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This page contains a letter to Larry Isaak, PhD,
Chancellor, North Dakota University System, requesting a change in how
the System has handled the topic (or its failure to handle the topic) of
infant circumcision in the various relevant departments of the
University, such as, law, ethics, medicine, psychology and sociology.
This letter (and a similar one sent to Isaak's predecessor, Chancellor
Douglas Treadway two years earlier in 1992) were never answered nor
acknowledged.
11/14/94
Larry Isaak, Chancellor
North Dakota University System
State Capitol, 600 E. Boulevard Ave
Bismarck, ND 58505
Dear Chancellor
Isaak:
This letter is
similar to a letter sent two years ago to Chancellor Treadway. It
concerns the North Dakota University System’s involvement in a social
practice many find deplorable and intellectually indefensible: routine
neonatal circumcision. Since I think our education institutions are
negligent in discussing the medical, moral, social, psychological and
legal ramifications of this sexual child abuse, I feel I must speak out.
Let me fill you
in on how I became involved and what I have found out about this
issue, especially in regard to the function of the University of North
Dakota's School of Medicine in our university system. I am disturbed
that the educational system of which I have been a proud part since my