebedeficientsoastorequireexternalcompletion, especiallyastheuseoftheforeskintothatorganisevident?Thiscommandmenthasnotbeenenjoinedasacomplement toadeficientphysicalcreation,butasameansforperfectingman'smoralshortcomings.Thebodilyinjurycausedtothat organisexactlythatwhichisdesireditdoesnotinterruptanyvitalfunction,nordoesitdestroythepowerofgeneration. Circumcisionsimplycounteractsexcessivelustforthereisnodoubtthatcircumcisionweakensthepowerofsexual excitement,andsometimeslessensthenaturalenjoymenttheorgannecessarilybecomesweakwhenitlosesbloodandis deprivedofitscoveringfromthebeginning.OurSages(Beresh.Rabba,c.80)saydistinctly:Itishardforawoman,with whomanuncircumcisedhadsexualintercourse,toseparatefromhim.Thisis,asIbelieve,thebestreasonforthe commandmentconcerningcircumcision.Andwhowasthefirsttoperformthiscommandment?Abraham,ourfather!of whomitiswellknownhowhefearedsinitisdescribedbyourSagesinreferencetothewords,`Behold,nowIknowthat thouartafairwomantolookupon'(Gen.xii.II). "Thislawcanonlybekeptandperpetuatedinitsperfection,ifcircumcisionisperformedwhenthechildisveryyoung,and thisforthreegoodreasons.First,iftheoperationwerepostponedtilltheboyhadgrownup,hewouldperhapsnotsubmit toit.Secondly,theyoungchildhasnotmuchpain,becausetheskinistender,andtheimaginationweakforgrownup personsareindreadandfearofthingswhichtheyimagineascoming,sometimebeforetheseactuallyoccur.Thirdly,when achildisveryyoung,theparentsdonotthinkmuchofhimbecausetheimageofthechild,thatleadstheparentstolove him,hasnotyettakenafirmrootintheirminds.Thatimagebecomesstrongerbythecontinualsightitgrowswiththe developmentofthechild,andlaterontheimagebeginsagaintodecreaseandtovanish.Theparents'loveforanewborn childisnotasgreatasitiswhenthechildisoneyearold.Thefeelingandloveofthefatherforthechildwouldhaveledhim toneglectthelawifhewereallowedtowaittwoorthreeyears,whilstshortlyafterbirththeimageisveryweakinthemind oftheparent,especiallyofthefatherwhoisresponsiblefortheexecutionofthiscommandment.Thecircumcisionmusttake placeontheeighthday(Lev.xii.3),becausealllivingbeingsareafterbirth,withinthefirstsevendays,veryweakand exceedinglytender,asiftheywerestillinthewomboftheirmothernotuntiltheeighthdaycantheybecountedamong thosethatenjoythelightoftheworld.ThatthisisalsothecasewithbeastsmaybeinferredfromthewordsofScripture: `Sevendaysshallitbeunderthedam'(Lev.xxii.27),asifithadnovitalitybeforetheendofthatperiod.Inthesamemanner maniscircumcisedafterthecompletionofsevendays.Theperiodhasbeenfixed,andhasnotbeenlefttoeverybody's judgement. "Thepreceptsofthisclassincludealsothelessonthatwemustnotinjureinanywaytheorgansofgenerationinliving beings(ibid.xxii.24).Thelessonisbasedontheprincipleof"righteousstatutesandjudgements"(Deut.iv.8)wemust keepineverythingthegoldenmeanwemustnotbeexcessiveinlove,butmustnotsuppressitentirelyfortheLaw commands,`Befruitful,andmultiply'(Gen.i.22).Theorganisweakenedbycircumcision,butnotdestroyedbythe operation.Thenaturalfacultyisleftinfullforce,butisguardedagainstexcess.ItisprohibitedforanIsraelite`thatis woundedinthestones,orhathhisprivymembercutoff'(Deut.xxiii.2),tomarryanIsraelitishwomanbecausethesexual intercourseisofnouseandofnopurposeandthatmarriagewouldbeasourceofruintoher,andtohimwhowouldclaim her.Thisisveryclear."

Butonemustrealisethat,accordingtoJewishbelief,oneisJewishif,andonlyif,one'smotherisherselfJewish:theretentionor otherwiseofaprepucehasnothingtodowithbeingJewish.Thus,aJewishmanwritingintheGuardian 97 says:

"MywifeisnotJewish.OurchildregardlessoftheconditionofhispenisisnotJewish,ifyoupayattentiontothe Orthodoxauthorities.Allthesame,itwasimportanttometohaveJuliuscircumcised....`Youknow,itstillwon'tmakehim Jewish,'saidDrCohen....IheldJulius'slegsdownandapart.WheneverIfeltatremorfromhim,Ipusheddownslightly harderontheknees.Theactionseemedtocomforthim.Hestoppedcrying.Hebecamecalm.Itwasalmostasifhetrusted us....DrCohengatheredJulius'sforeskinbetweenhisfingers,pulleditaway,andhissadlittleglanswasexposed....Iheard thesoundofDrCohen'sbreathing,andthenIheardthesoundofscissorstearingthroughskin.Andthen,amomentlater, thehorriblescreamthatJuliusmadeofutter,excruciatingpain....Supposedly,circumcisedpeniseshave30percentless sensitivitythanuncircumcisedones....Godisperfect,mancannotbe,soletusblemishoursynagoguefloorsandmutilate oursonstoproveit.Istilldon'tbelieveinGod.AndifIhaveanothersonIamsurethathewillbecircumcisedtoo."

Onecanonlyaskwhy?Whythismutilation,ofhisson,byamanwhodoesnotbelieveinGod,andthusforwhomthe`religiousduty' canhavenomeaningwhenthechildcannotbecomeJewishbysodoingit(orlessJewishbynotdoingit)andthus`culturalidentity' seemsmeaninglesswhenhedoesnotclaimanymedicalbenefitsfordoingitandheacceptsthatitispainful,anddamagingtopenile sensitivity? Bywayofcontrast,thereareJewsforwhomtheBrisMilahisunacceptable:

"AccordingtoJewishlaw,itisforbiddentocausetsa'arba'aleichaim,orpainoflivingthings.Eventhenecessarycausing ofpainisconsideredcruelinJudaism.Jewishlawevenprohibitsthepairingupofasmallandalargeanimalforplowingin casetheasymmetrycausesthelittleronediscomfort.Clearly,concernoverthepainofothershasstrongJudaicroots. "WhatabouttheconcernthatcircumcisioninvolvesthesurgicalalterationofaperfectlynaturalGod givenpartofthe body?Thisconcern,too,stemsfromJewishthought.Westernersgenerallyfindthebodilymutilationpractisedinother culturestobedeeplydistasteful.ThisdistasteisbasedontheHebrewBible'sdenouncementofpaganpracticessuchas tattooingandcuttingtheflesh.

"Thereisalsotheriskofseriouscomplications,andevendeath,fromcircumcision.Nomatterhowsmalltheserisksare, theymustbeconsidered.Now,eventhisconcernisanechoofJewishlaw.Judaismregardslifeasinfinitelysacredand givesitprecedenceoverallelse. "Accordingly,Jewishlawtellsusthatanymedicalprocedureinvolvingeventhepossibilityofrisktolifemustbeviewedas dangerousandis,therefore,strictlyforbidden.Thus,theriskofcircumcisionisnotjustamedicalconcern,butaJewishone. "ThousandsofJewstodayarequestioningcircumcision.Somearedecidingnottocircumcisetheirinfantsons.Bymy 98 estimates,AmericanRabbisaregettingatleast3,000callseachyearfromparentswhoareinconflictwiththerite." "Judaismisatremendouslyrichprosurvivalreligionthat,throughpersistentmistreatmentandmisinformation,isstill widelymisunderstood.However,themistakesthatitcarrieswithinit,suchastheritualofcircumcision,calledBritMilah, shouldnotbeconsideredanydifferentlythaninsocietyingeneral,nomatterhowessentiallyimportanttotheJewish cultureitisseen.Circumcisionischildabuse.Itismedicallyunnecessary.Itisnothingshortofatraumaticwaytointroduce anewbornmaleintotheworldandintotheJewishcommunity.ThecenturiesofacovenantwithGodhasproducedgreat denialinviewingtheveryrealpainofthenewborn.Fromthestartitrelegatesfemalesasbeinglessimportantthanmalesas historicallytherehasbeennoequivalentceremonytowelcomethenewbornJewishfemalebaby. "Makenomistakeaboutit,youngpeopledonotaskforandreactsharplytotheimpositionofadultvaluesonthemand theirbodies.Expectingnothingshortofacompleteandexuberantwelcomeintotheirworld,thepainofthetoolsusedby theMohel,orthedoctor,isarudeshocknotreadilyforgottenbythenewbornwithanalreadydevelopednervoussystem 99 andabrilliantmind."

AJewishmother,intheChannel4TVprogrammeWarCries:It'saBoy:
"I'maJewishmother.MysonMaxisfivemonthsoldandIrefusetohavehimcircumcised.[Itoldmymother]"Iwoulddo anythingnottohurtyou,myparents,excepthurtmychild."

6.Muslimcircumcision
ForMuslims,itisbynomeansclearthat,asoftenassertedandcitedbytheCommissioninfootnote3toPartIXoftheConsultation Paper,circumcisionisregardedasafundamentalandrequiredrite. ThereasonforitsperformanceseemstobethatAbrahamwasreveredandthatifhecircumcisedhimselfthenthatwasareasonforits performancebyMuslimsitalsoseemsthattherequirementforcleanlinessbeforeprayerwasafactor(thoughnoreasonseemstohave beenadvancedfornotusingwater,aswithotherbodypartsandseeminglynodifficultyisseenwiththeproprietyofprayersfromboys uncircumciseduntillatechildhood/teenageyears). DrSNKahnstatesin TheIslamicViewpoint :100
"Circumcision,encouragedinIslamandwidelypractisedbyMuslims,isatraditionoftheProphetandanimportant ritual"(emphasisadded).

RitualcircumcisionhasalsobeendiscussedbyDrSamiAldeebAbuSahlieh.101 Althoughhedealsrathermorewithfemalecircumcision, hisanalysisofthemindprocessbehindbothforms(i.e.maleandfemalecircumcision)isilluminating.Hewrites:

"CircumcisionasasignofalliancecanonlybefoundintwootherpassagesoftheBible.Elsewhere,itismorenarrative: KingSauldemandedonehundredPhilistineforeskinsfromDavid,beforehegavehisconsenttoDavidmarryinghis daughterMikal:"David....thoughtitwasagooddealinordertobecometheking'ssoninlaw...Hewenttowar...Hekilled 200Philistinemen,broughtbacktheirforeskins,countedtheminfrontoftheking....SoSaul...hadtoadmitthatJehovahwas onDavid'sside."ThisinterpretationoftheKoranicverseswithreferencetotheBibleisconsideredabusivebyImam MahmudShaltut(israffilistidlal).Whatismore,thistextualargumentbasedonJewishlawconcernsmalecircumcision only,notfemalecircumcisionthattheBibledoesnotmentionandthattheJewsdonotpractice(Falachasexcepted).Al Sukkarianswersthat,accordingtoIbnHagar,theJewsusedtocircumcisebothsexes,whichiswhyherejectsmaleand femalecircumcisiononthe7th[sic]day,soasnottolooklikethem.EventheauthenticBibletoday'soneisconsidered falsifieddoesnotcontainanytextrelatedtofemalecircumcision.Nonetheless,theMuslimsmustpracticeit,iftheMuslim lawmakesprovisionforit. "TheSunnah:Wewilltryheretoglean,fromtheworksofcontemporaryArabauthors,thedifferentsayingsofMohammed relatedtomaleandfemalecircumcision.ThemostoftenmentionednarrationreportsadebatebetweenMohammedandUm Habibah(orUmTatiyyah).Thiswoman,knownasanexciseroffemaleslaves,wasoneofagroupofwomenwhohad immigratedwithMohammed.Havingseenher,Mohammedaskedherifshekeptpractisingherprofession.Sheanswered affirmativelyadding:"unlessitisforbiddenandyouordermetostopdoingit."Mohammedreplied:"Yes,itisallowed. ComeclosersoIcanteachyou:ifyoucut,donotoverdoit(latanhaki),becauseitbringsmoreradiancetotheface(ashraq) anditismorepleasant(ahza)forthehusband."Accordingtoothers,hesaid:"Cutslightlyanddonotoverdoit(ashimmi walatanhaki),becauseitismorepleasant(ahza)forthewomanandbetter(ahab,fromothersourcesabha)forthe husband."Weshallhereinafterrefertothisnarrationastheexciser'snarration.Mohammedsaid:"Circumcisionisa sunnahforthemenandmakrumahforthewomen."Thetermsunnahheremeansthatitisconformtothetraditionof Mohammedhimself,orsimplyacustomatthetimeofMohammed.Thetermmakrumahisfarfromclearbutwecantranslate itintoahonorabledeed.SpeakingtotheAnsars'wives,Mohammedsaid:"Cutslightlywithoutexaggeration(ikhtafidna walatanhikna),becauseitismorepleasant(ahza)foryourhusbands."SomeonecametoMohammedandbecamea convertbeforehim.Mohammedtoldhim:"Shaveoffyourunbeliever'shairandbecircumcised."Mohammedsaid:"Lethim whobecomesaMuslimbecircumcised,evenifheisold."OneaskedMohammedifanuncircumcisedmancouldgoto pilgrimage.Heanswered:"Notaslongasheisnotcircumcised."Mohammedsaid:"Fivenormsdefinefitrah:shavingof thepubis,circumcision,moustachetrimming,armpitdepilationandnailclipping."Othernarrationsnametennormsamongst whichcircumcisionisalwaysmentioned.ThenormsoffitraharebelievedtobethosetaughtbyGodtoHiscreation.The maninpursuitofperfectionmustconformtothosenorms.Theyarenotcompulsory,butsimplyadvisable(mandubah), exceptforcircumcisionwhichismandatory.Basedonthesepremises,AlSukkaribelievesAdamtohavebeenthefirst circumcisedman.Hisdescendantshavingneglectedtheirobligation,itwasreconfirmedtoAbrahamandhisdescendants. Thuscircumcisionwouldbethesignwhichwoulddifferentiatethebelieverfromthenon believer."

6.1Muslimcircumcisionprocedures.
WhilsttheJewscircumcise,inaccordancewiththeirbeliefs,onthe8thdayoflife,Muslimsoftendelaycircumcisionuntillaterin childhood:sometimesaslateastheonsetofpubertyorevenmidteensorbeforemarriage.Theeffectonsuchaboyofthisamputation, withoutanaesthesia,particularlyaftertheonsetofpubertyrequireslittleimagination.Further,giventhatthereisnotaneed,aswith Judaism,tocircumciseonasetday,thereisnoreasonwhythedecisioncannotbelefttotheboyhimselfwhenheisoldenoughtoform hisownindependentviewastohisbeliefsystemsandhisownbody,whentheprocedurecanbeperformedundersuitableconditions andonanadultorganwhentheamounttobeamputatedcanbethemoreaccuratelyassessed.Itishardtoresistthethoughtthatthe reasonthatitistypicallyperformedinearlychildhoodisbecausethechildisatthatageverymuchinthepoweroftheparentsandunable toresistthismutilation. TheformofMuslimcircumcisionhasbeendescribedbyWilfredThesigerinhisbookArabianSands ,firstpublishedbyLongmansin 1959,anddescribinghistravelsinArabiafrom1945onwards.HewritesofmeetingaSalimbinTurkiawhose15yearoldhad`a curiouscockscombofhair,asignthathewasstilluncircumcised'.Later,hewritesofonehiscompanions,binKabinaagedabout16: althoughThesigersaysthatcircumcisionis`usuallyperformedonachildabouttheageofseven',hedescribesthehaggardappearanceof binKabinawhotellshimofhisrecentcircumcision3monthsearlier.Thesigeralsodescribessomeofthefeaturesofthisprocedure:often theflayedmemberwasthen`kippered'forseveraldaysthereafterbybeingheldinthesmokefromafireandsometimesmutilationssuch as`theflayingcircumcision'werecarriedout,inwhichtheskinwasremovedfromthenaveldowntotheinsideofthethighs. AlthoughtheflayingcircumcisioninthesensedescribedbyThesigerhasbeenbannedinArabcountries,veryradicalcircumcision, involvingtheremovalofmuchofthepenileskinwaspractisedinthesouthernpartsofOmanaslateasthe1970s. InanarticleTheKnifeedgeofManhood,thecircumcisionof7yearoldsinIstambulisdescribedandphotographed 102 Thecircumciser, KemalOzkan,claimstohavedoneasmanyas2000circumcisionsinaday,andisreportedasbeingalocalcelebrityandfeaturingin touristguidebookstothecityofIstanbulaccordingtohimtheidealageisbetween5and9butthatageis,seeforexampleCansever 103 , theagewhenproceduresontheboy'sgenitalsislikelytocausegreatmentaltrauma.AsAnnaFreudobserved:
"Eversincethediscoveryofthecastrationcomplexanalystshavehadampleopportunityintheirtherapeuticworktostudy theimpactofsurgicaloperations,onnormalandabnormaldevelopment.Bynowitiscommonknowledgethatsurgical interferencewiththechild'sbodymayserveasthefocalpointfortheactivation,reactivation,groupingandrationalization ofideasofbeingattacked,overwhelmedand(or)castrated.Thesurgeon'saction,fromminorsurgerytomajoroperations,is interpretedbythechildintermsofhislevelofinstinctdevelopment,orinregressiveterms.Whattheexperiencemeansin hislife,thereforedoesnotdependonthetypeorseriousnessoftheoperationbutonthetypeanddepthofthefantasies arousedbyit.If,forexample,thechild'sfantasiesareconcernedwithhisaggressionagainstthemotherprojectedontoher person,theoperationisexperiencedasaretaliatoryattackmadebythemotherontheinsideofthechild'sbody(Melanie Klein)ortheoperationmaybeusedtorepresentthechild'ssadisticconceptionofwhattakesplacebetweentheparentsin intercourse,withthechildintheroleofthepassivesexualpartnerortheoperationisexperiencedasamutilation,i.e.,as punishmentforexhibitionisticdesires,foraggressivepenisenvy,aboveallformasturbatorypracticesandoedipal 104 jealousies."

TheboyssitonamerrygoroundandarespunaroundOzkanstopsthewheeltoselectthenextboyforcircumcision.One7yearold isquotedassaying"Ifyoudon'tcut,I'llgiveyoudoublethemoneythatmyfatherispayingyou":hispleaisignored,hispenisisgrabbed and,afterthecircumcision,heishandedtohismotherandthewheelspinsagainwhilstOzkansharpenshisknifeforthenextvictim.

7.AustralianAboriginalCircumcision
Moneyetal 105 describecircumcision(or`dhapi')atage8or9:
"Oneof[theceremonialinitiatesamongtheelders]liesonhisbackontheground,theboylyingupwarduponhimand pinionedinalockedembrace.Anotherholdsdowntheboy'slegs.Athirddoestheactualcutting.Inancienttimesastone knifewasused.Todaytheinstrumentisarazorblade.Thecuttingismorelikelytobeaseriesofdissectionmovements.The boymaycryoutwiththepain.Immediatelytheforeskinisremoved,themeninchargecarrytheboyintothebushnearby whereheispassedthroughthesmokeofafireforspiritualcleansing.Thebleedingofhispenisisstoppedbycauterising withapieceofhotcharcoalandtheapplicationofhot,wetleaves....Themeaningoftheceremonyis,liketheoriginof circumcisionitself,lostintheunrecordedannalsofprehistory.Myowntheoreticalguessisthatitrepresentsasubstitute for,andanattenuationof,humansacrifice."

Meggit106 writesofthecircumcision,performedbetweentheageof11and13:
"Theriteofcircumcisionanditsattendantceremoniesfirmlyandunequivocallyestablishayouth'sstatusinWalbiri society.Shouldhefailtopassthroughtheserites,hemaynotenterintohisfather'slodge,hemaynotparticipatein religiousceremonies,hecannotacquireamarriageline,hecannotlegitimatelyobtainawifeinshort,hecannotbecomea socialperson."

Henotes,atpage253,that"TheWalbiriexplicitlyequatecircumcisionwithritualkilling"andatpage261describestheprocedureas follows:
"Abrotherseizesthenoviceandplaceshimfaceupwardonthetable,withhisfeettowardthefire.Anotherbrother straddleshimandpresseshispubesagainstthelad'sfacetosilenthiscries,whileathirdgripshislegs.abrotherholdsthe shaftoftheboy'spenis,inordertoprotect`theinsidebone'frominjuryoneofthecircumcisersstretchestheforeskin severalinches,andanothercutsitoffwithtwoorthreequickslices."

Subincision,althoughabandonedinanumberofcommunities,isperformedbytheWalbiriatage17andisdescribedbyMeggitatpage 265asfollows:
"Totheaccompanimentofloudchantingbythecompany,themandeftlyslicesopentheyouth'spenisfromthemeatustoa pointaboutaninchalongtheurethra."

Cawte, 107 inaremarkwhichseemsunacceptablyinsensitive,writesthat"Subincisionisanothermatterthisisgoingalittletoofarfor Europeantastesasubincisedmanmakesamessbysprayingratherthansquirtingintoiletsandurinals"(emphasisadded).Thatthis brutalfurthermutilationisdescribedmerelyas"goingalittletoofarforEuropeantastes"andthattheonlydisbenefitseeminglyisthatthe victimmakesamessduringurinationisatellingdemonstrationofthemindsettowardsgenitalmutilationasawholeandmale circumcisionandothermalegenitalmutilations.

8.Theoriginsofmodernnonritualcircumcision
Itisimportant,inconsideringthewholeissueofcircumcisionanditslegality,tohavefirmlyatthefrontofone'smindtheprimitivetribal originsandbarbarityoftheritualandtheabusefromitofthevictimdespiteattemptstosanitisetheritual,todivorceitfromitsoriginsin humansacrificeandtocloakitin`acceptably'religiousdemands.

8.1Masturbationcure
ItiscommonlyacceptedthatVictorianBritainwasdeeplytroubledbysexualmattersandthatthepaterfamiliaswasseenasanall powerfulfigure.Further,womenandchildrenwereseenasthepropertyoftheman:todowhatthemandeemedrightforhimselfand/or toservetheman'sdesiresandpurposes.ThetreatmentofwomenandchildreninVictorianBritainwasbarbarous,cruelandbeyondthe comprehensionofmodernsocietychildlabourandchildprostitutionwerecommonplace.Sexualhypocrisywasrife. Inparticular,theunwillingnesstofacesexualityinwomenwasseeninthedenial/refusaltoadmitthatwomenwerecapableoffeeling sexualpleasure(oratleastthatone'swifewasso`unrefined'sotofeel)ortoexperienceorgasmequally,thesexualpleasurefrom masturbationbyboyswasalsoseenasdeeplyunhealthy,uncleaninthemoralsense,andimpureitwasoftencalledthe`solitaryvice'. Masturbationwasseenasacauseofawidevarietyofillnessesfrommentalillhealth,epilepsy,alcoholismandahostofotherailments andifthatwererightthenitseemeddesirabletotakeanystepstocurbthis`vice'.Thus,inthemid1800sitwasthoughtthat circumcisionwouldhelpstopboysmasturbating. Whetheritwasthoughtthatthedeprivationofsensationandalsooftheskincomfortablytoerectinto,andmasturbatewith,wasthecure formasturbation,orthatthatitwasthatthemereactandintensepainofcircumcisionwouldbeasignofthe`inherentdangers'ofsex andsexualpleasure(certainlythedangersofsuchexpressionoutsidethesanctityofmarriage)isnotclear. ItseemsthatMoney,writingin1887in TreatmentofDiseaseinChildren ,consideredthatthepain,ongoingifpossible,was desirable:
"Whethermasturbationisacauseofepilepsyisdoubted.Buttherecanbenodoubtofitsinjuriouseffect.....Circumcision shouldalwaysbepractised.Itmaybenecessarytomakethegenitalareasosorebyblisteringfluidsthatpainresultsfrom attemptstorubthepart."

Probably,bothstrandsofthinkingwerepresentatthesametime.Whatdoesseemclearisthattheeffectofcircumcisionontheabilityto enjoysexualactivitieswasrecognisedbytheVictorians,asithadbeenbyMaimonides. TheVictorianswerewellawareoftheJewishcircumcision,(indeed,intheChristiancalendar,thereistheFeastoftheCircumcisionof Christ),aswellasMuslimcircumcisionandcircumcisioncarriedoutinotherpartsoftheworldsuchasAfricaandtheAustralian aboriginals.Clearly,circumcisiondidnotpreventthesemenfrombeingabletoprocreateanditwouldappearthatitwasbutasmallstep toconcludethatcircumcisionwouldhavenoharmfuleffectsifdoneonBritishboys.Thus,theyespousedanamputationwhichwhilst curbingsexualpleasurewouldnotpreventprocreationandwould,itwasthought,stopwhatwasseenasthedeeplydamaging`self abuse'ofmasturbationandwouldtherebypreventtheonsetofdreadfulillnesses. Thesamemasturbationphobiaalsodrovetheintroductionofroutineneonatalcircumcisionin19thcenturyUnitedStatesofAmerica(a countrywheresuchcircumcisionsweresome85%inthe1970sandwhich,althoughtheratesarenowdecliningespeciallyinthewestern states,stillaccountformorethan50%ofboys). AsFrederickHodges,themedicalhistorian,haswritten,involuntarycircumcisionwasintroducedandenforcedinAmericaasawayof surgicallydesensitizinganddenudingthepenisinordertomakemasturbationtheoreticallyimpossible.Thevastmajorityoforiginal circumcisionistswere,astheywereinVictorianBritain,Christianswhohadofcourseneverthemselves,beencircumcised.Theyknew exactlywhattheeffectsofcircumcisionwouldbe.Theycouldwellimaginethedestructioncircumcisionwouldcausetosexualsensation andfunctionwhenitwasforcedonboysandmenwhohadbeencaughtmasturbating.Adultswhohadbeenconvictedofmasturbation wereregularlyincarceratedinlunaticasylumsandsubjectedtocastration,circumcisionandelectricshock. ThemedicalhistoryofcircumcisionintheUnitedstatesisdiscussedbyDavidL.Gollaher108 whowrites:
"ThemedicalhistoryofcircumcisionintheUnitedStatesproperlybeginsin1870.Dr.LewisA.Sayrepublishedapaperin whichhesoughttoshowthatarangeofwellnighmiraculouscureswereeffectedbycircumcision."

OtherimportantUSdoctorswhopromotedcircumcisionasanantimasturbatoryprocedureinthe1870swereAbrahamJacobiand M.J.Moses.DrJacobi(18301919)wasthepresidentandfounderoftheAmericanPediatricSociety,thefirstChairmanoftheSection onDiseasesofChildrenoftheAmericanMedicalAssociation,PresidentoftheNewYorkStateMedicalSociety,PresidentoftheNew YorkAcademyofMedicine,andPresidentoftheAssociationofAmericanPhysicians.BothJacobiandMosesclaimedthatJewswere immunetomasturbationsolelybecausetheywerecircumcised.Theywerecitedasauthoritiesbymedicalwritersforthenextfew decades.BothclaimedthatnonJewswereespeciallypronetomasturbationandtothehorriblediseasesthatresultedfrommasturbation solelybecausetheyhadforeskins.Jacobiproducedmany"studies"toprovethis,andto"prove"thatthemaleforeskincausedepilepsy, paralysis,malnutrition,hysteria,andothernervousdisorders. 109

 In1871,Dr.Moseswrote 110 :
"AsanIsraelite,Idesiretoventilatethesubject,and,asaphysician,havechosenthemediumofamedicaljournal,thatI maynotbetrammelledinmyexpressions,asInecessarilywouldbewereIconfinedtothepagesofanordinarypaper...I refertomasturbationasoneoftheeffectsofalongprepucenotthatthisviceisentirelyabsentinthosewhohave undergonecircumcision,thoughIneversawaninstanceinaJewishchildofverytenderyears,exceptastheresultof associationwithchildrenwhosecoveredglanshavenaturallyimpelledthemtothehabit."

Itisquiteclearfromcontextthatthetitleword`Hygienic'had,intheUnitedStatesofthattimeaswithVictorianBritain,adifferent meaningthanitdoestoday.Atthistime,circumcisersusedwordssuchashygienetodenotemoralhygiene,notpersonalhygiene. Circumciserslikewiseusedthetermsanitarytodenotemoralpurity,andnotabsenceofgermsordirt.Bymanipulatingthemeaningof wordsinafashionpresagingthe"NewSpeak"ofOrwell'sclassic,1984,circumciserspathologizednormalfunctions:eroticsensitivity wasredefinedas"irritation."orgasmwasredefinedas"convulsions." JonathanHutchinson,whowasPresidentoftheRoyalCollegeofSurgeonsofEnglandin1889,wrotein1891apaperoncircumcision asapreventiveofmasturbation,inwhichhenotonlyadvocatedcircumcisionforthetreatmentandpreventionofthis"shamefulhabit", butalsoproposedthat

"ifpublicopinionpermittedtheiradoptionmeasuresmoreradicalthancircumcisionwouldbeatruekindness."

In1914,Dr.AbrahamWolbarst 111 wrote:

"Itisgenerallyacceptedthatirritationderivedfromatightprepucemaybefollowedbynervousphenomena,amongthese beingconvulsionsandoutbreaksresemblingepilepsy.Itisthereforenotatallimprobablethatinmanyinfantswhodiein convulsionstherealcauseofdeathisalongortightprepuce.InacasereportedbyA.H.BakerofElmira,N.Y.,repeated attacksofepileptiformconvulsionsoccurredinaboyaged5.Itwasfoundthattherewasanadherentprepucewithmarked adhesions.Afterthechildwascircumcisedtheconvulsionsceasedandhavenotsincerecurred...Wesafelyconcludethat circumcisionistoberegardedasapowerfulprophylacticagainstmasturbationandotherreflexneurosesthatresultfrom preputialirritation."

8.2`HygieneandPrevention'
Thatcircumcisionwasofnoeffectinpreventingmasturbationbecameselfevident:circumcisedboyshavethesameurgetomasturbate astheirintactbrothersandwilldoso,notwithstandingthatforthemitwillbe,aswithsexualintercourse,apaleshadowofthepleasure thatshouldhavebeentheirsbybirthright.Butthemotivationstocontinuetocircumciserequiredtheinventionbycircumcisersofavariety ofpseudomedical`rationales'forcontinuingtocircumcise:firstbyclaimsofcleanliness,thenthereduction/preventionofdiseasessuch ascancersofthecervixandpenistoclaimsthatcircumcisionwillreducetheincidenceofUTIs,AIDSandothersexuallytransmitted diseases.Thesefalseclaimshavebeendiscussedabovebuttheincreasinglydesperateeffortsbycircumciserstofindabenefitand/ora medicalrationalefortheirmutilationofothers,aseachclaimed`benefit'isrefuted,leadsonetoponderatthepsychopathologyofthese peopleinvolvedandcertainlytowonderattheireffortstoread/readwithanopenmindtherangeofmedicalliteraturewhichgivesthelie totheirclaims.

8.3Moderncircumcisionaneyewitnessaccount
Although,exceptforritualcircumcisions,neonatalcircumcisionshavebeenlargelyabandonedinBritain,inAmerica,whereneonatal circumcisionsarealucrativesourceofmedicalincomeandwherefromapeakofnearly90%ofallneonateboystoacurrentfigureof some59%,routineneonatalcircumcisionsarestill,intheteethofmedicalstudies,asocietalcommonplaceencouragedbythosedoctors whoprofitfromthefees(typically$200perneonatalcircumcision).MarilynFayreMilos,anAmericanRegisteredNurse,whose experiencesofwitnessingneonatalcircumcisionimpelledhertoabandonhernursingcareerandcourageouslytospeakoutagainstthis barbarity,haswrittenmovingly112 .Apartfromminordifferencesoftechnique(themoheldoesnotemployaprobebutusesasharpened fingernailtoripasunderandthentostripfullytheglanspreputialadhesionsanddoesnotuseaclamptocrushtheforeskinsoasto controlbleedingbeforeamputation)theresultismuchthesameasataBrisMilah.
"Westudentsfiledintothenewbornnurserytofindababystrappedspreadeagletoaplasticboardonacountertop acrosstheroom.hewasstrugglingagainsthisrestraintstugging,whimpering,andthencryinghelplessly.noonewas tendingtheinfant,butwhenIaskedmyinstructorifIcouldcomforthim,shesaid`Waituntilthedoctorgetshere'.I wonderedhowateacherofthehealingartscouldwatchsomeonesufferandnotofferassistance.Iwonderedaboutthe doctor'spowerwhichcouldintimidateothersfromfollowingprotectiveinstincts.Whenhedidarrive,Iimmediatelyasked thedoctorifIcouldhelpthebaby.hetoldmetoputmyfingerintothebaby'smouthIdid,andthebabysucked.Istoked hislittleheadandspokesoftlytohim.hebegantorelax,andwasmomentarilyquiet. "Thesilencewassoonbrokenbyapiercingscreamthebaby'sreactiontohavinghispenispinchedandcrushedasthe doctorattachedtheclamptohispenis.Theshriekintensifiedwhenthedoctorinsertedaninstrumentbetweentheforeskin andtheglans,tearingthetwostructuresapart.....Thebabystartedshakinghisheadbackandforththeonlypartofhis bodyfreetomoveasthedoctorusedanotherclamptocrushtheforeskinlengthwise,wherehethencut.Thismadethe openingoftheforeskinlargeenoughtoinsertacircumcisioninstrument,thedeviceusedtoprotecttheglansfrombeing severedduringthesurgery. "Thebabybegantogaspandchoke,breathlessfromhisshrill,continuousscreams.Howcouldanyonesaythat circumcisionispainlesswhenthesufferingissoobvious?Mybottomlipbegantoquiver,tearsfilledmyeyesandspilled over,Ifoundmyownsobsdifficulttocontain.Howmuchlongercouldthisgoon? "Duringthenextstageofsurgery,thedoctorcrushedtheforeskinagainstthecircumcisioninstrumentandfinally amputatedit.Thebabywaslimp,exhausted,spent. "Ihadnotbeenprepared,nothingcouldhavepreparedme.forthisexperience.Toseeapartofthisbaby'spenisbeingcut offwithoutananestheticwasdevastating.Butevenmoreshockingwasthedoctor'scomment,barelyaudibleseveral

octavesbelowthepiercingscreamsofthebaby:`There'snomedicalreasonfordoingthis.'Icouldn'tbelievemyownears, mykneesbecameweak,andIfeltsicktomystomach.Icouldn'tbelievethatmedicalprofessionals,dedicatedtohelpingand healing,couldinflictsuchunnecessarypainandanguishoninnocentbabies."

8.4SomequotesfromWarCries:It'saBoy
Intheautumn1995,Channel4TVtransmittedafilm,WarCries:It'saBoy,byVictorSchonfeld,whichdealtwithritualcircumcision. Somequotesfromthisfilmareilluminating: RabbiDavidSinger:
"Thelastbutone[circumcision]thatIdid,theparentsweretellingmethatbeforethecircumcisionthebabywasvery fractiousandwasalwayscryingatnightandveryunsettled,andthenightafterthebritwasdone,thebabyspentaquiet night,he'sstickingtoathree,threeandahalf,fourhourfeedingroutine,sotheywerequitedelighteditcouldbedone."

Jewishwomanonstreet:
"There'snopain.It'sababy,aweekold."

AnotherJewishwomenonstreet:
"I'vebeenatmanyandnotonechildhassuffered."

Dr.AdrianLloydThomas,Pediatrician(inresponsetobeingaskedaboutcircumcisionwithoutanesthesia):
"Youcanseethereaverydefiniteresponsefromthebabyassoontheforcepsareappliedtotheforeskin.Thebabyis holdinghisbreath,shivering.Infantshavinganoperationmayactuallyexperiencemorepainthanadultsdohavingthe sameprocedure,andthereasonforthisisthatthecontrolmechanisms,particularlyinthespinalcord,whicharehighly developedtodampdownandsuppresspaininamatureadultnervoussystem,arenotsowelldevelopedinthesmallbaby. So,thepainsignalstravelthroughuncontrolled,unsuppressed....Ithinkitwouldbeunwisetodrawthatconclusion[that thebabystoppedcryingbecausethepainwasover].I'dmoreprefertothinkthattheexperiencehadbeensooverwhelming thatthebabycan't...putupafightanymore....Mypersonalfeelingasapediatricanesthetististhatitisnotethicaltoperform circumcisionswithoutsomeformoftopicalanesthesia."

Narrator:
"...theBritishmedicalconsensusisthatnewborncircumcisionisnotmedicallywarranted,thatthebabyhasbeenmadeto giveupaprotectivecoveringoferogenoustissue,andthattheglansofhispenis,aninternalorganbiologically,willnowbe exposed."

Womanpediatricsurgeon:
"Someothercomplications...occurlater...whenchildrenhaverealizedthattheyhavebeencircumcised,theyfeel psychologicallythatsomethingisgrosslywrongwiththeirsexlife."

Man:
"Mypenis,insteadof...hangingstraightupanddownsothatthetopfacesforwardsandtheunderneathfacesback...the underneathwillfacetotherightor...willstartfacingforwardssoitdescribesasortofcorkscrewtwisttotheleft....Thereis aninterweavingofthephysicalmutilationwhichI'vehadtolivewithfornearly50yearsaswellastheawarenessthatIhave beendeprivedofoneoflife'sbasicpleasures."

Muslimman:
"Icanremember...blissfully...flowingalongasahappychildwhenonedaymyfather...tookmeovertothehairdresser....I wasthrustonthetableandcircumcised...abigshock...thepsychologicalpain...lastedon,thebetrayaloftrust....Ioften havenightmaresofapoundoffleshtakenoffalivehorse....Idon'tseeinanywaythatmycircumcisionhascontributedto myculturalidentityorracialidentity."

Africanmother:
"Hewastakentohospital...afewminuteslaterthey[toldus]thatthechildisdead."

Jewishwoman:
"I'veneverheardofanybodyinourfamilyorinourcircleofacquaintanceswho'severlostachildasaresultofbris...and it'sinconceivablethatitdidn'thappen.Andofcoursewhenyoustarttolookatitandaskforthereasonsforthatsilence, it'sobvious.Yousimplycan'tcoercesomebodyintodoingsomething...totheirchildrenif[they]knowthatthereistherisk thattheirchildmightdieorsufferinjury."

JamesHocksworth(athospitalwherehiselevendayoldson,circumcisedthreedaysbeforebyRabbiSinger,hadbeentakenbecause ofasevereinfectionofhiscircumcisionwound.[RabbiSingerdeniedhisprocedurecausedtheillness.]):
"...whenwebroughthiminheneededoxygensobadlythatthey...gavehimoxygenimmediatelyandthatbroughtbackthe colourinhim.Oncehe'dbeenputintheward...heturnedgreyishagain...lookedlikedeathwarmedupand...theyputhimin anintensivecareunit....Ihadthoughtitwas...aqualifieddoctorwhowasperformingthis.Ihadn'tbeenconsultedbyhimat all....Ibelieveheshouldhavehadmyconsent.I'mtheboy'sfatherandifyousawhim,youwouldnever,everdothis. Nobodycouldeverdothistotheirownchild.Hewasinsomuchpain.Hewasstrugglingtobreathe....There'snoneedtogo throughthatsuffering...hedoesn'tneedtohavehispeniscutattheendsothatit'srubbingaroundfordaysonendandhe's

inpainandscreaming...Ithinkit'sdisgraceful.Hecan'tspeak.Hedoesn'thavethevoicetosay`Idon'tlikethisandIdon't wantit'.Hedidn'thavethechoice.Hewaseightdaysoldandhegetsthrownonatableandhehastheendofhispeniscut off.Ithinkit'simmoralandIthinkit'sarrogantofthepeoplewhodoittopresumethattheyhavetherighttocutupother peopleforthesakeofreligion."

Jewishmother:
"I'maJewishmother.MysonMaxisfivemonthsoldandIrefusetohavehimcircumcised.[Itoldmymother,]"Iwoulddo anythingnottohurtyou,myparents,excepthurtmychild."

Dr.MajidKatme,President,IslamicMedicalAssoc.:
"Isshe,themotherorthefather,aretheyreallylisteningandsubmittingtotheteachingoftheirreligionoraretheyusing theirmindandquestioningthings?"

Dr.MorrisSifman,MedicalOfficer,TheInitiationSociety(Assoc.JewishCircumcisers):
"They[mohels]don'twantitfilmedbecause,frankly,theydistrustthemedia...weareupagainst,allthetime,thepossibility ofthiskindofthinghappeningwhichwoulddamagetheattitudeofsomeparentswhomightbeuncertainofwhattheywant todo....Ifitwouldbefoundthatcircumcisionispositivelyharmful,perhapswewouldthinkagain.ButIhavenodoubt I havenottheslightest,slightestdoubtthatthiswillneverhappen,becauseacommandmentgivenbyGodisagood commandment."

Dr.JennyGoodman,DoctorandPsychotherapist:
"Noneofusdoitformedicalreasons.Wedoitbecausewefearbeingcastoutfromthetribe.Butafterhavingdoneit,we comfortourselveswiththesemedicalmyths....Ifwecouldprogressfromsacrificethroughcastrationtocircumcision,then wecancontinuetoprogressallthewayawayfromanykindofphysicalinjury."

9.PsychologicalMechanisms.
Itishardnottowonderattheeffectofchildhoodcircumcisiononthevictimandatthedeepandhiddenmotivesdrivingthosewho wouldperpetuatethepracticeofcircumcisionforotherthanthetreatmentofadiseaseprocess.Thus,Ritter 113 writesaboutthepractice ofroutineneonatalcircumcisionintheUSAbydoctors,butwhosewordsseemapttodescribeallthosewhocircumcise:
"Theworstthingaboutcircumcisionisthatitproducescircumcisers.Thereisasegmentofphysicianswhohavethe psychiccompulsiontocircumcisesotheythemselvesdonotfeelgenitallyinferiorordifferent."

9.1ThePerpetrators
Inlookingatcircumcisionandthecallsforittocontinueintothe21stcentury,itisnecessarytoconsiderthemindsetofthosewho continuetoperformthismutilatingritual,andtoconsidertheextentthattheysufferfromsomeformofpsychosexualsicknessintheir needtomutilatethesexualorganofaboy. Woodmanseywroteinthe BritishMedicalJournal in1965:
"Somethingmustbedonetohelptheparentswhoshowsuchanirrationalneed....Consideraskingacolleaguewhosejob istohelppeoplewiththeiremotionalproblemstotrytodiscoverandalleviatetheparents'underlyingdifficulties,whichnot onlyimpelthemtodemandthisoperationbutwhich,ifnotadequatelydealtwith,mayperpetuatedifficultiesintheparent childrelationshipwiththeriskoflaterpsychiatricillnessinthechild...Thisimportantkindofworkcanandshouldbe undertakenbythemedicalsocialworkersinageneralorchildren'shospital,providedthattheyreceivesuitablepsychiatric 114 support." "ButthemohelwithwhomIhadworkedcountlesstimessuddenlyhandedmetheknife.Hepointedtomysquirmingson, whosehandsandlegsweretiedtotheboard.Theforeskinhadbeenpulledupovertheglansofthepenisandwasnow protrudingthroughanarrowslitofthesmall,stainlesssteelclamp....'It'sthegreatesthonorafathercanhave,'he added....Thereisnogreaterprimalangerthanthatcausedbyseeinganothermaleincarnalcontactwithyourwife,inthis casethephysicalintimacyofmotherandson.Andthereisnogreaterprimalenvythanthatcausedbylookingdownatthe personwhowasbroughtintotheworldspecificallytobeyoursurvivor....Thebreastprovides,buttheknifeprotects.It channelsthefather'snaturalangerandjealousyintoonecontrolledcut.Hetakesoffonesmallpartinordertopreserve andlovethewhole....Nofathershouldbedeniedthisexperience,evenvicariously,ofinflictinguponhischildaritualized blowsointenseastomakehimbothshakeandrecoil."[BirthRite,byJoshuaJ.Hammerman, TheNewYorkTimes Magazine ,March13,1994.]

IleneGelbaum,anAmericanmidwifewithcertificationstopermithertoperformcircumcisionsstated:"itreallyisatouching,moving, spinetinglingthingthatIparticipateinasaservicetothecommunity" 115 onecanbutspeculatewhatFreudmighthavesaidabouther motivationfor,andthe`spinetingling'devotionto,suchastask. Thewellknownpsychologicaldefencemechanismsofdenial,ofrationalisationandofcognitivedissonancewouldappeartobeatwork inthecontinuationofthebehaviourpatternsofcircumcisers.`Denial'istheprocesswherebyanindividualdistortshis/herperceptionof aneventsoastoavoidhavingtothinkaboutitthus,despitetheclearmedicalevidenceofthepainofcircumcision,manystilldenythat thecircumcisedinfanthaspainoranyharmfulsequelaefrom,andfollowingasaresultof,thecircumcision.Alsoofnoteisevidencethat asurprisingnumberofAmericanmenwereunaware,ataconsciouslevel,ofbeingcircumcisedorthattheirpeniscarriedascarfromthe amputation.Lilienfeld116 reportedthatin195834.4%wereunawareoftheircircumcisionstatusafigurewhichaccordedwiththatfound bySchlossberger 117 . `Cognitivedissonance'istheprocesswherebyindividualsseektomaintainharmonybetweenoramongvariousaspectsofanissueatthe cognitivelevel:Awakenings 118 observesthatcircumcisedmenwhohavecomplainedtodoctorsaboutbeingcircumcised,have

experiencedangerfromthedoctorstowhomtheyhavespoken. AsAwakenings observes:"Whyanger?"GiventheveryhighrateofcircumcisionintheUSA,theycomment:"Isitperhapsthatadoctor cannotallowhimselftobesympathetictoamalewhosaysthathehasbeenharmedbyanactwhichthedoctor'sownprofessionhas performedfortheman'sowngood?Suchdissonancemaywellcauseadoctortolashoutinanger." Thismightwellaccountfortheseeminginabilityofsomedoctorstolistentotheevidencefromtheirownpeerswhichunderminestheir existingprejudicesandmindset:thusanarticleinthe NewYorkTimes ,119 dealingwithcircumcision,quotesDr.TerryHejsle,director ofpediatricurologyatColumbiaCollegeofPhysiciansandSurgeons,onthespecialisedpleasurereceptorsoftheprepuce(asshownby TayloretalinTheprepuce:specializedmucosaofthepenisanditslosstocircumcisionop.cit)"Howdotheyknowthat?"asksHejsle.
"Theneuroreceptorsareintheglans,notinthehood."

ThisremarksaysmuchaboutDr.Hejsleandnothingaboutthestructureandfunctionoftheprepuceandthemechanismsofmalesexual pleasure. TheNewYorkTimes articlealsoquotesfromaDr.YehudaNir(apsychoanalystwhowasformerlyheadofchildpsychiatryat MemorialSloanKetteringHospitalinNewYork)that

"hehasn'tobservedcircumcisiontrauma.`Theonlythingmenareconcernedaboutwithregardtothepenisisitssize.'"

Again,thatsaysmoreaboutDrNir,hisattitudesandhismentalprocessesthanabouttherealityoftheharmofcircumcisionevenonhis facilelevel,itisselfevidentthatmenoftenhaveconcernsabouttheirpenisanditsfunctioningotherthanthatofsimplesize. AsAwakenings (op.cit.atn106)remarks:

"Withenoughcopingmechanismsathis/herdisposal,thetypicalcircumcisedsurvivorcanbecomfortablyinsulatedfrom thepainfulfactsandfeelingsaboutgenitalmutilation.Afterexaminationofthesamecopingmechanismsofthesurrounding culture,onefindsthatthemajorityofthoseinsocietiesthatpracticechildhoodgenitalmutilationremainblindtothis maltreatmentofchildren....DrErvinStaub,psychologyprofessorattheUniversityofMassachusetts,whohasstudiedand writtenextensivelyonthebehaviorofbystanders,states:`Wedownplayourownreactionsandconvinceourselvesthat whatweinitiallythoughtwasabusivebehaviorreallywasn'tthatbadafterall'.Hecallsthisextremelycommonphenomenon `pluralisticignorance'."

Theperson,behephysicianorotherwise,whoagreestocircumciseanotheriscomplyingwitharequesttoinflictpainonthatother humanbeing.Wheretheprocedureisrequiredbymedicalnecessity,thenitwill(oroughttobe)doneunderanaesthesiaandthedisease justifiestheresultingpainandloss.Whereitisnotforgenuinetherapeuticreasons,thenoneisremindedofthenoteablestudiesby ProfessorStanleyMilgramatYaleUniversity120 toseehowfarordinarypeoplewouldbepreparedtogoinobeyingacommandtoinflict painonanotherperson.Mostsubjectsobeyedthecommandtoinflictelectricalshocks(toaconfederatewhounbeknownsttothe subject,inreality,receivednoshock)toandbeyondalevelbelievedbythesubjecttorepresentdangertolife.Further,Milgramfound thatasubjectcouldbeinducedthroughgrouppressuretoinflictgreaterharmonthevictimthanthesubjectdidwhenheorshewere alone.

9.2TheVictims
Ithas,however,tobeadmittedthatthereisapaucityofstudiesofthepsychologicaleffectsofmalecircumcisiononthevictim.Perhaps thisisdueinlargeparttoanunwillingnessbydoctorswhoarethemselvescircumcisedand/orwhohavegrownupandreceivedtheir medicaleducationinasociety,suchasAmerica,whereroutineneonatalcircumcisionhasbeencommon,toacceptthepossibilityof damagefromtheprocedureandthustocarryoutproperstudies.DrNir'sstancewouldlendweighttothatstanceandtheprocessesof `denial'and/or`cognitivedissonance'operateforallcaughtupinwhatevercapacityinthismutilation. Suchworkasseemstoexistisrelatedtothemoregeneraleffectofchildhoodexperiencesonthepersonality.Buttherehasbeensome workdone. Canseverwrites121 :
"Summary.Inordertoevaluatethepsychologicaleffectsofcircumcision,asmallstudywasarrangedinwhichtwelve children,fromaverageandlowsocioeconomiclevel,weregivenGoodenoughandDAMtest,CAT,Rorschachandtwosets ofstories,priortotheoperationandfollowingit.Theresultsofthetestsshowedthatcircumcision,performedaroundthe phallicstageisperceivedbythechildasanactofaggressionandcastration.Ithasdetrimentaleffectsonthechild's functioningandadaptation,particularlyonhisegostrength.Byweakeningthecontrollinganddefensivemechanismsof theego,andinitiatingregression,itloosensthepreviouslyhiddenfears,anxieties,andinstinctualimpulses,andrendersa feelingofrealitytothem.Whatisexpressedfollowingtheoperationisprimitive,archaicandunsocializedincharacter.Asa defensivecontrolandprotectionagainstthesurgeoftheinstinctualforcescomingfromwithinandthethreatscomingfrom outside,theegoofthechildseekssafetyintotalwithdrawal,thisisolatesandinsulatesitselffromdisturbingstimuli.The resultsofthestudyraisedsomequestionsconcerningcertainpsychoanalyticformulations,forwhichfurtherresearchwas suggested."

Thedevelopmentalneuropsychologist,Prescottremarks 122 :
"Thereisawellestablishedbodyofscientificdatathatdocumentstheroleofsensorystimulationanddeprivationupon braindevelopmentandemotional,social,psychologicalandmentaldevelopment.Fromtheperspectiveofthe developmentalneuropsychologicalsciences,therecanbelittlequestionthattheextraordinarypainexperiencedbynew borns,childrenandadolescentswhoaresubjectedtoritualgenitalmutilationshasaprofoundeffectuponthebrainand laterbehaviors".Hecontinuesthatthispain"limitsandqualifiesallsubsequentexperiencesofpleasurewhichare experienceduponabackgroundofgenitalpainthatisnowdeeplyburiedinthesubconscious/unconsciousbrain".

 PrescottisalsoquotedintheNewYorkTimesarticleof19May1996:123
"You'renowencodingthatprimitive,immature,developingbrainwithpainwhenitwasdesignedtobeencodedwith pleasure.Thisisoneofthebeginningstagesofestablishingthesadomasochisticpersonality."

Sotoo,AnandandHickey[op.cit.atn20]:
"Inthelongterm,painfulexperiencesinneonatescouldpossiblyleadtopsychologicalsequelae".

ThisviewisechoedbyDr.RimaLaibow: 124
"Whenachildissubjectedtooverwhelmingpain,heconceptulisesmotherasbothparticipatoryandresponsible regardlessofmother'sintent.When,infact,motheristrulycomplicit,asingivingpermissionforunanesthetisedsurgery (i.e.circumcision)theperceptionoftheinfantofherculpabilityandwillingnesstohavehimharmedisindeliblyemplaced. Theconsequencesforimpairedbondingaresignificant". "Neonatalbondingaffectseverymaleinfant,whilepenilepathologyaffectsfew.":R.Dozor.
125

"Circumcisionperformedintheneonatalperiodisassociatedwithmarkedbehaviouralchangesthatmaylastupto24hours. Alliedtothisisachangeinsleeppatternwithprolongednon rapideyemovementsleep.Thischangehasbeeninterpreted asconsistentwithatheoryofconservationwithdrawaltostressfulstimulation.":Williams&Kapila(op.cit.atn32). "Babieswhohavebeensubjectedtopainmayhavedifficultyquietingthemselves.Followingcircumcision,thenormal progressionofsleepcyclesisreversedwithimmediateandprolongedescapeintonon REMsleep.Aftercircumcision, babieswithdraw,changetheirsocialinteractionswiththeirmothers,andmodifytheirmotorbehaviour.":D.B. 126 Chamberlain .

TheAmericanPsychiatricAssociation 127 hasthefollowing:

"309.89PosttraumaticStressDisorder[`PTSD' "Theessentialfeatureofthisdisorderisthedevelopmentofcharacteristicsymptomsfollowingapsychologically distressingeventthatisoutsidetherangeofusualhumanexperience(i.e.,outsidetherangeofsuchcommonexperienceas simplebereavement,chronicillness,businesslosses,andmaritalconflict).Thestressorproducingthissyndromewouldbe markedlystressingtoalmostanyone,andisusuallyexperiencedwithintensefear,terrorandhelplessness.The characteristicsymptomsinvolvereexperiencingthetraumaticevent,avoidanceofstimuliassociatedwiththeeventor numbingofgeneralresponsiveness,andincreasedarousal."

Thetrauma,bothphysicalandmental,ofnontherapeutic,butespeciallyneonatal,circumcisionwouldsuggestthatvictimsof circumcisionmightappropriatelybefollowedupforsignsofPSTDandotherpsychologicalsequelae.DrGoldman,apsychologist,ina timelyandthoughtfulbookdetailingthepsychologicaldamageofcircumcision,concludesthatthereisacausallinkbetweencircumcision andPTSD 128 DrFrederickLeboyerhassaid: 129 "Nooneisawareofthedeepimplicationsandlifelastingeffect[ofcircumcision].Thetortureis experiencedinastateoftotalhelplessnesswhichmakesitevenmorefrighteningandunbearable."Further,hewrites:"Allthattakes placeinthefirstdaysoflifeontheemotionallevelshapesthepatternofallfuturereactions.Howcouldabeingaggressedinthisway, whiletotallyhelpless,developintoarelaxed,trustingperson?'

10.FemaleCircumcision
FemalecircumcisionhasbeenspecificallymadeanoffenceinBritainbytheProhibitionofFemaleCircumcisionAct1985.Section1 provides:
"Subjecttosection2below,itshallbeanoffenceforanyperson (a)toexcise,infibulateorotherwisemutilatethewholeoranypartofthelabiamajoraorlabiaminoraorclitoris".

Insection2,afterexemptingfromtheambitofsection1operationsrequiredforthephysicalormentalhealthofthegirl,theActin section2(2)provides:
"(2)Indeterminingforthepurposesofthissectionwhetheranoperationisnecessaryforthementalhealthofaperson,no accountshallbetakenoftheeffectonthatpersonofanybeliefonthepartofthatoranyotherpersonthattheoperationis requiredasamatterofcustomorritual."

Whilstsuchlegislationmightnot,strictly,havebeennecessary,inviewofthelegislationinrespectofoffencesagainstthepersonand childprotectionlegislation,itintroducesaspecificprohibitionthatanynontherapeuticinterferencewiththefemalegenitalswasan offence,notwithstandingcultural/religiouspressures. Insomerespects(thatis,intheextentoftheanatomymutilated),femalecircumcisiondiffersfrommalecircumcision:althoughitcantake theformoftheremovalonlyoftheclitoralhood(theanalogueofthemaleprepuce),ittypicallyinvolvesmoreradicalexcisionsuchas amputationoftheclitoris,excisionofthelabiaandinfibulation.Whatitshareswithitsmalecounterpartisthealterationofthegenitalsand aresultingdysfunction. Whatisinstructiveistoexaminecommentsandrationalisationsmadetojustifyfemalecircumcision,quotedbyHannyLightfootKlein130 again,thosecommentsfindechoinremarksmadebycircumcisedmen,andthosewhowouldcontinuethepracticeofnontherapeutic

malecircumcision,tothepointthatallthatisrequiredistochangethegenderintheremarks:
"Withtheolderwomanthereisoftentheelementof:`itwasdonetome,whyshoulditnotbedonetotheyounggirls?' They(parents)donotwanthertosufferthestigmaofbeingdifferentfromothergirls.Shegoesthroughastageof reappraisalofthesituation,andcomestoacceptthatwhathasbeendonetoherisinherbestinterest". "Ofcourse,noneofusishappyaboutit,butwecanlivewithit,aslongastherearenoseriousmedicalcomplications." "Sheclaimsthattherewasnopain.Theonlypainsherecallswasatattemptingtopassurineaftertheoperation.Shesays shehashad`noproblemsatall' becauseofhercircumcision,andisveryhappyaboutit.Shefeelsthatcircumcisionisagoodpractice". "Shesaysthatshethinkspharaoniccircumcisionisagoodpractice,andfeelsshehaslostnothingbyherown circumcision".

Equallyrevealingareremarks,inatabularform,onfemaleandmalecircumcision,alsobyHannyLightfootKlein131

FemaleCircumcision "Shelosesonlyalittlepieceoftheclitoris,justthepart thatprotrudes.Thegirldoesnotmissit.Shecanstillfeel, afterall.Thereishardlyanypain.Women'spain thresholdsaresomuchhigherthanmen's." "Thepartsthatarecutawayaredisgustingandhideous tolookat.Itisdoneforthebeautyofthesuture." "Femalecircumcisionprotectsthehealthofawoman. Infibulationpreventstheuterusfromfallingout.Itkeeps hersmellingsosweetthatherhusbandwillbepleased.If itisnotdone,shewillstinkandgetwormsinhervagina. " "Anuncircumcisedvulvaisuncleanandonlythelowest prostitutewouldleaveherdaughteruncircumcised.No manwoulddreamofmarryinganuncleanwoman.He wouldbelaughedatbyeveryone." "Leavingagirluncircumcisedendangersbothher husbandandherbaby.Ifthebaby'sheadtouchesthe uncutclitorisduringbirth,thebabywillbeborn hydrocephalic.Themilkofthemotherwillbecome poisonous.Ifaman'spenistouchesawoman'sclitorishe willbecomeimpotent." "Acircumcisedwomanissexuallymorepleasingtoher husband.Thetightersheissewn,themorepleasurehe has." "Allthewomenintheworldarecircumcised.Itis somethingthatmustbedone.Ifthereispain,thenthatis partofawoman'slotinlife." "Doctorsdoit,soitmustbeagoodthing." Sudanesegrandmother:"Insomecountriestheyonlycut outtheclitoris,butherewedoitproperly.Wescrape ourgirlsclean.Ifitisproperlydone,nothingisleft,other thanascar.Everythinghastobecutaway." 35yearoldSudanesewoman:"Yes,Ihavesuffered fromchronicpelvicinfectionsandterriblepainforyears now.Yousaythatallifthisistheresultofmy circumcision?ButIwascircumcisedover30yearsago! HowcansomethingthatwasdoneformewhenIwas fouryearsoldhaveanythingtodowithmyhealthnow?"

MaleCircumcision

"It'sonlyalittlepieceofskin.Thebabydoesnotfeelanypainbecause hisnervoussystemisnotdevelopedyet

"Anuncircumcisedpenisisarealturnoff.It'sdisgusting.Itlookslike thepenisofananimal." "Anuncircumcisedpeniscausesurinaryinfectionsandpenilecancer.It generatessmegmaandsmegmastinks.Acircumcisedpenisismore hygienicandoralsexwithanuncircumcisedpenisisdisgustingto women."

"Anuncircumcisedpenisisdirtyandonlythelowestclassofpeople withnoconceptofhygieneleavetheirboysuncircumcised."

"Menhaveanobligationtotheirwivestogiveuptheirforeskin.An uncircumcisedpeniswillcausecervicalcancerinwomen.Italso spreadsdisease."

"Circumcisedmenmakebetterloversbecausetheyhavemorestaying powerthanuncircumcisedmen."

"Meninallofthe`civilized'worldarecircumcised."

"Doctorsdoit,soitmustbeagoodthing." Myownfather,aphysician,speakingofritualcircumcisioninflicted uponmyson:"ItisagoodthingthatIwasheretopreside.Hehad quitealongforeskin.Imadesurethatwegavehimagood,tight circumcision." 35yearsoldAmericanmale:"Ihavelostnearlyallinterestinsex.You mightsaythatI'mbecomingimpotent.Idon'tseemtohavemuch sensationinmypenisanymore,anditisbecomingmoreandmore difficultformetoreachorgasm.Yousaythatthisistheresultofmy circumcision?Thatdoesn'tmakeanysense.Iwascircumcised35 yearsago,whenIwasalittlebaby.Howcanthataffectmeinanyway now?"

WhilsttheActmaynothaveentirelyeliminatedfemalecircumcisionfromBritain,ithasdepriveditofanyshredofacceptabilityinthe populationasawhole.Butinsodoing,ithasdoneagravedisservicetoboys,bypermittingadistinctiontobesoughtbetweenitandits malecounterpart(withthesuggestionthatinthemalethepracticeis,medicalevidencetothecontrarynotwithstanding,somehow acceptableinawaythatfemalecircumcisionisnownotsoregarded).TheActdoeshowevergiveananswertothosewhowouldclaim, asitwasclaimedforfemalecircumcision,thatmalecircumcisionissoculturallyembeddedthatabanwouldbeineffectiveandignored eveniftheActhasnotwhollyeliminatedfemalecircumcisioninthiscountry,ithasprovidedasignthatsuchpracticesarenolongertobe toleratedinamodernandcivilisedsociety.

11.CircumcisionandtheCommonLaw
Inparagraph9.1oftheConsultationPaper,theCommissionsays:
"Theleadingcasesreferonlytotattooing,earpiercingandritualcircumcisionasexceptionstothegeneralrule.....and becausethelawisclear,statutehasintroducedsomecontrolsdesignedtoensurethatmostofthesepracticesarecarried outsafelyandhygienically."

Thisisawhollymisleadingstatement:theonlyleadingcasewhichreferstoritualcircumcisionisLordTempleman's,arguablyobiter, remarkinBrown .132 Adesayna canhardlybedescribedasa`leadingcase(anditsreferencetoritualcircumcisionisclearlyobiter).The lawappearstohaveintroducednocontrolsinrespectoftheperformanceofritualcircumcision,letaloneanytocontrolthesafetyand hygieneoftheprocedure. TheCommission'sapparentreliance,foritspropositionthatritualcircumcisionislawfulatcommonlaw,onthecasesofConey ,133 Donovan ,134 Adesanya ,135 AttorneyGeneral'sReference (No6of80) 136 and Brown (op.cit.atn147)seemsunconvincing. Coney , Donovan andAG'sReference (No6of80)areallsilentastomalecircumcisionandsimplyrefertotheexistenceofcertainexceptions tothegeneralprohibitionontheconsensualinflictionofbodilyinjuryitissubmittedthat,ontheirown,theycannotbesaidtocarry forwardtheCommission'spropositionastothelawfulnessofritualcircumcision. InAdesayna ,acaseattheCentralCriminalCourt,JudgeKingHamiltonQCisreportedashavingsaidthatthepotentialforserious injury,aspartoftheritualscarificationofthecheeksoftwoboysbytheirmother,wasgreatbecauseofthedangerthattheslightest moveoftheheadmightleadtoinjurytotheeye,indistinction,heconsidered,fromthe`acceptedpracticesofearpiercingandritual circumcision'.Thattheseremarksareillconsideredisclear,sincethereisanobviousdifferencebetweenpiercinganearlobeand amputatingaprepuceandevenin1974therewereenoughindicationsinthemedicalliteratureoftheharmfromneonatalcircumcision.If theriskofseriousinjurywereindeedproperlytobethecriterion,thentherisksofcircumcisionoughttohavebeenconsidered,since thesecanextendtolossofallorpartofthepenis,andevendeath.Onehastodoubttheextentthatargumentwasadducedinrespectof circumcisionandthusconsiderwhethertheremark,whichcertainlyseemsobiter,wasalsoperincuriam.Indeed,thereisanargument that,unattractiveastheritualscarificationofthebodyofachildmightappear(asitclearlydidsoappeartoJudgeKingHamiltonQC),it isinessencefarlessunacceptablethanritualcircumcision:unlikecircumcision,itamputatesnofleshandcausesnolossoffunction. WhilstLordTempleman,inBrown ,doeslistritualcircumcisionasoneofthelawfulinflictionsofbodilyharm,heistheonlyonetodoso althoughmalecircumcisionwastouchedoninargumentbyCounselforsomeoftheAppellants,thereportdoesnotsuggestthattheissue ofritualmalecircumcisionwasfullyorproperlyarguedbeforetheHouseandfurtheritseemsappropriatetoregardthelistingofan numberofactivitieswhichmightbesaidtobelawfulasunnecessaryforthemajorityviewonthequestioninthecertificate,andthus obiter.Thequestionconcernedtheissueofconsentasadefencetochargesarisingoutofsadomasochisticinjuriesand,asallwere agreed,whetherthoseinjuriesarisingfromthattypeofbehaviourwere,orwereasamatterofpolicy,toberegardedasbeingwithinthe permittedexceptions. Therehasbeenasurprisingpaucityofthoughtfulanalysisofthepracticeofmalecircumcisionbyacademiclegalwriters:suchmentionas thereistendstothebriefanddogmatic,whichismoreoftenthannotbasedonexpressorimplicitviewsofthephysicaleffects. Typicalofthe`briefanddogmatic'schoolofunsubstantiatedassertionisGlanvilleWilliams.In ConsentandPublicPolicy 137 hemakes theproperobjectiontothepassagein Rv.Donovan :
"Ifanactiscriminalinthesenseofbeinginitselfacriminalact,itisplainthatitcannotberenderedlawfulbecausethe persontowhomdetrimentisdoneconsentstoit.Nopersoncanlicenseanothertocommitacrime.Sofarasthecriminallaw isconcerned,therefore,wheretheactchargedisinitselfunlawful,itcanneverbenecessarytoproveabsenceofconsent onthepartofthepersonwrongedinordertoobtaintheconvictionofthewrongdoer.Thereare,however,manyactsin themselvesharmlessandlawfulwhichbecomeunlawfulonlyiftheyaredonewithouttheconsentofthepersonaffected."

GlanvilleWilliamsrightlysays:
"Thispassageisopentotheobviousobjectionthatitisnothingmorethanatautology....TheCourtthenproceededtosay that,`asageneralrule...itisunlawfultobeatanotherperson.....wheretheinflictionofbodilyharmisaprobable consequence'.Forthispropositionnoauthoritywasoffered...that[theissuebeforethecourt]wasnotwelldecidedmerely byanunsupportedassertionthattheactwasunlawful."

Onecanonlyagreewithhiscomments.Itisthusregrettablethatinthenextpassage,dealingwithsurgicaloperations,hefallsintothe verysametrapoftheunsupportedassertionthathepreviouslycastigated:
"Whatistobesaidofsuchoperationsasritualcircumcision,orcosmeticskingrafting?Theycauseatleasttemporarypain anddiscomfort,andtheyarenotnecessaryforreasonsofhealth.Itwouldbeobviouslyabsurdtoconcludethattheyare illegal"(emphasisadded).

Evengrantingthatheappearedtobeinconsiderableignoranceofthemedicalfactswhichwereavailableevenin1962astotherisks anddamageofmalecircumcision,andunawareofthepotentialhealthbenefitsoftherapeuticcosmeticsurgery,thereisnothingwhich supportshisconclusion,farlessmakingit`obviouslyabsurd'toquestionthelegalityofrituallycircumcisinganunconsentingbaby.The bestthathecanofferisthat"CircumcisionofJewishinfantsmightbeupheldongroundsofreligioustoleration":note,however,the cautious`might'whichsitsoddlywithhispreviousboldandunsupportedassertion.Further,GlanvilleWilliams,asdoestheLaw Commission,failstodrawthenecessaryandproperdistinctionsbetweenactswherethevictimconsentsforhimself,andthosewhere(as incircumcision)theassaultisassentedtobyapersonotherthanthevictimparticularlywherethereisnotemporalbenefitand considerableharmnor(thoughhereisnottheplacetoexaminecosmeticsurgery)doesheortheCommissionconsiderthedistinction betweencosmeticsurgery(atleastonachildasopposedtoanadult)forthecorrectionofsomedefectormalfunctionofbirthand/orthe alleviationoftheeffectsofinjuryorprevioustreatmentandtheablation/amputationoffunctionalfleshfromahealthychild. AmorepopulistanalysisistobefoundinBrazier 138 thismanagestocombineignoranceofthemedicalfactsandliteraturewithscant thoughttothelegalissues:
"Medicalopiniononmalecircumcisionisdivided.Untilrecentlymanydoctorsregardeditasrarelymedicallyindicated. Nowitseemscircumcisionprovidessomeprotectionagainstvenerealdisease,atanyrateforthecircumcisedman'spartner! Malecircumcisionisamatterofmedicaldebate.ForJewishandMuslimparentsitisanarticleoffaith.Thechildsuffers momentarypain.Althoughmedicalopinionmaynotnecessarilyregarditaspositivelybeneficial,itisinnowaymedically harmfulifproperlyperformed.Thecommunityasawholeregardsitasadecisionfortheinfant'sparents."

Since,ashasalreadybeendemonstrated,thebenefitshavebeenshownbymedicalstudiesnottoexist(evenignoringthatmedical opinionusedtobelievethattherewerebenefitsbutdoesnotnowconsiderthattobesoevenignoringtheobviousconflictinherremark that`circumcisionprovidessomeprotectionagainstvenerealdisease'with`medicalopinionmaynotnecessarilyregarditaspositively beneficial)andgiventheerrorofherassertion,againasmedicallydemonstrated,astothelackofharm,hercommentsareunworthyof seriousattention. MrSebastianPoultercomesclosesttoaproperanalysisofmalecircumcisioninacademicwriting,albeitthathiswritingisflawedbya misunderstandingoftheeffectofthemedicalstudiesonpain,risksandinevitablelossesanddamage.Hewrites 139 thattattooingand scarificationarenotlegal,citingforscarificationAdesanya andmakingforbothpracticesthepointthatthechildmightcometoregret thepermanentbodyalteration(andtheotherreasonsfortheenactmentoftheTattooingofMinorsAct1969).Onpolicyconsiderations heobservesthattheremightbetwoobjectionsraised:firstthat"theymayoccasionallybedangerouswhenperformedbyanunqualified person,possiblyresultinginseriousinjury...orleadingtoaninfection.Thesecondisthatwherethemarksaredesignedtobepermanent, theymaylatercometoberesentedbythechildwhenhehasgrownup.....andiftheiroriginalpurposelaterseemstohimtobe misguidedorirrelevant."Indeedhequotes,withwhatseemsapproval,theremarkinAdesanyathat"Youandotherswhocometothis countrymustrealisethatourlawsmustbeobeyed....[I]tcannotbestressedtoostronglythatanyfurtheroffences...inpursuanceoftribal traditionsinNigeriaorotherpartsofAfrica....canonlyresultinprosecution......Othershavebeenwarned". Neitherthejudgeinthoseremarks,norindeedPoulter,seemtohaverealisedfullytheincongruityofcondemnationoftribaltraditionsof `NigeriaorotherpartsofAfrica'whilstnotcondemningthe,essentiallytribal,traditionsofJudaismandIslam. Inrelationtomalecircumcision,Poulterwrites,atparagraph6.26,
"Inthiscountrythecircumcisionofyoungboyshasbeenalegitimateandacceptedsurgicaloperation[emphasisadded]for verymanyyears.Asaroutineprocedure(asopposedtoareligiousrite)ithasadmittedlydeclinedconsiderablyin popularityduringthecourseofthiscentury,fromaroundathirdofallboysinthe1930stoabout6%today.Thecurrent viewofthemedicalprofessionherenowgenerallyseemstobethatthereisnorationaljustificationformasscircumcision sincetheriskstohealthandhygieneofnotbeingcircumcisedareminimal....InEnglandritualcircumcisionofmaleinfantsis usuallyperformedinthecaseofJewsbymohlim,whoareprimarilyreligiousfunctionariesalbeithighlytrained.....Provided theproperstandardsofcareareadheredtothereisnormallynodangerofharmtotheinfant,apartfromashortperiodof painincaseswherenoanaestheticisused.Complicationscanobviouslyariseoccasionallybothfromtheuseofan anaestheticonaveryyoungchildandfromintenseandprolongedcryingfollowedbyvomitingandlossofbreathingwhere itisnotused.However,longtermharmfulconsequencesappeartobeminimalandtherearegreaterhazardsinperforming theoperationonadultmen.Fewcriticismsofthecurrentsituationareevermade."

Onceagain,removethemedicalmisunderstandings(forwhichseesections2and3above)andthepracticebecomesstarklyabusivein itspain,whichpacePoulterandothers,isnotofashortperiodandnotwithoutlongtermconsequences,initsrisksasshownbymedical studiesandinthosestudies'demonstrationofdeep,inevitableandirreparablelossanddysfunction.Itisalsoofinterestthatheseesthe practiceofmalecircumcisionasasurgical(i.e.amedical)procedureandpresumablyitsexemptionfromthegeneralprohibitionon inflictionofharmasprincipallyflowingfromthat. Indeed,inparagraph6.27,Poulterrightlyobserves,asagroundforopposingfemalecircumcision,that"amajorconsequenceofthe operationisthatthesexualenjoymentofthewomanconcernedisinevitablygravelyimpairedinanirreversiblemanner"thesamegoes forcircumcisedmales,evenwhentheprocessofdenialbythecircumcisedandthecircumciserswillnotallowthemtofacethat demonstratedfact. Poultercontinuesinparagraph6.28:
"ThebasicrighttobodilyintegritywhicheveryonepossessesundertheEnglishcommonlawmeansthatanyinterference withthisrightamountstoanassaultorbattery....Thequestionraisedincasesofcircumcision,excisionorinfibulationis whethertheoperationcanbejustifiedasconstitutinglawfulasopposedtounlawfulinterferencewiththisright...."

Pausingthere,itisnoteworthythatPoultergroupsmalecircumcisionwiththeformsoffemalegenitalmutilation. Hecontinues:

"Althoughtherearenoprecedentsinthisfieldtorelyontherewouldappeartobethreepossiblegroundsuponwhicha defenceoflawfulnessmightsucceedatcommonlaw.Thefirstisthattheprocedureistherapeutic.Ifthiscanbeestablished aparentcanvalidlyconsenttoitonbehalfofachildwhoistooyoungtounderstandwhatisbeingdone.Itwouldappear unlikelythatthislineofdefencecouldgenerallysucceedotherthanincomparativelyrareinstancesofphysicaldefector abnormality.Second,althoughthematterisnotentirelyfreefromdoubt,itseemsthataparentmayequallyvalidlyauthorise anontherapeuticoperation,provideditisnotactivelyagainsthischild'sinterests.Thiswouldappeartohavebeenthe basisuponwhichthevastmajorityofmaleinfantshavebeencircumcisedinthiscountrywithimpunityfromtime immemorial.Thereisnoneedunderthisheadingfortheparenttoestablishthattheoperationispositivelybeneficialforthe child,merelythathewasactingreasonablyinauthorisingit.Third,ithasbeententativelysuggestedthataparentmayeven authorisesomethingthatisagainsthischild'sinterestsifitiscompensatedbysufficientadvantagetoothersandisnot seriouslydetrimentaltothechild.Thisexceptionisparticularlyappositeforestablishingthelegitimacyoftransplant operationswhichdirectlybenefitpatientsinpressingneed(e.g.abrotherorsister).Itseemsextremelyunlikelythatitcould justifythemoreremoteandcontroversialbenefitofsatisfyingadeeplyfeltcommunityattachmenttotraditionalcustoms. Moreover,totheextentthatfemalecircumcision,excisionandinfibulationareinfactmutilationsandhenceseriously detrimentaltothechildthedefencewouldberuledoutinanycase."

Poulterconcludesthatmalecircumcisionislawfulbutthiscanonlybesoifheiscorrectbothastohisanalysisofthelegalrightofa parenttoassenttoanassaulttothebodilyintegrityofhischildfornontherapeuticgrounds(i.e.hisgrounds2and3)andonthe correctnessofhisviewthatmalecircumcisionisharmlessandisnotinmedicaltermsanditsconsequencestothevictimtobeequated withfemalecircumcision.ThecorrectnessofhisviewofparentalconsentseemsopentodoubtinviewofGillick 140 butevenifhewere correct,themedicalevidenceofharmdefeatshisconclusionforhis`ground'2,andthemoresofor`ground'3givenhiscommentonthe unavailabilityofthedefencefortheperformanceof`traditionalcustoms'. ItisalsoaninterestingobservationthatPoulterquotesinfootnote6tothisparagraph,GranvilleWilliams'observation141 totheeffectthat for`grounds'2and3parentalconsentwouldbeinsufficientifthechildwasoldenoughtounderstandwhatwasinvolvedandwaseither leftuninformedoractuallywithheldhisconsent.Whyshoulditbeacceptabletoperformcircumcisiononanewbornwhoiswholly vulnerable,butnotonanunconsentingolderchild?Perhaps,theadviceofMaimonides(op.cit.above)isappositehere:
"Thislawcanonlybekeptandperpetuatedinitsperfection,ifcircumcisionisperformedwhenthechildisveryyoung,and thisforthreegoodreasons.First,iftheoperationwerepostponedtilltheboyhadgrownup,hewouldperhapsnotsubmit toit.Secondly,theyoungchildhasnotmuchpain,becausetheskinistender,andtheimaginationweakforgrownup personsareindreadandfearofthingswhichtheyimagineascoming,sometimebeforetheseactuallyoccur.Thirdly,when achildisveryyoung,theparentsdonotthinkmuchofhimbecausetheimageofthechild,thatleadstheparentstolove him,hasnotyettakenafirmrootintheirminds."

TheCommission'sclaim,andthoseacademicandotherwriterswhoclaimlikewise,thatmalecircumcision`islawfulunderEnglish commonlaw'(forwhichnotonescrapofauthorityforthispropositionisoffered)isnotsupportedbytheQueenslandLawReform Commission("QLRC")whoseresearchpaperofDecember1993 142 onthecircumcisionofmaleinfantsmadenosuchclaimforthe legalityatcommonlawformaleinfantcircumcision,despitethemajorityofAustralianmales'beingcircumcisedbythe1960s(anda currentrateofmalecircumcisionofbetween25%and35%,notwithstandingadeclineinthenumbersofneonatalcircumcisionssincethe 1960s).TheQLRCstatesthatinQueenslandapersoncanconsenttowhatwouldotherwisebeasimpleassaultbutconsentdoesnot removecriminalresponsibilityformoreseriousinjuriessuchaswounding.Theydiscussthe`medicalexemption'intheCriminalCode section282(whichpermitssurgicaloperationsonaperson"...iftheperformanceoftheoperationisreasonablehavingregardtothe patient'sstateatthetimeandtoallthecircumstancesofthecase")andtheissueof`real'consentasadefence.Atpage14theystate that:"Intheabsenceof`real'consent,circumcisionofmaleinfantswouldfallwithinthedefinitionofassaultundersection245ofthe QueenslandCriminalCode.Itmightalsobeanoffenceendangeringlifeorhealth.Anumberofcriminaloffencesmaybecommitted dependingonthecircumstancesofthecase,suchas..[andtheQLRCthendiscussoffencesrangingfromcausinggrievousbodilyharmto unlawfulwounding". Inconcluding,page17,that"Whetherornotcircumcisionwouldbeforthebenefitoftheparticularchildandwhetherornotitwouldbe reasonablehavingregardtothechild'sstateatthetimeandtoallthecircumstancesofthecasewouldneedtobeassessedonacaseby casebasis",itisclearthattheQLRCregardthepermissibilityofmaleneonatalcircumcisiononthebasisofthe`medicalexemption' ratherthansomeruleofcommonlawand/orthatitisafreestandingandindependentexceptiontothegeneralprohibitionofthe consensualinflictionofinjury.Thelimitsonparentalconsentarediscussed:atpage38theQLRCstates:"Thecommonlawoperatingin Queenslandappearstobethatifayoungpersonisunable,throughlackofmaturityorotherdisability,togiveeffectiveconsenttoa proposedprocedureandifthenatureoftheproposedtreatmentisinvasive,irreversibleandmajorsurgeryandfornontherapeutic purposes,thencourtapprovalisrequiredbeforesuchtreatmentcanproceed.Thecourtwillnotapprovethetreatmentunlessitis necessaryandintheyoungperson'sbestinterests[theQLRCcitetheHighCourtofAustraliainSecretary,Dept.ofHealthand CommunityServicesv.JWBandSMB:143 [175CLR218Marion'sCase].Theycommentthat"Thebasisofthisattitudeistherespect whichmustbepaidtoanindividual'sbodilyintegrity....Unlessthereareimmediatehealthbenefitstoaparticularchildfromcircumcision, itisunlikelythattheprocedureitselfcouldbeconsideredastherapeutic....Thecircumcisionisinvasive,irreversibleandmajor.Itinvolves theremovalofanotherwisehealthyorganpart.Ithasseriousattendantrisks....Onastrictinterpretationoftheassaultprovisionsofthe QueenslandCriminalCode,routinecircumcisionofamaleinfantcouldberegardedasacriminalact.Further,consentbyparentstothe procedurebeingperformedmaybeinvalidinthelightofthecommonlaw'srestrictionsontheabilityofparentstoconsenttothe nontherapeutictreatmentofchildren". Itisclear,however,thattheQLRChavemisunderstoodthegravamenoftheobjectiontocircumcisionbystatingthatitisbasedon `humanrightsandpreservationofbodilyintegritygrounds'.Theobjectionisnotoneof`humanrightsandpreservationofbodilyintegrity grounds'simplicter,butratherthattheresultingseveredysfunction,andtheassociatedpainandrisks,maketheinvasionofbodily integrityandthebreachofarangeofthechild'shumanrightsparticularlygrave.Insuggestingthattribal/culturalassimilationmightoffera basisforconcludingthattheproceduremightstillberegardedasbeneficialtothechild,theQLRCmakenomentionoftheinevitable dysfunctionthatresultsfromanycircumcision:thustheirconclusionastothepossibleoutcomeoftheapplicationoftheprinciplesof175 CLR218Marion'scasetoinfantcircumcisionisdefective.Whatisclear,however,isthattheQLRCpaperofsome41pagesandsome 13pagesofappendicesis,despiteitsflaws,amoreseriousattempttoexaminetheissuethantheperfunctorytreatmentofthe ConsultationPaperandgivesnosupporttoaclaimoflegitimacyofnontherapeuticcircumcisionatcommonlaw.

12.OffencesAgainstthePerson:thecurrentview
TheLawCommission'sdifficultieswiththelawonoffencesagainstthepersonmustfindanechowithpractitionersandLordLowry,in Rv.Brown ,atp248CadoptstheLawCommission'swordsfromtheCommission'sConsultationPaperNo122(atparagraph7.4)as totheuntidystateofthelawflowingfromtheOffencesAgainstthePersonAct1861.Whilst,formuchofthetime,theunclarityofthe lawdoesnotcausegreatpracticaldifficulties,thelackofacoherentframeworkcan,forexampleaswiththeactivitiesthesubjectofRv. Brown,giverisetoconfusion.IntheConsultationPaper,theLawCommissiondealswitharangeofbehaviourwhereitmightbesaid thatconsentrenders,ormightbesaidtorender,theapplicationofforcetoanotheraslawful:theserangefromactivitieswhichmost wouldregardaswhollyproper,suchasmedicaltreatment,throughsportsofvariousformstothebizarreandoftendistastefulsuchas genitalpiercingandsadomasochisticbehaviour. Thecurrentviewisfoundexpressedin Collinsv.Wilcock 144 whereRobertGoffLJsaid:
"thefundamentalprinciple,plainandincontestable,isthateveryperson'sbodyisinviolate.Ithaslongbeenestablished thatanytouchingofanotherperson,howeverslight,mayamounttoabattery.SoHoltCJheldin Colev.Turner (1704)6 Mod.149that`theleasttouchingofanotherinangerisabattery.'Thebreadthoftheprinciplereflectsthefundamental natureoftheinterestsoprotected.AsBlackstonewroteinhisCommentaries,17thed.(1830)vol.3,p120:`thelawcannot drawthelinebetweendifferentdegreesofviolence,andthereforetotallyprohibitsthefirstandloweststageofitevery man'spersonbeingsacred,andnootherhavingarighttomeddlewithit,inanytheslightestmanner.'Theeffectisthat everybodyisprotectednotonlyagainstphysicalinjurybutagainstanyformofphysicalmolestation.Butsowidelydrawn aprinciplemustinevitablybesubjecttoexceptions.Forexample,childrenmaybesubjectedtoreasonablepunishment peoplemaybesubjectedtothelawfulexerciseofthepowerofarrestandreasonableforcemaybeusedinselfdefenceorfor thepreventionofcrime.But,apartfromthesespecialinstanceswherethecontrolorconstraintislawful,abroaderexception hasbeencreatedtoallowfortheexigenciesofeverydaylife.Generallyspeaking,consentisadefencetobatteryandmost ofthephysicalcontactsofordinarylifearenotactionablebecausetheyareimpliedlyconsentedtobyallwhomovein societyandsoexposethemselvestotheriskofbodilycontact.Sonobodycancomplainofthejostlingwhichisinevitable fromhispresencein,forexample,asupermarket,anundergroundstationorabusystreet....Althoughsuchcasesare regardedasexamplesofimpliedconsent,itismorecommonnowadaystotreatthemasfallingwithinageneralexception embracingallphysicalcontactwhichisgenerallyacceptableintheordinaryconductofdailylife.Weobservethat,although inthepastithassometimesbeenstatedthatabatteryisonlycommittedwheretheactionis`angry,revengeful,rudeor insolent'(seeHawkins, PleasoftheCrown ,8thed.(1824),vol1,c15,section2),wethinkthatnowadaysitismorerealistic, andindeedmoreaccurate,tostatethebroadunderlyingprinciple,subjecttothebroadexception."

LordLaneCJinAttorneyGeneral'sReference (No6of80)saidatpage718that:
"Wethinkthatitcanbetakenasastartingpointthatitisanessentialelementofanassaultthattheactisdonecontraryto thewillandwithouttheconsentofthevictimanddoubtlessforthisreasonthattheburdenliesontheprosecutionto negativeconsent.Ordinarily,then,ifthevictimconsents,theassailantisnotguilty."

But,atpage719,LordLanethenspokeofaneedfora"partlynewapproach":
"Theanswertothisquestion[atwhatpointdoesthepublicinterestrequirethecourttoholdotherwise?]inourjudgment,is thatitisnotinthepublicinterestthatpeopleshouldtrytocause,orshouldcause,eachotheractualbodilyharmforno goodreason.Minorstrugglesareanothermatter.So,inourjudgment,itisimmaterialwhethertheactoccursinprivateor publicitisanassaultifactualbodilyharmisintendedand/oriscaused.Thismeansthatmostfightswillbeunlawful regardlessofconsent.Nothingwhichwehavesaidisintendedtocastdoubtupontheacceptedlegalityofproperly conductedgamesandsports,lawfulchastisementorcorrection,reasonablesurgicalinterference,dangerousexhibitions, etc.Theseapparentexceptionscanbejustifiedasinvolvingtheexerciseofalegalright,inthecaseofchastisementor correction,orasneededinthepublicinterest,intheothercases."AsLordLowryputitin Rv.Brown atp254D,when commentingonthispassage,LordLane'spropositionwas"thatitwasnotinthepublicinterestthatpeopleshouldtryto cause,orshouldcause,eachotheractualbodilyharmfornogoodreasonandthatitisanassaultifactualbodilyharmis caused(exceptforgoodreason)."

AsLordLowrymadeitclearinBrown ,atp255C,LordLane'swordswereintended,asLordLanehimselfmadeclearintheCourtof Appealinthe Brown case[1992QB491,500]tobeofgeneralapplicationandnottosomespecialfactualsituation. Thereisnothingintheseextractstogiveanycomforttocircumcisers:allassaultswhichinflictactualbodilyharmareillegalunlessthey formoneofthecategoriesofexceptionwhichwereandcontinuetoberegardedassuch.

12.1Rv.Brown
Despitesomeearlierauthoritythatconsentcouldaffordadefencetotheinflictionofinjuries,themajorityinBrown heldthat,certain exceptionsaside,consentwouldnotoperateinlawtoexcusetheinflictionofinjuriesofactualbodilyharm,orhigher. Inconsideringthecertifiedquestion,themajoritywereclearlyaffectedbytheirpersonalrepulsionattheactivitiesoftheAppellantsthus itisdifficulttofindarationalbasisforadecisionwhichwould,seemingly,permitgenitalpiercingforreasonsofvanityandperceived cosmeticreasonsbutnottheselfsameactwhendonetosatisfythesexualpassionsoftheactorandthewhollyconsentingandmore thanwillingrecipient.Someoftheallegedilleffectsofsadomasochisticacts,seeforexampleLordTemplemanatp.236BFareas applicabletocosmeticgenitalpiercingsandalsotoritualcircumcisions(especiallythoseperformedbylaymeninordinarypremisesor houses). LordTemplemaninBrown atp231Dsays:
"Insomecircumstancesviolenceisnotpunishableunderthecriminallaw.Whennoactualbodilyharmiscaused,the consentofthepersonaffectedprecludeshimfromcomplaining.Therecanbenoconvictionforthesummaryoffenceof commonassaultifthevictimhasconsentedtotheassault.Evenwhenviolenceisintentionallyinflictedandresultsinactual bodilyharm,woundingorseriousbodilyharmtheaccusedisentitledtobeacquittediftheinjurywasaforeseeableincident ofalawfulactivityinwhichthepersoninjuredwasparticipating.Surgeryinvolvesintentionalviolenceresultinginactualor

sometimesseriousbodilyharmbutsurgeryisalawfulactivity.Otheractivitiescarriedonwiththeconsentbyoronbehalf oftheinjuredpersonhavebeenacceptedaslawfulnotwithstandingthattheyinvolveactualbodilyharm.Ritual circumcision,tattooing,earpiercingandviolentsportsincludingboxingarelawfulactivities."

AsLordTemplemanobserved,atp231F,someactivitieswhichwereoncethoughtofaslegal,ceasedtoberegardedassuch:"Inearlier dayssomeotherformsofviolencewerelawfulandwhentheyceasedtobelawfultheyweretolerateduntilwellintothe19thcentury. Duellingandfightingwereatfirstlawfulandthentoleratedprovidedtheprotagonistswerevoluntaryparticipants". DespiteLordTempleman'scommentsastowhathedescribesas`lawfulactivities',whichareintheirenumerationarguablyobiter,itis clearthattheclassofforcewhichmightbeapplied,notwithstandingthelevelofinjuryinflictedorrisked,isnotstatic:changesinsociety anditsculture,appreciationoftheconsequencesofanactivityand/orofitsresultingharmwouldallcallforareexaminationofthe appropriatenessofthecontinuationoftheexemptionhithertoassumedtoapplytoaparticularactivity. LordJauncey'slistofpermissibleexceptionstothegeneralruleprohibitingassaultswhichinflictedbodilyharmwasrathermorelimited thanthatofLordTempleman:atp242,LordJauncey,discussing Rv.Donovan [1934]2KB498,saysthatSwiftJconsideredthe exceptionstothegeneralrulethatanactlikelyorintendedtocausebodilyharmisanunlawfulact:suchexceptionsincluded:
"friendlycontestswithcudgels,foilsorwrestlingwhichwerecapableofcausingbodilyharm,roughandundisciplined sportsorplaywheretherewasnoangerandnointentiontocausebodilyharmandreasonablechastisementbyaparentor apersoninlocoparentis.Hemightalsohaveaddednecessarysurgery."

Later,LordJauncey,atp244Hto245A,saidthatthelinetobedrawnbetweenthoseactswherethevictim'sconsentwouldprovidea defenceandthosewhereitwouldnotlaybetweencommonassaultsandassaultsoccasioningactualbodilyharmwithinsection47ofthe OffencesAgainstthePersonAct,oranoffenceundersection20ofthatAct,"unlessthecircumstancesfallwithinoneofthewellknown exceptionssuchasorganisedsportingcontestsandgames,parentalchastisementorreasonablesurgery." Accordingtothemajorityview,circumcisionwould,notwithstandingconsent,beunlawfulunlessitformedacurrentpartofthegroupof exceptionstothegeneralprinciple. LordMustill,whilstdissentingontheanswertothecertifiedquestionandadoptingasomewhatdifferentapproachtothemajority,found himselfforcedtolookempiricallyatcertainsituationswhereinjurywascaused.Hefoundhimselfunabletomaintainthe`intellectually neat'method,asbeingtoosimple,atp258Gto259C,describingaspectrumofforceatsomepointonwhich"consentordinarilyceases tobeananswertoaprosecution",andconductedananalysisoftheactivitieswhereconsentmightoperatetoexcusetheactor.Non therapeuticmalecircumcisionisnotraisedbyhimasoneofthosecategoriesandinthecourseofthatexamination,atp261C,Lord Mustillmakesthepointthat:
"Norhasitbeenquestionedontheargumentofthepresentappealthatsomeonewhoinflictsseriousharm,because(for example)heisinspiredbyabeliefintheefficacyofapseudomedicaltreatment,oractsinconformitywithsomeextreme religioustenet,isguiltyofanoffencenotwithstandingthatheisinspiredonlybyadesiretodothebesthecanforthe recipient".

ThesewordsofLordMustill,inthelightoftheseveredamagecausedbymalecircumcisiondemonstratedbythemedicalliterature,seem whollyappositeto,andsupportiveofaprosecutionof,nontherapeuticcircumcision.

13.ChildProtection
Whatevermighthavebeenthepositionundercommonlawandevenif(which,intermsofanindependent,freestandingexemptionfrom thegeneralruleisveryfarfromclear)malecircumcisionwasinearlierdayslawfulatcommonlaw,itisnecessarytoconsiderwhether thatpositionsurvivestoday,giventhatcircumcisioninvolvestheapplicationofforcetothevictimwhichwouldfoundanassault.Equally, sinceitinvolvestheamputationoftheprepuce,itencompassesawoundforsection20oftheOffencesagainstthePersonAct,1861, and,itissuggestedinthelightofcurrentmedicalknowledge,constitutes`grievousbodilyharm'forthepurposesofthatAct.The lawfulnessofitscontinuationmust,attheleastasisconfirmedbytheCommission'swishtoplacetheissue(asitisput)beyonddoubt,be highlyquestionable. AlthoughtheCommissionhaschosentodiscusscircumcision,andinparticularritualcircumcision,aspartoftheroleofconsentinthe criminallaw,therealityisthatthevictimofritualorroutineinfantcircumcisionnevergiveshisconsentindeedhisconsentisneversought since,exhypothesi,heistooyoungeventospeak.Theprocedureought,thus,tobeconsideredwithinthegeneralframeworkofassent onbehalfofanother,andwithinthelimitsonthatprocessofassent.Theselfauthorising`assent'whichisgivenisafarcryfromconsent inthestrictsenseandisasrationalastanceasallowingaperson,inretaliationforsomeslightorotherharm,toauthorisehimselftokill, ormaimorseriouslyinjurethepersonwhohasoffendedhim. Insection1(1)ChildrenandYoungPersonsAct1933,quotedinnote19toparagraph11.8oftheConsultationPaper,apersonwho `wilfullyassaults'achildor`causesorprocureshimtobeassaulted.....inamannerlikelytocausehimunnecessarysufferingorinjuryto health'(emphasisadded)shallcommitanoffence. Itisdifficulttoseehowthisprovisiondoesnotapplytoanynontherapeuticmalecircumcision:theactisdoneintentionallyandthus wilfullyitcausesunnecessarysufferingandinjuresthefullandhealthysexualfunctioningofthepenis. Itisacceptedthatthereappearstobenoreportedcasewhereaprosecutionhasbeenmountedunderthissectioninrelationtoa circumcision,butthatmayowemoretoanuntutoredperceptionoftherealityoftheharmcausedandareluctancebyvictimsto complainatsomethingdoneinearlyinfancy,notleastwhenitsperformancehadreligiousovertones.

13.1Paramouncyofwelfareofchild

Theoriginsoftheprotectionofthechildgobacktoearlydaysanditsmodernexpressioninthiscenturyreflectsthattradition,aswellas amoreenlightenedviewastochildren,theirneedsandvulnerabilitiesandisgivenexpressprotectionbystatute. InReZ (aminor)(freedomofpublication) 145 thehistoricalnatureofthecourt'sjurisdictionwasdiscussedandtheexerciseofthat jurisdictionconsidered.Astheheadnotehasit: "Held(1)Althoughthewardshiporinherentjurisdictionofthecourttoprotectminorswhoseinterestswereatriskofharmwasintheory unlimited,inpracticethecourtwoulddeclinetoexercisethosepowerswhereforexamplethefreedomofpublicationwastheprevailing interestandthematerialtobepublishedwasonlyindirectlyreferabletothechild.Thecourtwouldhoweverexercisethatjurisdiction wherethematerialtobepublishedwasdirectedatthechildortoanaspectofthechild'supbringingbyhisparentsorotherswhocared forhimincircumstanceswherethatpublicitywasinimicabletohiswelfare.Inthatsituation,thecentralissuebeforethecourtrelatedto themannerofthechild'supbringingand,inaccordancewiths1(1)aoftheChildrenAct1989[Section1(1),sofarasmaterial,provides: Whenacourtdeterminesanyquestionwithrespectto(a)theupbringingofachild,thechild'swelfareshallbethecourt'sparamount consideration],thechild'swelfarewasthecourt'sparamountconsiderationandprevailedovertheinterestinthefreedomofpublication (seep977dtop978c,p985jandp986hj,post) ReX(aminor)(wardship:restrictiononpublication)[1975]1AllER697,Rv CentralIndependentTelevisionplc[1994]3AllER641,XCCvA[1985]1AllER53andReW(aminor)(wardship:freedomof publication)[1992]1AllER794applied. "(2)Thedisclosurebyaparentofconfidentialinformationrelatingtoachildwasanexerciseofparentalresponsibilitywithinthemeaning ofs3(1)bofthe1989Actwhichthecourtwasempoweredtorestrainbymeansofaprohibitedstepsorderunders8oftheAct.In consideringwhethercertainstepsshouldbytakenbyaparentinmeetinghisparentalresponsibilitythecourtwasdeterminingaquestion withrespecttotheupbringingofthechildand,assuch,s1(1)ofthe1989Actappliedtomakethewelfareofthechildthecourt's paramountconsideration.Thecourtwasthereforeunderadutytoexerciseitsownjudgmentastowherethechild'swelfarelayand couldrefusetopermitaparent'sexerciseofparentalresponsibilityeventhoughitwasbonafideandreasonableifitwascontrarytothe child'sbestinterests(seep979j,p980df,p981e,p983d,p984b,p985jandp986jtop987a,post). "3)Inthecircumstances,themother'splacementofthechildattheinstitutewasaproperdischargeofherparentalresponsibilityto secureherchild'smedicalandeducationaladvancementandherdecisiontowaivetheconfidentialitywhichthechildwouldotherwise enjoyinrespectofthosemattersandtopermithertoappearinthedocumentarywasclearlyanexerciseofthatresponsibility.Inbeing askedtodecidewhetherthechildshouldtakepartintheprogrammethecourtwasdeterminingaquestionwithrespecttoherupbringing and,accordingly,s1ofthe1989Actappliedtomakethechild'swelfaretheparamountconsideration.Onthatapproach,thejudgewas correctinhisconclusionthat,notwithstandingthefundamentalimportanceofthefreedomofpublicationofinformation,thewelfareofthe childwouldbeharmedandnotadvancedbyherparticipationinthemakingandpublicationoftheprogrammeandthatsheshould continuetoenjoytheprotectionagainstpublicitywhichtheinjunctionsgaveher.Itfollowedthattheappealwouldbedismissed(seep 980e,p981d,p984fg,p985gtojandp987ab,post)." WardLJinhisjudgmenthasahelpfulreviewoftheprotectivejurisdictionofthecourtsinthecourseofwhichhegiveswhathedescribes asatestfortheexerciseofdiscretion.Itisclearthatheseestwosituations:onewheretheupbringingofachildisconcerned,where statuterequiresthattheinterestsofthechildareparamountandsituationsconcerningthewelfareofthechildwherethechild'sinterests might(butnot`must')havetobesubordinatedtooverridinginterests. "2.Whenwelfaredominatesthedecision Thechild'swelfareshallbethecourt'sparamountconsiderationwhenthecourtdeterminesanyquestionwithrespecttotheupbringingof thechild:s1(1)ofthe1989Act.Thatmeans:
"'Whenalltherelevantfacts,relationships,claimsandwishesofparents,risks,choicesandothercircumstancesaretaken intoaccountandweighed,thecoursetobefollowedwillbethatwhichismostintheinterestsofthechild'swelfare'"(SeeJ vC[1969]1AllER788at821,[1970]AC668at710711perLordMacDermott.) "....Itisnotalwaysnoteasytodecidewhenaquestionofupbringingisbeingdetermined. "....Inmyjudgmentaquestionofupbringingisdeterminedwheneverthecentralissuebeforethecourtisonewhichrelates tohowthechildisbeingreared.Ifthematterbeforethecourtrequiresthedeterminationofanyquestionwhichistobe characterisedasonewithrespecttotheupbringingofthechild,thenthechild'swelfareisthecourt'sparamount considerationandwelfareprevailsoverthefreedomforpublication."

Thequestionastotheculture,religionorethosinwhichthechildistoliveandwithinwhichtogrow,aswellasthealterationofchild's body,isclearlyanissueofthe`upbringing'ofthatchildandassuchfirmlywithins.1oftheChildrenAct1989,(andthusthechild's interestsareofparamountconsideration)butevenifthesemattersweretoberegardedassimply`welfare',therewouldstillhavetobe abalancingofcompetingclaims(andabalancingwhichwouldhavetohaveregardtotherequirementsthatexpressionoffreedomsfind properlimitswhentheyharmordepriveothersoftheirfreedoms). AsLordScarmansaysin GillickvWestNorfolkandWisbechAreaHealthAuthority [1985]3AllER402at420,[1986]AC112 at184:

"Theprincipleofthelaw,asIshallendeavourtoshow,isthatparentalrightsarederivedfromparentaldutyandexistonly solongastheyareneededfortheprotectionofthepersonandpropertyofthechild. "Givingconsenttomedicaltreatmentofachildisaclearincidentofparentalresponsibilityarisingfromthedutytoprotect thechild.Arrangingforeducationcommensuratewiththechild'sintellectualneedsandabilitiesisafurtherincidentofthe parentalresponsibilitywhicharisesfromthedutyoftheparenttosecurethechild'seducation."

13.2ChildrenAct1989
TheChildrenAct1989isthecurrentstatutorymechanismfor,andexpressionof,theneedtogivefullprotectiontotheinterestsofthis vulnerablegroupinsocietyandprovidesinsection1thatthewelfareofthechildisparamount:
"Whenacourtdeterminesanyquestionwithrespectto(a)theupbringingofachild...thechild'swelfareshallbethecourt's paramountconsideration."

13.3Parentalconsent
AlthoughcapacitytoconsentreceivessomeattentionintheConsultationPaper,andthecircumstanceswhenitmightbeinvalidand/or vitiateddiscussed,thequestionofconsentbyapersonwithcapacitytoconsentforapersonunderdisabilityreallyonlyrisesinthe ConsultationPaperinrelationtomedicaltreatmentand,inparagraph11.4istouchedoninrespectoftheissueoflawfulcorrection.Yet theverynatureofritualcircumcisionisthatitisperformedonachildeithershortlyafterbirth,oratatimebeforepubertyandthe `consent'isgiven,sincethevictimwilllegallylackthecapacitytogivehisownconsent,byanotherperson.ItissubmittedthatProfessor DavidFeldman,whoseresponsetothefirstconsultationpaperistouchedonatparagraph3.25oftheConsultationPaperiscorrect whenheisquotedassuggestingthat"aparent'sconsenttotheritual,nontherapeutic,circumcisionofachildmayamounttoaformof inhumantreatmentcontainedinArticle3[oftheEuropeanConventiononHumanRights]".Butitissubmittedthatheiswrong,bothin domesticandinternationallaw,that"itwasassumedthattheparent'sconsenttothepracticewillgenerallybesufficienttopreventthe circumcisionfromconstitutingacriminalact".(SeealsothediscussionofthepositioninQueensland[146andbelow). 13.3.1Medicaltreatmentgenerally Atparagraph8.23,theCommissiontouchesontheissuethatthetreatmentbeforthepatient'sbenefit,remarkingthat"thisisa requirementthatneedsverycarefulconsideration"andcitingDenningLJashethenwasinBraveryvBravery 147 thatthemedical exemptiondidnotextendtotreatmentcarriedoutwith"consentbutwithoutjustcauseandexcuse". TheCommission'sownstanceisfarfromclearherebutwouldappeartobethatthereshouldbenoneedtodemonstratethatthe operationwas,inordertoenjoythe'medicalexemption'fromcriminalliability,inthepatient'sbestinterest.Inparagraphs8.318.48, certainareasofmedicalinterventionarediscussed,suchasabortion,sexreassignmentandclinicaltrials,butthequestionishereand elsewhereduckedastowhethertheremight,oroughtto,becircumstanceswhentheclearlackofbenefittothepatientvitiatesany apparentconsentgivenbyaproxyandrendersthetreatmentcriminal. Thereareclearlyissuesofpublicpolicyherewhichdeserved,butdonotreceive,discussioninthecontextoftheConsultationPaper. Therecanbelittledoubtthatadoctorwhoperformsanoperationonapatient,particularlyoneinvolvingsignificantriskandinevitable lossoffunction,withoutanytherapeuticbenefitrightlyrisksacivilclaimfordamagesaswellasstricturefromhisprofessionalbody. Further,isitsounreasonabletodemandthatbeforeheenjoystheprotectionoftheexemptionfromtheordinaryprovisionsofthe criminallaw,thedoctorbeabletoshowthattherewasatleastanarguableclaimthathisprocedurehadsomebenefit?Certainlythelack ofsuchabenefit,whenthenatureofthedoctorpatientrelationshipoftrustandtheneedfortheconsenttohavesomebasisofprior information(astotheneedfor,therisks,andpossibleoutcome,oftheoperationtogetherwithsomediscussionasappropriateofother treatments),mightwellbeafactorwhenconsideringthelegalityofmedicaltreatment. EveniftheCommission'sviewisappropriateinrelationtothetreatmentofadults,whosematurityandabilitytobalancerisksagainst perceivedbenefits(evenbenefitswhicharenotmedicalinthestrictuseofthatterm)mightjustifyit,itisfarfrombeingeitherreasonable orindeedinlinewithcurrentideasofparentalduties,theobligationsofchildprotectionandchildwelfare. Quiteapartfromtheprovisionsofchildprotectionlegislationtouchedonabove,whereconsentissoughtfromaparentforthemedical treatmentofachildthereis,quiteapartfromanyrequirementofmedicalethicsandgoodpractice,agrowingawarenessof,andabody ofstatuteandcaselawsupportingthepropositionthatthereis,aneedtodemonstratethatthetreatmentisinthechild'sbestinterest(or, atleast,toputitatitslowest,thatthetreatmentisnotinimicaltothechild'sinterestsandwelfare). Wherethechildissufferingfromadiseaseprocessthenthebenefitforthechilditselffromappropriatemedicaltreatmentwillnotbe difficulttofindwherehealthyandhighlyimportantfleshisamputatedfromthehealthyorgan(withresultinggravedysfunction)ofa healthychildfornoreasonthanritualthentheonusisonthosewhowouldconductthismutilationtojustifytheiractionagainstthe backgroundofthegenerallaw,andtodemonstratethattheiractionsarelawful,thatthemutilationisinthebestinterestsofthechildand thatitdoesnotexposehimto`unnecessarysufferingorinjurytohealth'. Theproposalsformedicaltreatmentsetoutatparagraph8.50etseqoftheConsultationPaper,andinparticularparagraph8.50(2), wouldappeartoexcludedoctorswhoperformmalenontherapeuticcircumcisionsfromenjoyingthe`medicalexemption':itwouldfit noneofthecategoriesofmedicaltreatmentsetoutinparagraph8.50(2)(b).Thusthedoctorwhoperformedanontherapeutic circumcisionwouldappeartobeasvulnerabletocriminalchargesasamohelorotherlaycircumciser. EvenifthereisnostrictrequirementingeneraltermsforconsentunderEnglishlawformedicaltreatmenttobeonthebasisoffully informedconsent,ascontrastedwiththepositioninotherjurisdictions,northattherebeageneralneedtodemonstratethebenefittothe patient,thetendencyisforconsenttobemoreinformedthaninearlierdays,andforbenefittobesought:itwouldbebizarreifmedical treatmentshould,whetherasaresultofdevelopmentsinthelaworotherwise,bemoreprotectivethantheprotectionaffordedtoachild whoisseenasacandidateforritualcircumcision. 13.3.2TheAustralianview

InConsenttoMedicaltreatmentofYoungPeople,(op.citatnote161)theQueenslandLawReformCommission(`QLRC')discuses issueswhicharecentraltomalechildcircumcision,butignoredwhollybytheCommissionintheConsultationPaper.Theysuggestthat `healthcare'foranadultbe:

"....anytreatment,serviceorprocedure (a)tomaintain,diagnoseortreattheadult'sphysical ormentalconditionand (b)carriedoutby,orunderthesupervisionof,ahealthcareprovider"

andtheysuggestthatsuchadefinitionbeusedforconsideringthetreatmentofchildren.TheQLRCremarkthatinBritishColombia, Canada,insection16(1)InfantsAct1992healthcareisdefinedasmeaning`anythingthatisdoneforatherapeutic,preventive, palliative,diagnostic,cosmeticorotherhealthrelatedpurpose'. ItisclearthattheLawCommissionintheConsultationPaperhaveassumedthatparentshavearightunderEnglishlaw(purportedly unlimited,itwouldseem)toconsenttothegenitalmutilationoftheirmalechildren,particularlyforritualreasonsinsoassuming,theLaw CommissionharksbacktothestandardsofVictorianBritainanditserroneousviewthatafatherenjoyedwhatwereineffectalmost unlimitedrightsoverhischildrenandthisviewisdepressinglyfamiliartothosewhoreadthecontributionsfromlayAmericanparentsin theInternetdiscussionsonneonatalcircumcisionwhereitisfrequentlystatedthatparentshavetheunfetteredrighttoauthorise circumcisionoftheirneonateboys. Inthosecircumstances,abriefreminderofthecorrectlegalpositionwouldappeartobeapposite.AstheQLRCstates:
"Thecommonlawdoesnotconferuponparentsrightsovertheirchildren....However,itdoesimposecertaindutiesupon parentsrelatingtothemaintenanceandsupportoftheirchildren. "Thepositionatcommonlawisthatparentsarethenaturalguardiansandcustodiansoftheirchildandassuchhave variousduties,powersandresponsibilitiesinrelationtothechild,includingthepowertoconsenttomedicaltreatmenton behalfofthechild....InSecretary,Dept.ofHealthandCommunityServicesv.JWBandSMB:1992175CLR218[Marion's case]at278,JusticeBrennanhasdescribedtheparentalpowerasfollows:
"Theresponsibilitiesandpowersofparentsextendtothephysical,mental,moral,educationalandgeneralwelfareofthe child....Theyextendtoeveryaspectofthechild'slife.Limitsonparentalauthorityareimposedbytheoperationofthe generallaw,bystatutorylimitationsorbytheindependencewhichchildrenareentitledtoassert,withoutextrafamilial pressure,astheymature.Withintheselimits,theparents'responsibilitiesandpowersmaybeexercisedforwhattheyseeas thewelfareoftheirchildren.'"

TheQLRCcontinuewiththeobservationbyJusticeMcHughin Marion'scase ,thatifaspartofsuchparentalobligations,"parentswere underaspecificdutytoprovidemedicaltreatmentfortheirchildren,thenthenecessarycorollarywouldbeapowerofparentsto consenttomedicaltreatmentasderivingfromthatdutybutincommonlawthereappearstobenosuchdutyonparents(perhaps becauseofthethennatureofmedicaltreatment,andthestatusofdoctors,inpreviouscenturieswhenthecommonlawwasdeveloping)." Despitelegislationmakingitanoffence,incertaincircumstances,toneglecttoprovidemedicaltreatment,JusticeMcHughconcluded that:

"[N]othinginthetermsofthislegislationnorintheimplieddutieswhichtheyimposegiveanygroundforconcludingthat parentshaveageneralpowertoconsenttothemedicaltreatmentoftheirchildren.Noneofthislegislation,forexample, provides,evenbyimplication,adutytoprovidecosmeticsurgeryortreatment.Atmost,thelegislationimposesadutyon parentsnottoneglecttoprovidenecessarymedicaltreatmentfortheirchild."

TheQLRCdiscussestheseverallimitationsonaparent'spowertoconsenttothetreatmentofchildren,thus: Norighttoabsolutecontrol. Theperceivedrightofcontrol,ofthefather,inthe19thandearly20thcenturieshasbeenseverelydiminishedoverthelast150years. Thus,inadditiontochildprotectionlegislation,therehasbeenanincreasingrecognitionofthechildasanindividualinitsownrightand, asnotedinMarion'scase,"Theoverridingcriterionofthechild'sbestinterestisitselfalimitonparentalpower"aviewwhichfinds supportin Gillick's case.JusticeMcHugh,in175CLR218Marion'scase,concludedthat:

"Moderncaselawmakesitimpossible,therefore,toassertthatparentshaveanaturalrightofalmostabsolutecontrolover theperson,education,conductandpropertyoftheirchildren.Consequently,thepowerofparentstoconsenttomedical treatmentandsurgicalproceduresinrespectoftheirchildrencannolongerberegardedasexistingasanincidentor corollaryofsucharight."

Thepowermustbeexercisedinthebestinterestsofthechild.
"Aparenthasnoauthoritytoconsenttothemedicaltreatmentofhisorherchildunlessitisinthebestinterestsofthe child.Thisisbecauseimplicitinparentalconsentisunderstoodtobethedeterminationofwhatisbestforthewelfareofthe child[175CLR218Marion'scaseatp240].Ifaparentpurportstoconsenttoatreatmentwhichisnotinthebestinterestsof thechild,theconsentisofnoeffectandanypersonactingonsuchconsentwouldbeguiltyofassaultifanyphysical interferenceisinvolved.Notably,whatisinthebestinterestsofachildisamattertobedeterminedobjectively"(emphasis added).

Thepowerisexercisedinthecourseofafiduciaryrelationship. Fiduciaryrelationshipshavebeendescribedasthoseoftrustandconfidence.JusticeMasoninHospitalProductsLtdv.UnitedStates SurgicalCorporation 148 :

"Thefiduciaryundertakesoragreestoactfororonbehalfoforintheinterestsofanotherpersonintheexerciseofapower ordiscretionwhichwillaffecttheinterestsofthatotherpersoninalegalorpracticalsense.Therelationshipbetweenthe partiesisthereforeonewhichgivesthefiduciaryaspecialopportunitytoexercisethepowerordiscretiontothedetriment ofthatotherpersonwhoisaccordinglyvulnerabletoabusebythefiduciaryofhisperson."

Further:
"Itispartlybecausethefiduciary'sexerciseofthepowerordiscretioncanadverselyaffecttheinterestsofthepersonto whomthedutyisowedandbecausethelatterisatthemercyoftheformerthatthefiduciarycomesunderadutytoexercise hispowerordiscretionintheinterestsofthepersontowhomitisowed."

Wherethereis,ormightbe,conflictbetweeninterestsoftheparentandthoseofthechild,JusticeMcHughobserved,inMarion'scase:
"Nodoubtinmostcasesofmedicaltreatmentorsurgery,noconflictwillarisebetweentheinterestsoftheparentsand thoseofthechild.Inothercases,theriskofconflictmaybesoslightortheoreticalthatitcanbedisregarded.butinsome cases andclaimsthatanabortionorsterilisationisinthebestinterestsofachildarelikelytobeamongthemaconflict betweentheinterestsoftheparentsandthechildmayarise.Insuchacase,theapplicationofestablishedandfundamental principlewilldenytherightoftheparentstoconsenttotheoperationortreatment.Ifanoperationortreatmentistobe performedorcarriedoutinsuchacase,onlyacourtofgeneraljurisdictionexercisingtheparenspatriaejurisdiction.....can authorisetheoperationortreatment."

AstheQLRCproperlyconcludes:
"Itmightbeassertedthatwhatisintheparents'orfamily'sbestinterestswouldautomaticallybeinthechild'sbest interests.Thisdoesnotalwaysfollowinallcasesthebestinterestsoftheyoungpersonmustbeconsideredandnot merelyassumed."

ThepositioninQueensland(andthus,sinceMarion'scasewasaHighCourtdecision,inAustraliaasawhole)isthatthebestinterestsof thechildmustbefoundationforanydecisioninrelationtothatchildandthatthetest,itissuggested,anobjectiveone.Healthcare treatment,thatisanoperationortreatmentwhichisrequiredfortherapeuticreasons,willordinarilybecaretowhichparentscan consentascontaining,havingbalancedthetherapeuticbenefitagainsttherisks,clearandobjectiveevidenceofbeinginthechild'sbest interests.Nontherapeuticprocedurescannotcontainsuchclearandobjectiveevidenceand/orthesituationisonewherethereisa conflictorriskofconflictbetweenthecompetinginterestsofparentsandchildandthustheauthorityofthecourtmustbesoughtifthe procedureistobecarriedout.Further,itisclearthateachcasemustbeconsideredonanindividualbasisandthepositionofeachchild decidedonacasebycaseconsideration,ratherthananyblanketcondonationeithergenerallyor,moreoffensively,toaparticular group,foraparticularpractice.Thetesttobeapplied,astowhethercourtauthorityisrequiredis,asindicatedbyMarion'scase,that thenontherapeuticprocedureinvolves: Invasive,irreversibleandmajorsurgery. Significantriskofmakingthewrongdecisioneitherastoachild'spresentorfuturecapacitytoconsentoraboutwhatarethebest interestsofachildwhocannotconsent Consequencesofawrongdecisionwhichareparticularlygrave. AstheQLRCmadeclearinitspaperoninfantmalecircumcision,nontherapeuticcircumcisionmeetsthosecriteriaforreferraltothe courtforapproval. 13.3.3TheAmericanview AsregardstheUnitedStatesofAmerica,whicharecommonlawjurisdictions,DrRVanHowe(op.cit.atn8),wroteinrespectofthe legalpositionasregardsparentalconsentintheUnitedStatesofAmerica:
"InRePhillipB. TheCaliforniaCourtofAppealruledthatparentalautonomyisnotabsolute.InLittlevLittlea14year oldmentallyincompetentbutotherwiseperfectlyhealthy,daughterapplied(throughaguardianadlitem)foranorder authorizinghermothertoconsenttotheremovalofakidneyfromtheherbody,forthepurposeoftransplantingthekidney intoherbrotherwhowassufferingfromendstagerenaldisease.ATexasCourtofAppealsaid`No'.`Significantly,however, forourpurposes,thispowerofparents...toconsenttosurgicalintrusionsuponthepersonoftheminor...islimitedtothe 150 powertoconsenttomedicaltreatment.' Black'sLawDictionary definesmedicaltreatmentas`abroadtermcoveringall stepstakentoeffectacureofanyinjuryordisease:thewordincludingexaminationanddiagnosisaswellasapplicationof 151 remedies.' Todate,allcourtshaveheldthatsurgicalremovalofanynormalhealthy,nondiseased,uninjuredpartofthe bodyisnot`treatment.' "Inasimilartransplantationcase,aLouisianaCourtofAppealruledthatsurgerycouldnottakeplaceandtheCourtowed `protectiontoaminor'srighttobefreeinhispersonfrombodilyintrusiontotheextentofthelossofanorganunlesssuch 152 lossbeinthebestinterestoftheminor.' Likewise,therulingin WisconsinvYoder subjectsparentaldutyandrightto limitations`ifitappearsthatparentaldecisionswilljeopardizethehealthorsafetyofthechild,orhavepotentialfor 153 significantsocialburdens.' "Followinginkind, Kate'sSchoolvDepartmentofHealth limitedaparents'righttoprescribetheirtreatmentofchoicefor 154 theirmentallyretardedchildren. "In ValerieN.vValerieN.theCaliforniaSupremeCourtfoundthattheparentsas`conservators,werenotentitledtohave conservatee,whowasunabletoconsenttosterilization,sterilizedinasmuchastherewasneitherevidenceofnecessity... norsufficientevidencethatlessintrusivemeans...werenotpresentlyavailabletoconservatee.'TheCourtfurtherheld`... astothosemedicalprocedurespermittedaftercourtauthorizationtheLegislaturehasrequiredajudicialdeterminationthat theconditionoftheconservateerequiretherecommendedcourseofmedicaltreatment.'TheCourtalsofounditis
149

necessaryto`preservetheright...tobefreeofintrusivemedicalandsurgicalprocedures.'

155

"In PrincevMassachusetts ,TheUnitedStatesSupremeCourtruledthat`parentsmaybefreetobecomemartyrs themselves.Butitdoesnotfollowtheyarefree...tomakemartyrsoftheirchildrenbeforetheyhavereachedtheageoffull 156 andlegaldiscretionwhentheycanmakethatchoiceforthemselves.' "

Dr.CarsonStrong, 157 writes:

"....Thefirstviewemphasizesthepatient'sstatusasaperson.Accordingtothefirstview,respectforpersonsrequiresthat thelivesandbodiesofpersonsbeinviolable.Decisionsshouldbefirmlyguidedbyconcernssuchasrespectforlife, preservationofthephysicalintegrityofthebody,andrespectforthereproductivecapacitiesofpeople.Thus,itiscentral tothisviewthatrespectforpersonsbesecuredbyadherencetocertainrulesdesignedtoprotecttheinviolatenessof persons.Theserulesincludethefollowing:....andthephysicalintegrityofthebodyshouldbepreserved.Thisview appropriatelycanbereferredtoasthe`inviolabilityofpersons'view." And"Bycontrast,thesecondapproachmightbecalleda`beneficencecentered'view.Itfollowstheimportantethical principlethatwhenapatient'swishesareunknown,surrogatedecisionmakingshouldbeguidedbythepatient'swell being.Inthebeneficencecenteredview,decisionsshouldbeindividualizedtothespecificpatient'sneeds,ratherthan basedonfirmrules." "Whenafamilymemberservingassurrogatedecisionmakerisnotactingonthebasisofoneofthese`legitimate'standards [substitutejudgementstandardorthebestinterestsstandard](forexample,whenthesurrogateweighsfamilyinterests againstpatientinterests),anydecisionmadeonbehalfofthepatientmaybequestioned,andinitiativestakentoreplacethe surrogatedecisionmaker...."

RuthMacklin158 ,makesthepointthat:
"Despitetherecentdeclineintheuseofthebestintereststandardforincompetentadultpatients,thatstandardhas prevailedinmedicalsituationswherethepatientsarechildren....Theoncesimplepictureofparentsasthesoleandproper decisionmakerfortheirchildrenhasbeenalteredbyanumberofdifferentdevelopments.Oneistheriseofthechildren's rightandchildren'sliberationmovements,leadingtoacallforincreaseddecisionmakingautonomyforadolescentsand evenyoungerchildren.Arelateddevelopmentistheideathatchildrenneedadvocatestospeakontheirbehalfwhen parentsdecideoractwrongly."

TheAmericanAcademyofPediatricshasconsidered 159 theethicalproblemofconsentbyparentstothemedicaltreatmentofchildren. Whilstfarfrombeingwithoutflaws,thestatementdoeshighlight(evenifitthensomewhatducks)thecentralproblemoftensionbetween theparents'wishesandthebestinterestsofthechild.

"Thus`proxyconsent'posesseriousproblemsforpediatrichealthcareproviders.Suchprovidershavelegalandethical dutiestotheirchildpatientstorendercompetentmedicalcarebasedonwhatthepatientneeds,notwhatsomeoneelse expresses.Althoughimpassesregardingtheinterestsofminorsandtheexpressedwishesoftheirparentsorguardiansare rare,thepediatrician'sresponsibilitiestohisorherpatientexistindependentofparentaldesiresorproxyconsent.[citing: 160 Weir ]."

13.3.4ConsenttoTreatmentofChildreninEnglishLaw
13.3.4.1Sv.S,Wv.OfficialSolicitor InSv.S, Wv.OfficialSolicitor 161 LordMacDermottsaid,inausefulcommentastotheparamouncyoftheinterestsofthechild:
"OntheauthoritiesthatIhaveseentodate,oneshouldlookatwhataretheparamountinterestsofthechildotherinterests aresubordinate,unlesstheyeithercoincidewiththemorunlessthereissomeexceptionalreasonforgivingeffecttothem."

Theconclusionwasinthatcasethatsomeprocedures(therethetakingofabloodsampletoresolveapaternityquestion)couldbe permittedonthebasisofalowertestthanthebestinterestsofthechild,namelythatitwouldbepermittedifitcausednoharmtothe child. 13.3.4.2Gillick InGillickvWestNorfolkandWisbechAreaHealthAuthority 162 LordFrasersaid:

"Itwas,Ithink,acceptedbothbyMrsGillickandbytheDHSS,andinanyeventIhold,thatparentalrightstocontrola childdonotexistforthebenefitoftheparent.Theyexistforthebenefitofthechildandtheyarejustifiedonlyinsofaras theyenabletheparenttoperformhisdutiestowardsthechild,andtowardsotherchildreninthefamily.Ifnecessary,this propositioncanbesupportedbyreferencetoBlackstone'sCommentaries(1BlCom(17thedn,1830)452),wherehewrote: `Thepowerofparentsovertheirchildrenisderivedfromtheirduty'....Oncetheruleoftheparents'absoluteauthorityover minorchildrenisabandoned,thesolutiontotheprobleminthisappealcannolongerbefoundbyreferringtorigidparental rightsatanyparticularage. Thesolutiondependsonajudgmentofwhatisbestforthewelfareoftheparticular child. "(emphasisadded).

LordScarmanalsosaidin Gillick :
"Parentalrightsclearlydoexist,andtheydonotwhollydisappearuntiltheageofmajority.Parentalrightsrelatetoboththe personandthepropertyofthechild:custody,careandcontrolofthepersonandguardianshipofthepropertyofthechild. Butthecommonlawhasnevertreatedsuchrightsassovereignorbeyondreviewandcontrol.Norhasourlawevertreated thechildasotherthanapersonwithcapacitiesandrightsrecognisedbylaw.(emphasisadded)Theprincipleofthelaw,as Ishallendeavourtoshow,isthatparentalrightsarederivedfromparentaldutyandexistonlysolongastheyareneeded fortheprotectionofthepersonandpropertyofthechild...whenacourthasbeforeitaquestionastothecareand upbringingofachilditmusttreatthewelfareofthechildastheparamountconsiderationindeterminingtheordertobe made.Thereishereaprinciplewhichlimitsandgovernstheexerciseofparentalrightsofcustody,careandcontrol.Itisa principleperfectlyconsistentwiththelaw'srecognitionoftheparentasthenaturalguardianofthechildbutitisalsoa

warningthatparentalrightmustbeexercisedinaccordancewiththewelfareprincipleandcanbechallenged,even overridden,ifitbenot."

13.3.5Discussion
TheapproachestomedicalinterventionsinvolvingchildrenarediscussedbyMsLindaDelany.163 Thosewhowouldapplytoallnon therapeuticcircumcisionsadifferentand/orlowerlevelofprotectionofthechildthaneitherofthoseidentifiedbyMsDelanymustclearly articulatethis:demonstratingwhysuchadifferingapproachisnecessary,properandjustifiedagainstgenerallegalprinciplesandcivilised legalnorms. ThefactualsituationbeingdiscussedbyMsDelanyisthepracticeofrequiringachildtodonateanorganorbodilymaterialforthe benefitofanother,suchasatransplanttoaseriouslyillsiblingwhilsttheseproceduresmayofteninvolvethereductioninfunction(at leastpotentially,aswhereoneoftwokidneysisdonated)theymayalsomerelyinvolvethelossofbodyfluidswhichthedonorwill restorenaturally. AsMsDelanyobserves,thereistheapproach,whollyconsistentwiththelineoftheChildrenAct1989,oftheHouseofLordsin Gillick whereamedicalprocedureispermittedonly(myemphasis)ifitservesthebestinterestsofthechildwhoundergoesit.The second,stemmingfromSv.S, Wv.OfficialSolicitor 164 acceptsthatparentscangivevalidconsenttotreatmentswhicharenot"against theinterestsofthechild" Applying,however,eitherapproachtonontherapeuticcircumcision(wherethelossandrisksaresignificant,wherethereisnorecipient tobenefitandwhere,atbest,the`benefit'tothevictimisanintangibleandsomewhatquestionbeggingculturalidentity)wouldleadto theconclusionthataparentisnotabletogivevalidandeffectiveconsenttoanontherapeuticcircumcision:sincethemedicalliterature makesitclearthatsuchamputationsareharmfulofthevictim,consentcouldnotvalidlybegivenunderthetestin Sv.S,nor,afortiori, undertheGillick testwheretheprocedureisallowedonlyifitisinthechild'sbestinterests. Perhapsinlookingatthelimitsnowbeinglaidonparentalconsenttooperationsontheirchildren,andontheimpactofreligiousviewson thedecisiontoinflictritualcircumcisiononachild,itmightbeilluminatingtoconsiderthewordsofLordDonaldsonMRin ReT165 dealingwiththequestionwhetheraJehovah'sWitnesshadgivenavaliddirectionthatshedidnotwishtoreceiveabloodtransfusion. Didshereallymeanwhatshesaid,orhadhermindandwillbeenoverbornebyothers?Hesaid:
"Inconsideringtheeffectofoutsideinfluences,twoaspectscanbeofcrucialimportance.First,thestrengthofwillofthe patient....Second,therelationshipofthe`persuader'tothepatientmaybeofcrucialimportance.Theinfluenceofparentson theirchildrenorofonespouseontheothercanbe,butisbynomeansnecessarily,muchstrongerthanwouldbethecase inotherrelationships. "Persuasionbasedonreligiousbeliefscanalsobemuchmorecompellingandthefactthatargumentsarebeingdeployed bysomeoneinaverycloserelationshipwiththepatientwillgivethemaddedforceandshouldalertthedoctorstothe possibilitynomorethatthepatient'scapacityorwilltodecidehasbeenoverborne.Inotherwordsthepatientmaynot meanwhathesays."

Therearethose,circumcisedatbirthforsolelysocietalreasons,whofindthattheirchosenconversioninadultlifetoreligions,suchas(it isunderstood)HinduismandBuddhism,havebeenimpededbythetenetsofthosereligionsthatthelossofbodypartsiswrongunless requiredforcompellingmedicalreasons.Thedecision,takenfor,andimposedupon,theminearlylifeastothecultural/religiousidentity theyweretofollowhasdeprivedthemofthefundamentalrighttodecideforthemselvesinadultlifewhethertofollowareligion,andifso whichreligiontofollow.

14.EuropeanCharterforChildreninHospital
Thisprovidesthattherighttothebestpossiblemedicaltreatmentisafundamentalright,especiallyforchildren.Inparticular,itrequires thatchildrenandtheirparentsbeinformedinamannerappropriatetotheirageandunderstanding,andhavearighttoinformed participationinalldecisionsinvolvingtheirhealthcare.Thatstepsbetakentominimisephysicalandemotionalstress.Thateverychildbe protectedfromunnecessarymedicaltreatmentandinvestigation.That childrenbetreatedwithtactandunderstandingandtheirprivacyberespectedatalltimes. Dr.PriscillaAlderson 166 comments:
"AspectsoftheCharterwerereinforcedbythe1989UnitedNationsConventionontheRightsoftheChild...Basicallythe Conventionadvocatesthreekindsofrightsforchildren.Adultsarehappytodiscussthefirsttwokinds: "rightstoresourcesandcaregoodhospitalcare,food,warmth,safety,parent'slovingcare "rightstoprotectionfromharmfromneglectandabuse,fear,painandloneliness,fromtoomanymedicalinterventionsor theneglectofbeingdeniednecessarymedicaltreatment.However,manyareuneasyaboutthethirdkind: "rightstoselfdetermination,dignity,respect,integrity,noninterference,therighttomakeinformedpersonal decisions....Yettherighttoselfdeterminationisthekeytoallrights.Youcantalkaboutresources,careandprotection undertheheadingofchildren'swelfareorinterests,butdonotneedtouserightslanguagetopromotethesebenefits.The 167 righttochoseisacrucialpartofbeingarightholder.AliceMiller,theSwisspsychoanalyst,hasshown thatcenturiesof harsh,evencruel,childrearingillustratedifferencesbetweenadults'ideasof`care',`protection',whatis`rightforchildren', versuschildren'srightstochosehowtheywouldliketolive."

The`NHS:ThePatient'sCharterServicesforChildren'(Apr1996)followstheseconceptsif(andexperiencewiththeCitizen's Chartertodategenerallydoesnotinspireconfidence)theguidelinesareproperlyandfullyapplied,itwouldnotbewithintheCharterfor

anynontherapeuticcircumcisiontobeperformedinanNHShospital.TheChartermakesitclear(page2)thatthecareisowedtothe child,whomust(page13)begivenanexplanationofthetreatmentproposed(includingbenefits,risksandalternatives)andthechild's emotionalanddevelopmentalneedswillbetakenintoaccount.Noneoftheseadmirableaimscanbeotherthanfloutedifaboyis circumcisedbyadoctor(nomatterwhetherhepurportstobeactinginamedicalorreligiouscapacity)attherequestoftheparentsfora nontherapeuticreason.

15.EuropeanConventiononHumanRights
PartIIIoftheConsultationPaperdiscussestheEuropeanConventiononHumanRights(`ECHR').Inparagraph3.12,Article3ECHR isquotedwhichprovidesthat:
`Nooneshallbesubjectedtotortureortoinhumanpunishmentordegradingtreatment'

InTyrervUK168 theStrasbourgCourtadoptedthedisjunctiveinterpretationofArticle3ECHR(seealsoparagraph3.13etseqofthe ConsultationPaper). Article8ECHRprovidesthat:

(1)everyonehastherighttorespectforhisprivateandfamilylife,hishomeandhiscorrespondence. (2)thereshallbenointerferencebyapublicauthoritywiththeexerciseofthisrightexceptsuchasisinaccordancewiththe lawandisnecessaryinademocraticsocietyintheinterestsofnationalsecurity,publicsafetyortheeconomicwell beingof thecountry,forthepreservationofhealthormorals,orfortheprotectionoftherightsandfreedomofothers.

InCostelloRobertsvUK169 thecourtacknowledgedthattheconceptof`privatelife'coveredaperson'sphysicalandmoralintegrity. Inparagraph3.22,Article9ECHRissetoutinfull:

(1)Everyonehastherighttofreedomofthought,conscienceandreligionthisrightincludesfreedomtochangehisreligion orbeliefandfreedom,eitheraloneorincommunitywithothersandinpublicorprivate,tomanifesthisreligionorbelief, worship,teaching,practiceandobservance. (2)Freedomtomanifestone'sreligionorbeliefsshallbesubjectonlytosuchlimitationsasareprescribedbylawandare necessaryinademocraticsocietyintheinterestsofpublicsafety,fortheprotectionofpublicorder,healthormorals,orfor theprotectionoftherightsandfreedomofothers.

InArticles8and9thereisaneedforabalancingactbetweentheindividual'sfreedomsandthenecessaryrestrictionsonthemas requiredforanumberofpublicpolicyreasons,oneofthemoreimportantofwhichistheneedtoensurethatanother'sfreedomsarenot therebyinfringed.Asisnotedinparagraph3.23,Article9ECHRthusdrawsadistinctionbetweentherighttofreedomofthoughtetc andtherighttomanifestone'sreligionorbeliefs.:astheCommissionobserves,itisnecessarytoconsidernotonlywhetherarestriction ofaparticularreligiouspracticeinfringesArticle9(1)butalsowhethersuchrestrictioncanbejustifiedunderArticle9(2).Seealso Article14UNConventionontheRightsoftheChild. Giventheindividual'sright,Article8ECHR,tobodilyintegrityandthelimitationonthemanifestationofareligiouspracticeunderArticle 9(2),givenalsothelossofbodilyintegrity,thepain(whichfallswithintheprohibitionofinhumantreatmentinArticle3ECHR),therisks andinevitabledysfunctionofmaleritualcircumcision,ithardtoseehowthepracticeoftheritualcanbepermittedtocontinuegiventhe medicallydemonstratedrisksanddysfunction.Theclaiminthenameoffreedomofreligionforthecontinuationofthisritualcannotbe accepted:therestrictiononthispracticeisjustified,notonlybyArticle9(2)butalsobyArticles3and8ECHR.

16.Thereligiousdemands
Inherentdifficultiesinthefreedomofreligiousthoughtandtherestrictionsthatmighthavetobeplacedasamatterofpublicpolicyonthe practiceofcertainaspectsofreligionaretouchedoninPartIIIandalsoinPartIX. ItisclearthattheCommission,indealingwiththequestionofritualmalecircumcisionhasbeenheavilyinfluencedbythefactthatitis practisedbyJewsandMuslims:inparagraph9.2,itisdescribedasbeinginsistedonbyIslamicandJewishlaw(seealson.2tothat paragraph)evenifthatbeso(anditisfarfromcertainthatitisso),thereisnoreason(otherthanperhapsawhollymisplaced`political correctness')forthedifficultiesbothlegallyandmorallyinsuchapracticebeingignored.Indeed,onthebasisoftheCommission'sown proposals(seeparagraph9.27andPartXVIparagraph36)circumcisioninthenameofanyotherreligionorbyanyotherculturalgroup wouldnotenjoytheproposedexemption.TheproposedexemptionwouldapplysolelytoJewishandMuslimcircumcisions,which promptsthequestion`Why?':isitthattheprocedureisrecognisedasharmfulandthusmustbeconfinedtothesetworeligionsonlyasa specialexception,inwhichcasewhereisthediscussionofthis,oristhisaninadvertentomissionbasedonawhollyinadequately thoughtoutposition?Whicheverthereason,theCommission'streatmentisunacceptablebothasitstandsandasamatterofprinciple andpublicpolicy. TheCommissiondoesdiscuss,insomewhatsuperficialterms,theissuesofhumanrightsinthecontextofotherconsensualassaultsona personindeedthetensioninherentinthefreedomofreligiousthoughtandtherestrictionsthatmighthavetobeplacedasamatterof publicpolicyonthepracticeofcertainaspectsofreligionaretouchedoninPartIIIandalsoinPartIX.Thatthesediscussionsmight haveanybearingonthepracticeofareligious/ritualmutilationeitherseemnevertohaveoccurredtotheCommissionor,perhaps,the Commissionfeltthatthepracticewouldinevitablybeseenasoffendingagainstthefundamentalhumanrightsofthenonconsentingvictim ifitwerediscussedanddecidedtoducktheissue.Thisomissionofanydiscussionofthereligiousandculturaldimensionsofritual circumcisioninaconsultationpapersuchasthisisnotacceptable.

ItwouldseemthattheCommission'sstanceisdrivenbytwofactors:awishtopreservewhatitseesas`traditional'andaperceivedneed toplacate(atanycost?)theJewsandMuslims(butnotseeminglyanyothergroupwhocircumciseforritualreasons).Thesefactors appeartohaveproducedatreatmentofritualmalecircumcisionwhichismisleadingtothepointofdishonesty,whichdismissesthe matterinascantfewlinesandwhichavoidsanydiscussionoftherealissues(perhapsbecausetodiscussthemwouldbeclearlyto demonstratetheunacceptabilityandunlawfulnessofthepractice). Asfortheargumentoftradition,thewordsofOliverWendellHolmesseemapposite:

"[I]tisrevoltingtohavenobetterreasonforaruleoflawthanthatsoitwaslaiddowninthetimeofHenryIV.Itisstillmore revoltingifthegroundsuponwhichitwaslaiddownhavevanishedlongsince,andtherulepersistsfromblindimitationof 170 thepast" .

Further,inrelationtoritualmalecircumcisionatleast,theCommission'sphilosophicalpositionwouldseemtobeoneof`Legal Moralism'andthediscussionofthatstance,andthecriticismsofitbyMrRobertsinAppendixCoftheConsultationPaperareapt. ProfessorDwyer 171 convincinglyarguesthattheviewthatparentshaverightsovertheirchildrenisincorrectanduntenable:therights resideinthechildrenwiththeparentsactingasagentsforthechildrentoenforcethoserights.Dwyeriswritingfromacultureanda constitutionwhichsetsgreatstoreonfreedomfromstateinterferenceandonreligiousfreedom,tothepoint,heargues,thatthecorrect positionhasbeenblurred.Insuggestingashedoes,DwyerechoesEnglishlawastothenatureoftheparentchildrelationship. HetakesashisbasisthattherightsgivenbytheAmericanConstitutionaregrantedtoanindividualforhimtodeterminehisownaffairs therighttodeterminetheaffairsofanotherisnotageneralright,evenwheredecisionsaretakenforanincompetentadult,andheargues thatdictasuggestingthatthisrighttodeterminetheaffairsofanotherexists,exceptionally,inrelationtotheparentandchildisflawed.He seessimilaritiesintheconceptoftheclaimedrightsofparentsovertheirchildren(theirclaimed`otherdeterminingright')withslavery whichisprohibitedbyvirtueofthe13thAmendmenttotheAmericanConstitution[AmendmentXIIISection1:`Neitherslaverynor involuntaryservitude,exceptasapunishmentforcrimewhereofthepartyshallhavebeendulyconvicted,shallexistwithintheUnited States,oranyplacesubjecttotheirjurisdiction'].HecitesArmerandWidawsky172 definingslaveryasa"powerrelationofdomination, degradation,andsubservience,inwhichhumanbeingsaretreatedaschattel,notpersons." Dwyermakesthepoint(intermsthatalsomadebytheQueenslandLawReformCommission,supra)that"itisnotselfevidentthata connectionexistsbetweenparents'religiousbeliefsandchildren'sinterests"itwouldbenecessarytohavetodemonstratethis connection"inorder,itwouldseem,tojustifytheSupremeCourt'sdeterminationthatparentsshouldhavegreaterrightsofcontrolover theirchildren'sliveswhenparentalpreferencesregardingtheupbringingofchildrenarisefromreligiousratherthansecularbeliefs.Itis necessarytoshowthattheveryfactofadheringtoareligionanyreligionwhosetenetsincludepreferredmodesofparentingmakes aparentbetterableormoredisposedtofurtherthetemporalinterestsofthechild"andhemakesthepointthat`temporal'interestsare allthattheStatecanproperlyconcernitselfwith. Further,heobservesthat"itisveryoddtotieoneperson'srightstoanotherperson'sinterests.Inourlegalculture,rightsordinarily protecttherightholder'sinterests,nottheinterestsofotherpersons.Thus,itisfittingtoaskwhy,ifwhatwearemostconcernedwithis protectingchildren'sinterests,wedonotgrantchildrenthemselvestherightsnecessarytoprotectthoseinterests.Why,instead,dowe relyontheconceptuallyawkwardnotionofparent'srights?" AsDwyersays:
"...evenifitdoesonthewholefurtherparents'intereststopossessrightstodirecttheirchildren'slivesinwaysthatare harmfultothechildren,thestateshoulddeemsuchinterestsillegitimateandrefusetogivethemprecedenceoverthe interestsofchildren.Theproblemwithsuch`interests'isthattheyentailtreatingchildreninstrumentally,usingchildrenin waysthatsacrificetheirwelfareinterestsinordertofurthertheulteriorinterestsofparents"and"Thisistruewhetherthe parents'motivesareselfregardingorsolelyconcernedwiththewellbeingofthechild(e.g.iftheparentsbelievetheyare sacrificingthechild'stemporalinterestsinordertofurtherthechild'sspiritualinterests).Ifstatedecision makersthemselves believecertainparentingpracticesordecisionstobeharmfulforachild,thentheiradvocatingparentalrightstoundertake thosepracticesordecisionsnecessarilymeansthattheyarewillingtoacceptthesacrificeofthechild'sinterestforthesake ofsatisfyingtheparents.Thereluctanceofliberalsinparticulartotakeastandagainstreligiouslymotivatedparentingof whichtheypersonallydisapproveis,Ibelieve,duelargelytotheirbelievingthatliberalvaluesoftoleranceandrespectfor diverseideologicalviewsrequirethestatetodefertotheviewpointoftheparentsindeterminingwhetherparticular parentingpracticesshouldbepermissible.Thismightbeadefensiblepositionfromwhichtodeterminethepermissibilityof whatindividualsdotothemselvesorwhatconsentingadultsdotoeachother.However,itisamistakeinthecaseof children,whoarenotthesamepersonsastheirparents,nor,ingeneral,consentingparticipantsinthereligiouspracticesof theirparents.Liberalsshouldinsteadviewthechildrearingbehaviorsofparentsthesamewaytheyviewactionsaffecting anyothernonconsentingpersons.......wedonotsimplygivepeoplerightstouseother,non consentingpersonsas instrumentsfortheadvancementoftheirowninterests.Nordowepermitpeopletoinflictwhatamajorityofthecommunity considerstobeharmonother,nonconsentingpersons,regardlessoftheirmotivationsfordoingso."

Dwyerconcludesthathisanalysisshowsthat"noneoftheintereststhatmaybeboundupintheconflictbetweenparentsandtheState overtheappropriateformsofchildrearingsupportstheperpetuationofparents'rights.Objectionstostateinterventionsthatwouldbe detrimentaltothewellbeingofachildcanstandentirelyonanassertionofthechild'srights.Parents'rightsarenecessaryonlytoward offstateinterventionsthatwouldonthewholeenhanceachild'swellbeing.Thataimisillegitimatebecauseitentailsawillingnessto sacrificethewelfareinterestsofchildreninordertoadvanceuncertain(giventhepossiblelongtermharmtotheparent/childrelationship discussedabove)and,inanyevent,nonfundamentalinterestsofparentsorofothermembersofsociety.Wedonotallowadultstobe treatedasmereinstrumentsfortheachievementofothers'ends,andweshouldnotallowchildrentobetreatedinthiswayeither." ProfessorBrigman,some10yearsearlier,arguedthatcircumcisionwasaformofchildabuse 173 .HetooarguesthattheUScourtsare entitledtointerveneinfamilylifeand/orreligiouspracticewhen,asitwasputinWisconsinv.Yoder,(op.citatn.167)"...itappearsthat parentaldecisionswilljeopardisethehealthorsafetyofthechild,orhaveapotentialforsignificantsocialburdens."Inconsideringthe
174

religiousbasisofritualcircumcisionhestartswiththeUSSupremeCourtdecisionofReynoldsv.UnitedStates (involvingthe prosecutionofaMormonforbigamy)wheretheCourtdistinguishedbetweenreligiousbeliefsandreligiouspracticesandruledthatwhile thegovernmentcouldnotinterferewithreligiousbeliefs,itcouldlimitpracticesperformedinthenameofreligionthatwereharmfulto society.Todootherwise,accordingtotheCourt,wouldbeto"maketheprofesseddoctrinesofreligiousbeliefsuperiortothelawofthe land,andineffecttopermiteverycitizentobecomealawuntohimself."

17.Theculturalclaim
Inparagraph9.13etseqreligiousandculturalpracticesarediscussedandthecaseofAdesayna summarised.In(1975)24ICLQ136 MrSebastianPoulter,insupportingthecorrectnessoftheAdesayna decision,suggested(seealsotheConsultationPaperparagraph 9.15)thatpossiblereasonsinadditiontothejudge'swere:thethinkingbehindtheTattooingofMinorsAct1969theincreasing inobservanceoftheritualinNigeriawhichmadespecialtreatmentoftheritualinEnglandandWaleslessacceptableandtheneedto applythecriminallawequallytoeveryone. Accordingtoparagraph9.16,MrPoulterchangedhismindsome12yearslater,in EthnicMinorityCustoms,EnglishLawand HumanRights 175 .ThediscussionofMrPoulter'sviewsinparagraph9.17etseqgivesasomewhatmisleadingimpressionofhisviews, however.WhatMrPoultersuggestsisthat,whilstitmightbeappropriatetoallowsometolerancetominorities,therearelimitsonthat tolerance.Thesehesuggests,pacenote48toparagraph9.18,aretobefoundintheneedtorecognisethefreedomsofothers.He writesthatclaimsbasedonreligiousorculturalfreedomwhichviolateother'sfundamentalrights"mustclearlyfail.....anycustomwhich deniesanotherpersontherighttolife(e.g.humansacrifice)orinvolvescruel,inhumanordegradingtreatmentorpunishment(e.g. physicalmutilationofwrongdoersorfemalecircumcision)isboundtobedeniedrecognition."Thus,contrarytotheimpressiongivenby footnote48,femalecircumcisionismentionedasbutoneexampleofpracticeswhichgobeyondtheproperlimits. MrPoultercontinuesthattheclaimforreligiousfreedommayberejectedonthebasisofthevariouslimitedgrounds,e.gpublicorderor publicsafety."SimilarlyifitcouldbescientificallyprovedthattheJewishandMuslimmethodsofslaughterinvolvedgreatersufferingthan prestunningtheremightbeacaseforarguingthatthespecialreligiousexemption(ins.36(2)SlaughterhousesAct1974)shouldbe repealedonthegroundthatcausingunnecessarysufferingoffendsagainstcurrentnotionsofpublicmorality." ThereisnothinginMrPoulter'sarticlewhichwouldsupportthenotionthathewouldplaceahighervalueonthepreventionofcrueltyto animalsthanhewouldtothepreventionofcruelty,risksanddysfunctiontochildren.MrPoulteristhusagreatdeallesspermissivethan theConsultationPaperwouldsuggest:whilsttherearesomedifferencesbetweenmaleandfemalecircumcision,thepainisbroadlythe same,thelossofsexualfunctionexistsinboth(eventhoughthelossmaybegreaterinthefemalebecauseofthegreaterexcisionofflesh typicallyperformed)andbothinvolveinvoluntarylossonthepartofthevictimofbodilyintegrity,cruelandinhumantreatment,and permanentdisfigurement:alltheseareviolationsofthefundamentalrightsandfreedomsoftheunconsentingvictim. Onecanperhapspredictanargumentfromthosewhowouldcircumciseasamatterofritualorcustomthatthechild`benefits'froma procedurewhichmarkshimasamemberofarace,group,tribe,sectorreligionandthatcontinuingobservanceofthereligious demandsofritualmutilationformanimportantbondbothofthegroupitselfandofthechildtothegroup.Analternativeargumentmight beadvancedthatinadditionto`groupidentity'fromcircumcision,thereisthedangerthatifainfantisnotcircumcisedinaccordancewith thedictatsoftheparentalcultureand/orreligionthatchildmightsufferrejectionbythefamilyand/ortheremightbetensionswithinthe familyarisingfromthechild'sintactstatus.Theobjectionstotheseargumentsincludethatafamilyorgroupwhichissoinsecureand disturbedastoplacenovalueonthechildasanindividualandwhichregardsthechildasnomorethanapossession,apttobesubjected togenitalmutilation,islikelyalreadytobedysfunctionalinthebroadestsense. Ritualcircumcisionistoignoreboththepainandharmoftheprocedureandthatitisinflicteduponachildwhosefundamentalhuman rightsareoverridden,andwhosefreedomtochoseinadultlifehisownbeliefsystemshasbeenimpairedandtheywouldtradean inevitablesexualdysfunctionforthepossibleavoidanceofdamagestemmingfromtheirowninabilitytocopewiththeconsequencesof accordingtheirchildrenfulllegalrights.Thosewhowouldtrytoargueforthecontinuationofthisritualmutilationdosoaspartiprisand canderivenosupportfromthemedicalevidencenorfromacademicssuchasMrPoulterand(seemingly)ProfessorFeldman 176.

18.TherealityofmalecircumcisionandtheConsultationPaper'sproposals
TheCommission'sview,inparagraph9.1,astotheallegedclarityofthelawconcerningritualcircumcision,(echoedinparagraph9.2: "MalecircumcisionislawfulunderEnglishcommonlaw")isunderminedbytheConsultationPaperitself.Ifthelawwereindeedasclear astheCommissionwouldhaveusbelieve,thenitiscuriousthatACPOsawaneed,asreportedinparagraph9.2,to"maketheposition entirelyclear"itisalsoofnotethatreferenceismadeto"formulatingrulesastothenatureoftheconsentgivenbythevictimandthe limitsandthecircumstancesinwhichconsentislegallyeffective."Exhypothesi,thevictimdoesnot,andcannotconsent,becauseheisan infantoryoungchildparentspurporttoassentonhisbehalf,butthatisnotthesame.Further,thelimitsetcofconsent,assuggestedby ACPO,arenottouchedoninrelationtoritualcircumcision. TheCommission'spropositionisfurtherunderminedbythelastsentenceofparagraph9.2.TheCommission'sproposal(seeparagraph 8.50)isthatthe`medicalexemption'beconfinedtoa`dulyregisteredmedicalpractitioner'.Ifthelawwere`clear',asallegedbythe Commission,andritualcircumcisionwerelawfulatcommonlaw(andtheinferencethatthereaderoftheConsultationPaperisinvitedto drawisthatitissolawfulasanexceptioninitsownrightratherthanasafeatureofamedicalprocedure),thentheallegedlawfulness wouldcontinueanditwouldbeirrelevantwhethertheoperatorwasadulyregisteredmedicalpractitioner,capableofbenefitingfromthe `medicalexemption',ornot.Further,itwouldnotbenecessaryto"putthelawfulnessofritualmalecircumcisionbeyondanydoubt"(as suggestedinparagraph9.27)ifthelegalpositionwereintruthasstatedbytheCommissioninparagraphs9.1and9.2. Ritualcircumcisionis(apartfrommedicaltreatmenttoapersonunabletoconsentforhimself,andlawfulcorrection)asituationwhere thevictimisnotconsentingforhimselftotheinflictionofviolenceuponhisperson.Thepersonpurportingtoconsentonbehalfofthe circumcisedvictimiseitherthepersoninflictingtheviolenceorthepersonwho,inthewordsoftheChildrenandYoungPersonsAct

1933,`causesorprocureshimtobeassaulted.....inamannerlikelytocausehimunnecessarysufferingorinjurytohealth'.Itthusseems whollyinappropriatetodealwithritualcircumcisioninapaperdealingwithsituationswherethevictimhasconsentedforhimselftothe inflictionuponhisownbodyofinjurytheconsiderableconfusionofthoughtintheConsultationPaperwouldhavebeenavoidedhadthe issuesofmedicaltreatment(particularlyforthoseincompetenttoconsent),lawfulcorrectionandnontherapeuticcircumcisionbeendealt withasquitedifferentandseparatequestions.Indeed,itishardtoresistthesuspicionthattheinclusionofritualcircumcisioninthe ConsultationPaperwasanattemptslipthroughand/orpassoffaslegitimateapractice,whichcausesgravedamageandisabreachof civilisedlegalnorms,undercoverofaliberalisationgenerallyofthelawontheinflictionofrelativelyminorandessentiallyselfauthorised injuries. Medicaltreatmentcanbeseenashavingasitsessentialendaimthecureand/orpreventionofadiseaseprocessanditisthatpurpose whichjustifiesitsbeingdoneeventothepointofconsiderablemutilation.Sports(wheretheparticipantsare,ofcourse,volunteers)can, ofcoursebethesourceofseriousinjuries,butthemoreusualcuts,scrapesandbruisesare,typically,minorandquicktohealwithno lastinglongtermeffectsandthebenefitsofexercisecanbeseenasjustifyingtheriskofinjury.Equally,parentalcorrectiontendsinflict morepainthandamageand,itisacommonplacetostate(butseeLordMustillin Brown atp267A),thatitmustnot"gotoofar"and mustbe"forthepurposeofcorrectionandnotthegratificationofpassionorrage."Ifitgoestoofarthenthecourtscananddointervene. Indeed,itisironicthattheprincipleofphysicalcorrectionofchildrenisincreasinglycomingunderattack,bothdomesticallyand internationallybutthefargraver,andirreparabledamageofcircumcision,attractsonlyaperfunctorymentionbytheConsultationPaper. Evenif(whichisdoubted)theCommissioniscorrectinstatingthatcircumcisionhasbeenlawfulatcommonlaw(andthatonthebasisof onlytwocaseswherementionofitwasprobablyobiter),itisperhapsnottoofancifultoseetheattitudetocircumcisionasstemming fromitshistoricalperspective.OriginallyitwaspractisedinBritainonlybyJews,whowerehistoricallyseeninBritainasanaliengroup notwhollyunderthelawanditsprotection(aswiththelawsagainstusury)andMuslims.ThustheJewishandMuslimritualmutilationof theirinfantboyscouldbeseenasnothavinganimpactonsocietyasawhole.Further,giventhatthereisnorequirementfora professionalqualificationfortheperformingofasurgicalintervention,mightnotthenonprosecutionofritualcircumcisionalsohave flowedfromitsquasi`surgicalandmedical'connotations,particularlywhenwronglyitwasseenashavingfewdisadvantages,ratherthan fromitsbeinganexemptedprocedureinitsownright. Certainly,inthe19thcentury,circumcisionacquiredthepseudomedicaljustificationasbeingpreventiveofmasturbation(andtheillness thoughttofollowfrommasturbation)and,thus,anymorerecentgeneraltoleranceofcircumcisioncanbeseenasderivingfromthe latitudeaccordedmedicaltreatment(beittheVictorianrationaleortheequallymedicallydiscreditedclaimsofmorerecentyears),rather thancompellingevidenceofitsbeingoneoftheexemptionsfromtheprohibitionagainstviolence.Amedical`justification'wouldalso servetogiveritualcircumcisionaspuriousrespectabilityandjustification.

18.1Commission'sproposals
TheCommissionsumsupitsproposalsinPartXVI.Inparagraph1,itproposesthatthesameprinciplesshouldapplytoallinjuries inflictedwithconsent(soitsays,butthendrawsadifferenttreatmentforritualcircumcision)thattheinfliction,paragraphs2and3,of `seriouslydisablinginjury'shouldremainacriminaloffencebutthattheinfliction,paragraphs5and6,oflesserinjuriesshouldnotbea criminaloffence. `Seriouslydisablinginjury'isdefinedinparagraph7asaninjurywhich: (1)causesseriousdistress,and (2)involvesthelossofabodymemberororganorpermanentbodilyinjuryorpermanentfunctionalimpairment,orseriousorpermanent disfigurement,orsevereandprolongedpain,orseriousimpairmentofmentalhealth,orprolongedunconsciousnessandindetermining whetheraneffectispermanent,noaccountshouldbetakenofthefactthatitmayberemediablebysurgery. Inparagraph12,theCommissionproposesthatavalidconsentmaynotbegivenbyapersonwithoutcapacity(andcapacityis discussedin,interalia,paragraphs13and14).Anexceptionisproposedfor`propermedicaltreatment,paragraph31,whichisdefined in31(2).Inparagraph38,theCommissionproposesthatnovalidconsentmaybegivenbyapersonundertheageof18toinjuries inflictedfor`sexual,religiousorspiritualpurposes'. Itisremarkablethat,againsttheseproposals,malecircumcisionisdismissedwithafewperfunctorylinesinPartIX(see,bycontrast,the lengthofPartXIonlawfulcorrection),andwiththeoccasionalreferenceselsewhereintheConsultationPaper.EveniftheCommission's whollyerroneousassertion,unsupportedinanyway,thatitis`generallyacceptedthattheremovaloftheforeskinofthepenishaslittle,if any,effectonaman'sabilitytoenjoysexualintercourse'wereright,onemighthaveexpectedsomediscussionastowhyritualmale circumcisionshouldbeexceptedfromthegeneralprinciplesand,inparticular,fromthegeneralproposalinrelationtoconsensualinjuries forsexual,religiousorspiritualpurposesatparagraph38ofPartXVI.Equally,itisverydifficulttounderstandwhy,whenitbydefinition requirestheamputationofthehealthyandfunctionalfleshfromahealthypenis,itistoberegardedasdifferingfromanyotheramputation andisanact`not,therefore,regardedasmutilation'(seeinparticularthedefinitionsof`mutilate'and`mutilation'above)andaccorded somespecialtreatment.Further,asansomewhattechnicalaside,anexemptionforcertainritualcircumcisionsforcertainmembersof religiousgroupsmight(butIhavenotthoughtitworthpursuingthisminorpoint)renderanyBillcontainingsuchaproposalhybrid. Again,thefactthattheconsentbutnotthesacrificecomesnotfromthevictimbutfromapersononhisbehalf,mighthaveindicateda needforarathermorethoroughexaminationofthisritualinflictionofpainful,riskyandgravelydamaginginjury. Further,thoughinparagraphs3.223.27and9.139.19thereissomediscussionofreligiousandculturalissues,thereisnomention thereofritualmalecircumcisionalbeitthattheveryreasonofritualmalecircumcisionisreligiousforJewsandMuslimsandculturalfor othergroups.

Theremarkthat`itisgenerallyacceptedthattheremovaloftheforeskinofthepenishaslittle,ifany,effectonaman'sabilitytoenjoy sexualintercourse'is,initsadoptionofforeloreandmythanditswoefulfailuretomakeevenacursorysearchofthebodyofmedical literature,unworthyofabodychargedwiththeconsiderableresponsibilityofexaminingthebodyofEnglishlaw.Themedicalevidence, butbrieflydiscussedabove,rendersthethrustofparagraph9.2oftheConsultationPaperquiteuntenable.WhilsttheEditorialComment intheBritishJournalofUrology ,77,1996:925wasnotavailabletotheCommissionwhenitproducedtheConsultationPaper,the materialonwhichthatcommentisbasedwasreadilyavailable. Theclaimoflegalityofthismutilatingprocedureundercommonlawisnotonlymadewhollywithoutanyauthoritybeingcitedinsupport, butisanassertionwhichisopentoconsiderabledoubt,evenbeforethe20thcentury'smoreenlightenedviewofchildren.Further,itis clearthattheCommission'sviewofritualcircumcisionandthusofitsallegedlegalitydependscruciallyontheassertionastothelackof harmbeingcorrect:tothepointthatonceharmcanbeobjectivelydemonstrated,theassertionastothelegalityofitfails. Itisagainstthemedicalstudiesofcircumcisionthattheproceduremustbelookedattoseewhetherornotitisasharmlessasthe ConsultationPaperwouldwishtosuggestinpara9.2orwhetheritisinrealitynotonlyharmfulbutthattheharmissuchthatisreadily fitsinsideeithertheexistingdefinitionof`grievousbodilyharm'orthePaper'snewlevelofinjury,namely`seriouslydisablinginjury'.

18.2`Seriouslydisablinginjury'
IntheCommission'sproposalsintheConsultationPaper,`Seriouslydisablinginjury'istobedefinedasaninjurywhich: (1)causesseriousdistressand (2)involvesthelossofabodymemberororganorpermanentbodilyinjuryorpermanentfunctionalimpairment,orseriousorpermanent disfigurement,orsevereandprolongedpain,orseriousimpairmentofmentalhealth,orprolongedunconsciousness.(myemphasis). Thepainexperiencedasainevitableconsequenceoftheunanaesthetisedcircumcision,quiteapartfromthedistresswhichmightbe causedbysomeoralloftherangeofcomplicationsandarealisationinlaterlifeoftheinevitablelosses,meansthatcircumcisionsatisfies thefirstlimboftheproposeddefinition. Circumcisionalsoclearlysatisfiesalmostallofthevarious,disjunctive,headsofthesecondlimbsincecircumcisioninvolves: thelossofanorganorbodymember(theprepuce) anditinvolvespermanentbodilyinjury andpermanentfunctionalimpairment andserious andpermanentdisfigurement andsevere andprolongedpain. Inotherwordswherethesecondlimboftheproposeddefinitionwouldbesatisfiedifbutoneofthevariouscategoriesofharmwere established,circumcision(asmyemphasisseekstohighlight)satisfiesmostofthem(andthereissupportinthemedicalliteraturethatit mightalsoresultinseriousimpairmentofmentalhealth,and,insomeifnotall,casesinprolongedunconsciousness). ThereisamajorobjectiontotheCommission'sproposalatparagraph36ofPartXVIthat"Weprovisionallyproposethatthe circumcisionofmalechildren,performedwiththeirparentconsentinaccordancewiththeritesoftheJewishandMuslimreligions,should continuetobelawful":thatisthatitwouldcreateaclassofchildrenwho,solelybyanaccidentofbirthandasaresultofbeingmale infantswhohaveJewishorMuslimparents(butseeminglynot,inthewaythattheproposedexemptioniscurrentlydrafted,childrenborn toparentsofotherbeliefsystemswhocircumciseforreligious/culturalreasons)aretobediscriminatedagainstasaresultofsex,race and/orreligionandtosufferthepain,risksanddysfunctionofritualcircumcisionwhichthemajorityofboysinBritainarespared.Quite apartfromanyprohibitionsagainstdiscriminationonthosegroundscontainedininternationallaw,suchacreationofagroupof secondclasscitizenswouldseemtobebothabhorrentandtoflyinthefaceofdomesticlegislationprohibitingracialandsexual discrimination.

19.InternationalLaw
Itisnotuncommontoseeattemptsbyindividualsandgroupstotreatinternationallegalprovisions,andtoalesserdegreedomesticlaws, asiftheywereasortof`supermarketpickandmix'selectionofsweets,fromwhichthoseelementswhichtheindividualtakesas grantinghim,orpreserving,freedoms,rightsandprotectionswhichheseesasimportant,whilstatthesametimerejectingthoseother provisionswhichheregardsasintrusive(eventhoughtheyareaimedatensuringthatthefreedomsofothersaregivenpropereffect) becauseandonlybecausethepartswhichheregardsasunacceptablecontainproper(thoughheofcoursedoesnotconcedethemas beingproper)limitstohisactions.Thusthecommonprovisionastofreedomofreligionisseizeduponwithenthusiasmandthe balancingprovisionastoproperlimitssoastoprotectothersisrejected.Itisasifapersonseekstorelyonlawsagainstviolenceto himself,whilstregardinghimselfasfreetodisregardthoseconcerninghisviolencetowardsothers.

This"pickandmix"approachbecomesevenlessacceptablewhenitisclearthattheperformanceofritualcircumcisionis,atleastfor JewsandpossiblyalsoforMuslims,amethodfortheparenttobeamoreobservantmemberofhisreligionratherthananactofgrace betweenthechildandgod:theparentsacrificessomethingwhichisnothisinorderthathehimselfmightgainfavourwithhisgod. DespiteBritain'sfailuretomeetitsinternationalobligationsandtoincorporatetheEuropeanConventiononHumanRightsintodomestic legislation(seeLordMustillin Brown atp272C),thatConventionisonetowhich,asLordMustillobservedatp272F,Britainandits courtsmusthaveregard.Equally,otherinternationalinstruments,signedandratifiedbyBritaincannotbeignorednorflouted.Evenifit wereotherwise,thefundamentalhumanrightsarticulatedtherewoulddemand,asamatterofpublicpolicy,toberespected. [CIRP note:TheUnitedKingdomlaterdidlegislatetheECHRintodomesticlawbytheHumanRightsAct1998.] TheEuropeanConventionhasbeentouchedonaboveinadditionregardmustbehadto,butnotexclusivelyto,theUniversal DeclarationonHumanRights,and,especially,theUnitedNationsConventionontheRightsoftheChild. Thesemakeitclearthatcircumcisionfornontherapeuticreasonsisadenialtothecircumcisedboyofhisfundamentalhumanrights.In thepremisesitissuggestedthatthecurrentpolicyofEnglishlaw(ofeither,iftheCommissionarerightastothecurrentpositionofits legality,regardingcircumcisionaslegalunderdomesticlaworattheleasttakingnofirmpositionbutallowingthepracticetobe conductedwithoutinterference)isopentochallengeandcouldreadilybechallenged,undertheEuropeanConvention,intheforumof theCourt.Inthatevent,itwouldbecrediblethattheplaintiffwouldprayinaidinsupportofhiscasetheprovisionsofotherinternational instrumentswhichrestate,albeitwithoutsuchreadyenforcementmachinery,similarfundamentalrights.

19.1UniversalDeclarationofHumanRights
Article2 EveryoneisentitledtoalltherightsandfreedomssetforthinthisDeclaration,withoutdistinctionofanykind,suchasrace, colour,sex,language,religion,politicalorotheropinion,nationalorsocialorigin,property,birthorotherstatus. Article3 Everyonehastherighttolife,libertyandthesecurityofperson. Article5 Nooneshallbesubjectedtotortureortocruel,inhumanordegradingtreatmentorpunishment. Article7 Allareequalbeforethelawandareentitledwithoutanydiscriminationtoequalprotectionagainstanydiscriminationin violationofthisDeclarationandagainstanyincitementtosuchdiscrimination. Article18 Everyonehastherighttofreedomofthought,conscienceandreligionthisrightincludesfreedomtochangehisreligionor belief,andfreedom,eitheraloneorincommunitywithothersandinpublicorprivate,tomanifesthisreligionorbeliefin teaching,practice,worshipandobservance. Article29 1Everyonehasdutiestothecommunityinwhichalonethefreeandfulldevelopmentofhispersonalityispossible. 2Intheexerciseofhisrightsandfreedoms,everyoneshallbesubjectonlytosuchlimitationsasaredeterminedbylaw solelyforthepurposeofsecuringduerecognitionandrespectfortherightsandfreedomsofothersandofmeetingthejust requirementsofmorality,publicorderandthegeneralwelfareinademocraticsociety. 3TheserightsandfreedomsmayinnocasebeexercisedcontrarytothepurposesandprinciplesoftheUnitedNations. Article30 NothinginthisDeclarationmaybeinterpretedasimplyingforanyState,grouporpersonanyrighttoengageinanyactivity ortoperformanyactaimedatthedestructionofanyoftherightsandfreedomssetforthherein." AswiththeEuropeanConventiononHumanRights,thereisabalancingbetweenconflictingrights:theindividual'srights tobeprotectedfrom"tortureortocruel,inhumanordegradingtreatmentorpunishment",Article5,issafeguardedbythe generalrestrictiveprotectioninArticle30whichprohibitstheengaginginactswhichareaimedat"thedestructionofanyof therightsandfreedomssetforthherein",andthefreedomofreligionetcinArt.18mustbeseeninthatlight.

19.2InternationalCovenantonCivilandPoliticalRights
Article2 1.EachStatePartytothepresentCovenantundertakestorespectandtoensuretoallindividualswithinitsterritoryand subjecttoitsjurisdictiontherightsrecognizedinthepresentCovenant,withoutdistinctionofanykind,suchasrace, colour,sex,language,religion,politicalorotheropinion,nationalorsocialorigin,property,birthorotherstatus. 2.Wherenotalreadyprovidedforbyexistinglegislativeorothermeasures,eachStatePartytothepresentCovenant undertakestotakethenecessarysteps,inaccordancewithitsconstitutionalprocessesandwiththeprovisionsofthe presentCovenant,toadoptsuchlegislativeorothermeasuresasmaybenecessarytogiveeffecttotherightsrecognizedin thepresentCovenant.3.EachStatePartytothepresentCovenantundertakes:

(a)Toensurethatanypersonwhoserightsorfreedomsashereinrecognizedareviolatedshallhaveaneffectiveremedy, notwithstandingthattheviolationhasbeencommittedbypersonsactinginanofficialcapacity (b)Toensurethatanypersonclaimingsucharemedyshallhavehisrighttheretodeterminedbycompetentjudicial, administrativeorlegislativeauthorities,orbyanyothercompetentauthorityprovidedforbythelegalsystemoftheState, andtodevelopthepossibilitiesofjudicialremedy (c)Toensurethatthecompetentauthoritiesshallenforcesuchremedieswhengranted. Article5 1.NothinginthepresentCovenantmaybeinterpretedasimplyingforanyState,grouporpersonanyrighttoengageinany activityorperformanyactaimedatthedestructionofanyoftherightsandfreedomsrecognizedhereinorattheirlimitation toagreaterextentthanisprovidedforinthepresentCovenant. 2.Thereshallbenorestrictionuponorderogationfromanyofthefundamentalhumanrightsrecognizedorexistingin anyStatePartytothepresentCovenantpursuanttolaw,conventions,regulationsorcustomonthepretextthatthepresent Covenantdoesnotrecognizesuchrightsorthatitrecognizesthemtoalesserextent. Article18 1.Everyoneshallhavetherighttofreedomofthought,conscienceandreligion.Thisrightshallincludefreedomtohaveor toadoptareligionorbeliefofhischoice,andfreedom,eitherindividuallyorincommunitywithothersandinpublicor private,tomanifesthisreligionorbeliefinworship,observance,practiceandteaching.2.Nooneshallbesubjectto coercionwhichwouldimpairhisfreedomtohaveortoadoptareligionorbeliefofhischoice. 3.Freedomtomanifestone'sreligionorbeliefsmaybesubjectonlytosuchlimitationsasareprescribedbylawandare necessarytoprotectpublicsafety,order,health,ormoralsorthefundamentalrightsandfreedomsofothers. 4.TheStatesPartiestothepresentCovenantundertaketohaverespectforthelibertyofparentsand,whenapplicable,legal guardianstoensurethereligiousandmoraleducationoftheirchildreninconformitywiththeirownconvictions.

19.3UNConventionontheRightsoftheChild1989
This,themostrecent,andmostchildcentred,internationalinstrumentisclear. InthePreamble,thereisthefollowingpreambularparagraph12:
"Takingdueaccountoftheimportanceofthetraditionsandculturalvaluesofeachpeoplefortheprotectionand harmoniousdevelopmentofthechild,"

Thereis,inthepreambularparagraphs,animportantdistinctiontobedrawnbetweenthelanguageofmostofthemandthatof preambularparagraph12:namelybetween`Recognizing.....'and`Takingaccount......'.Theclearsignalfromthedifferenceinlanguageis thatthosemattersinthe`recognising'paragraphsformedabasisorframeworkfortheArticleswhichfollow,whereasthe`Takingdue accountoftheimportanceofthetraditionsandculturalvaluesofeachpeoplefortheprotectionandharmoniousdevelopmentofthe child'wasseenasnotoverridingtheprotectionsandrightsenunciatedintheConvention[see,forexample,alsoArt.3(3)].Thispointis importantinviewoftheprovisionsofArticle31(2):"StatesPartiesshallrespectandpromotetherightofthechildtoparticipatefullyin culturalandartisticlifeandshallencouragetheprovisionofappropriateandequalopportunitiesforcultural,artistic,recreationaland leisureactivity."WhatisclearfromthestructureoftheConventionasawholeisthatthoseactivitieswhicharedamagingand/orinimical tothechildanditshealth,developmentandbestinterestsarenotpermittedandonlytotheextentthatthefamily'sculturallifearenotin conflictarethoseculturalactivitiestobepermitted.Thus,Article31(2)doesnotoverridetheprovisionsofArticle24(3)"StatesParties shalltakealleffectiveandappropriatemeasureswithaviewtoabolishingtraditionalpracticesprejudicialtothehealthofchildren"
Article1 ForthepurposesofthepresentConvention,achildmeanseveryhumanbeingbelowtheageofeighteenyearsunless, underthelawapplicabletothechild,majorityisattainedearlier." This,itwillbenoted,requiresthattheConventionbeapplied,withoutdistinctionastosex,toallchildren. Article2 1.StatesPartiesshallrespectandensuretherightssetforthinthepresentConventiontoeachchildwithintheirjurisdiction withoutdiscriminationofanykind,irrespectiveofthechild'sorhisorherparent'sorlegalguardian'srace,colour,sex, language,religion,politicalorotheropinion,national,ethnicorsocialorigin,property,disability,birthorotherstatus. 2.StatesPartiesshalltakeallappropriatemeasurestoensurethatthechildisprotectedagainstallforms ofdiscriminationorpunishmentonthebasisofthestatus,activities,expressedopinions,orbeliefsofthechild'sparents, legalguardians,orfamilymembers. ThisarticlerequiresStateinterventiontoprotectthechildfromalldiscriminationandthus,limits,strictly,therightsofthe parentsorguardiansofaminor.Here,aselsewhere,Article18oftheViennaConventionontheLawofTreaties1969,which providesthatastate,whileatreatyisawaitingratificationaftersignature,maynot"acttodefeattheobjectandpurposeofa treaty",mightwellbeilluminatingeveniffailurefullytoimplementmightnotattractinternationalcondemnation,enactment, orevenaproposalbyaofficialbody(formallychargedbytheStatewithlawreview)forsuchanenactment,mightwellbe seenasbothagravebreachandaprovocativeoneandonesoatoddswiththeConventionthatsuchbehaviourwouldnot bepermittedevenbeforeanydecisionastoratification.

Article3 1.Inallactionsconcerningchildren,whetherundertakenbypublicorprivatesocialwelfareinstitutions,courtsoflaw, administrativeauthoritiesorlegislativebodies,thebestinterestsofthechildshallbeaprimaryconsideration. 2.StatesPartiesundertaketoensurethechildsuchprotectionandcareasisnecessaryforhisorherwellbeing,takinginto accounttherightsanddutiesofhisorherparents,legalguardians,orotherindividualslegallyresponsibleforhimorher, and,tothisend,shalltakeallappropriatelegislativeandadministrativemeasures. 3.StatesPartiesshallensurethattheinstitutions,servicesandfacilitiesresponsibleforthecareorprotectionofchildren shallconformwiththestandardsestablishedbycompetentauthorities,particularlyintheareasofsafety,health,inthe numberandsuitabilityoftheirstaffaswellascompetentsupervision." Circumcisionisnotperformedinthebestinterestofaminor,butisinsteadperformedtorelievetheanxietiesofparents regardingnormalhumansexualanatomyandtofulfilparentalexpectationsofreligious,socialandsexualconformity. Parentalorculturalbeliefthatgenitalmutilationtoanydegreeisinthebestinterestsoftheminorisirrelevant.Parents cannotendangerthelivesoftheirchildrenorcauseirreparablephysicaldisfigurementsimplytoraisethemwithinthe confinesoftheirculture.Furthermorethe`competentauthorities'inthissituationtheworldwidemedicalprofessionare opposedtocircumcisionwithoutobviouspathology. Article4 StatesPartiesshallundertakeallappropriatelegislative,administrative,andothermeasuresfortheimplementationofthe rightsrecognizedinthepresentConvention.Withregardtoeconomic,socialandculturalrights,StatesPartiesshall undertakesuchmeasurestothemaximumextentoftheiravailableresourcesand,whereneeded,withintheframeworkof internationalcooperation.

DespiteBritain'sseemingfailuretogiveeffecttothisprovision,itremainsaninternationalobligationonthiscountryandinthecontextof theConsultationPaper,anysteptakennowtogivelegitimacytothecontinuationofthepracticeofnontherapeuticcircumcision, particularlywheninahighlydiscriminatoryform,wouldbeagravebreachbothofthisarticleaswellasthisandotherConventionsasa whole.

Article8 1:StatesPartiesundertaketorespecttherightofthechildtopreservehisorheridentity.

Aprimarysenseofidentityresidesintheintegrityofthesexualorgans.Youngmalesareespeciallyatriskofdamagetothisidentityby mutilationordisfigurementoftheirpenises.
Article14 1.StatesPartiesshallrespecttherightofthechildtofreedomofthought,conscienceandreligion. 2.StatesPartiesshallrespecttherightsanddutiesoftheparentsand,whenapplicable,legalguardians,toprovidedirection tothechildintheexerciseofhisorherrightinamannerconsistentwiththeevolvingcapacitiesofthechild. 3.Freedomtomanifestone'sreligionorbeliefsmaybesubjectonlytosuchlimitationsasareprescribedbylawandare necessarytoprotectpublicsafety,order,healthormorals,orthefundamentalrightsandfreedomsofothers.

ThefreedominArticle14(1)isimpairedforarituallycircumcisedchildsincethatmutilationforotherthanpressingmedicalreasons constitutesapossibleimpedimenttojoining,orevenithasbeensuggested,marryingintoreligionssuchasBuddhismandHinduismand thephysicalmarkingoftheinfantinthenameofreligionisitself,evenwithoutthepossibleeffectonalaterwishtochangereligious adherence,adenialofthatchild'sfreedomofchoice.

Article13 1:Thechildshallhavetherighttofreedomofexpression. Circumcisionofaminor,eitheratanagewhenthechildisunabletoexpresshiswillorbyforceagainsthisconsent,violates thechild'srightofexpressionbyitsperformance.Italsoviolatesthefreedomofsexualexpressionbypermanentlyand unnecessarilydiminishingthesexualsensationsandfunctionsofthepenisasintendedbynature. Article19 1.StatesPartiesshalltakeallappropriatelegislative,administrative,socialandeducationalmeasurestoprotectthechild fromallformsofphysicalormentalviolence,injuryorabuse,neglectornegligenttreatment,maltreatmentorexploitation, includingsexualabuse,whileinthecareofparent(s),legalguardian(s)oranyotherpersonwhohasthecareofthechild. 2.Suchprotectivemeasuresshould,asappropriate,includeeffectiveproceduresfortheestablishmentofsocialprogrammes toprovidenecessarysupportforthechildandforthosewhohavethecareofthechild,aswellasforotherformsof preventionandforidentification,reporting,referral,investigation,treatmentandfollowupofinstancesofchild maltreatmentdescribedheretofore,and,asappropriate,forjudicialinvolvement. NonmedicalcircumcisionhasbeendefinedbymanyprofessionalwritersasalloftheactsforbiddenbyArticle19(1).This Articlealsorestrictstheabilityofguardianstoconsenttounnecessaryandharmfulprocedures,andrequiresmedical professionalswhohavecareofminorstoprotectthemfromalltheseformsofabuse. Article24 1.StatesPartiesrecognizetherightofthechildtotheenjoymentofthehighestattainablestandardofhealthandtofacilities

forthetreatmentofillnessandrehabilitationofhealth.StatesPartiesshallstrivetoensurethatnochildisdeprivedofhisor herrightofaccesstosuchhealthcareservicessetforthinthepresentConventionandinotherinternationalhumanrights orhumanitarianinstrumentstowhichthesaidStatesareParties. 2.[notquoted] 3.StatesPartiesshalltakealleffectiveandappropriatemeasureswithaviewtoabolishingtraditionalpracticesprejudicialto thehealthofchildren. 4.StatesPartiesundertaketopromoteandencourageinternationalcooperationwithaviewtoachievingprogressivelythe fullrealizationoftherightrecognizedinthepresentarticle.Inthisregard,particularaccountshallbetakenoftheneedsof developingcountries.

Inlightoftheappallingrecordofriskanddysfunctionfromcircumcisionwhichcanonlybedescribedasprejudicialtothehealthof minors,Article24(3),whichispartofanArticleprovidingaprotectiveframework,requiresthatthesepracticesmustnotbeusedto justifynonmedicalcircumcisionofminors.Intheabsenceofpathologyorinjury,therighttoconsenttotheamputationofhealthygenital structuresfortraditional,cultural,orcosmeticreasonsmustrestsolelywiththeaffectedindividualonreachingtheageofconsentand thenonlywhenthatconsentisfullyinformed. TheprohibitioninArticle24(3)covers,inviewofArticle1,childrenofbothsexesandthuscircumcisionofbothsexes.Thelanguage, andthusthemeaningisclearandthisissonotwithstandingthattheevilthatwasintheforefrontofmindsmayhavebeenfemale circumcision.ByvirtueofArticle31oftheViennaConventionontheLawofTreaties1969,thewordsoftreatyprovisionsmustbe giventheirordinarymeaningandbyArticle32,recoursemaynotbehadtothetraveauxpreparatoireunlessthemeaningofthetreaty provisionsisonthefaceofitunclear,orpossibly,whereallthepartiesareinagreementsotorefer.Tosuggestthatonlyfemale circumcisionistoberegardedasinbreachofthevariousconventionsonHumanRights,andtheConventionontheRightsoftheChildin particular,isbothtodenythemedicalevidenceastothepain,risksandsexualdysfunctionfrommalecircumcisionandalsotoarguefor theformalisationofdiscriminationagainstthesemalechildrenonthegroundsoftheirsex,raceandthereligiousbeliefsofthefamilyinto whichtheyareborn:thosewhowouldsosuggestmustproducecompellingargumentsthatthisisproper.
Article37 StatesPartiesshallensurethat: (a)Nochildshallbesubjectedtotortureorothercruel,inhumanordegradingtreatmentorpunishment......"

Giventhepain,risks,diminutionofsexualfunctionandlossofprivacy,bodilyintegrityandfreedomofchoiceinanumberofimportant areasoflife,nontherapeuticcircumcisionisagravebreachofthiscommonprovisionofinternationalinstrumentsonhumanrights. Bearinginmindthepredictablecriesthatthispaperwillinevitablyprovoke,bearinginmindthatmanycircumcisionsareperformedby doctors(whethertheypurporttobeactingquadoctororinsomeothercapacity)andalsobearinginmindtheunacceptabilityofa"pick andmix"approachtolegalprotections,itwouldbeappositetocitepartofTheNurembergCode(1947)(whichfollowedthe unspeakablydepravedbehaviouroftheNazis)astomedicalethics:

PrincipleI :Thevoluntaryconsentofthehumansubjectisabsolutelyessential.Thismeansthatthepersoninvolved shouldhavethelegalcapacitytogiveconsentshouldbesosituatedastobeabletoexercisefreepowerofchoice,without theinterventionofanyelementofforce,fraud,deceit,duress,overreachingorotherulteriorformofconstraintorcoercion andshouldhavesufficientknowledgeandcomprehensionoftheelementsofthesubjectmatterinvolvedastoenablehim tomakeanunderstandingandenlighteneddecision.

Circumcisionofminorsviolatestheprincipleofinformedconsentbecausetheydonothavelegalcapacitytogiveconsent,areunableto exercisefreepowerofchoice,andhavenoknowledgeandcomprehensionoftheamputationoritsshortandlongtermconsequences. Parentalconsenttononmedicallyindicatedcircumcisionisinvalidbecauseitstepsoutsidetheirdutyandrighttoconsenttotreatmenton behalfoftheirchildreninlifethreateningsituations. Further,astomedicalethics,theBritishMedicalAssociationwrote 177 :

"ThestandardestablishedbytheWorldMedicalAssociation theDeclarationofTokyogiveslittlescopefor ambiguityonwhetherornotdoctorsshouldbecomeinvolvedintorture[ofprisoners].Itmakesitclearthat"thedoctor shallnotcountenance,condoneorparticipateinthepracticeoftortureorotherformsofcruel,inhumanordegrading procedures."

Therecanbenodoubt,inthelightoftheevidenceheretouchedon,thatnontherapeuticcircumcisionisaformofcruelandinhuman treatmentwithgraveimpactonthevictim'sphysicalandemotionalhealth,function,andbodilyintegrityandthusoffendingnationaland internationallaws. AUruguayanpsychiatrist,whenquestionedabouthisparticipationintorture,replied:"Iwasconfinedtomyfunction.Iignoredother aspectsandthereweresomeaspectsIdidn'twanttoknowabout.....Itwasn'tmypurpose.Iamadoctor"aremarkwhichchillingly echoesthatbyRudolfHessathistrialatNuremberg:"Ireallynevergavemuchthoughttowhetherit[masskilling]waswrong.Itjust seemedanecessity.Wejustneverheardanythingelse."Onalltheevidence,thiscallousnessandindifferencetotheindividualby circumciserscontainsthesamemindset,thesameabdicationofresponsibility.

20.Discrimination
Therearemanyattitudeswhichare,rightly,abhorredbyacivilisedsociety,condemnedbyinternationalconventionsandprohibitedby nationallegislation:theseincludediscriminationonvariousgrounds.Yetthediscriminationagainstboysinpermittingtheinevitably

damagingmutilationoftheirgenitals,whilstenactinglegislationtodeclareascriminalthesimilarprocedurewhendonetogirls,isatthe leastasdamagingasanyotherexpressionofdiscrimination,andgiventheresultingandirreparablesexualdysfunctionthemoresothis mutilationinvolvestheamputationofhighlyfunctionalandsensitiveflesh,therebyablatingthevictim'sabilityfullytoenjoysexual intercourse. Kluge,aprofessorofphilosophy,comparesfemalecircumcisionwithmalecircumcisionand,expressingthesameviewsonboth, writes178 :

"Toarguedifferentlyistobeguiltyofdiscriminationonthebasisofsex....Bothinvolvewhatinothercontextswouldbe callednonconsensualmutilationofaminorfornonmedicalreasons."

Further,toallowcircumcisionfurtherdiscriminatesbetweenthoseboyswho,becauseofanaccidentofbirth,facenontherapeutic circumcisionandthosemorefortunateboyswhodonotandworsestilltocountenancetheenactmentoflegislationtopermitthe continuationofsuchamutilationforritualreasons(butonlyforsomewhodoitforthisreason:yetanotheractofdiscrimination) presumablythusdeprivingtheboyofhisabilitytosuethoseresponsibleforhisgrievousinjuryashecannowdo. Rejoicing,rightly,inourbeingamulticulturalsocietydoesnot,ashasbeendemonstratedabove,meanthatweshouldbeblindto practices,whatevertheirsourceandmotive,whicharethemselvesabusiveanddiscriminatoryofothers,andwhichdirectlyandinevitably diminishthefreedoms,thehumanrights,theintegrityandthedignityofothers.

21.Conclusion
Nontherapeuticcircumcisionispainful,riskyanddisablingassuchitisunlawfulandoffendsagainstdomesticandinternationallaws:it givesrisetocriminalandcivilliability.Itraisesissuesofindividualhumanrights,moralissues,issuesofdiscrimination,physicaland psychologicaldamage:itisanabuse(sexual,physicalandemotional)ofthechild. Itdoesnotinvolvetheconsentoftheinjuredpartyinanywayatallindeedthevictim'sreactionsclearlydemonstrate,asclearlyasthe childisable,hispain,terrorandlackofconsent.Thepurported`consent'(moreappropriatelytobeseenas`assent')byotherstothe inflictionofthis,typicallyunanaesthetised,amputationbreacheslegalobligationsofparentalduties,andthusbreacheslegalprovisionsfor theprotectionoftheweakandinnocentchild.TheinclusionofthisissueintheConsultationPaper,whichdealswiththequestionsof consentbyapersonforhimselftotheinflictiononhimselfofinjurybyanother,ismisconceivedandbasedoninadequateconsiderationof thelegalpositionandacompletefailuretoconsiderthemedicalposition. Althoughexistinglawsaresufficienttosustainaprosecutionandacivilclaimarisingfromcircumcision,fortheavoidanceofanydoubt (forthesamereasonsthattheProhibitionofFemaleCircumcisionAct1985waspassed)andtoavoiddiscriminationasbetweenthe sexesand/orbetweengroupsofmalechildren,malenontherapeuticcircumcisionshouldbeaccordedthesamelegislativeprohibitionas femalecircumcision. Itmight,however,incontrasttothe1985Act,beacceptabletopermitamanovertheageof18(andinlinewiththecurrentprovision fortattooing)toconsenttohavehimselfcircumcisedforculturalorreligiousreasons,asanexceptiontothegeneralruleproposedbythe LawCommissionintheConsultationPaperastothecontinuingbanontheconsensualinflictionofseriouslydisablinginjury.But circumcisiondoneasanontherapeuticproceduretoanunconsentingchildisabhorrent,destructiveandalegal,ethicalandmoralaffront whichhasnoplaceinanysocietywhichwishestocallitselfcivilised,notleastaswenearthe21stcentury.AsKarlMenningerhassaid: "What'sdonetochildren,theywilldotosociety."AndasGandhisaid:"Ifwearetohaverealpeace,wemustbeginwiththechildren."

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ChristopherPrice,M.A.(Oxon). MaleCircumcision:ALegalAffront. BriefsubmittedtotheLawCommissionofEnglandandWales.December1996.

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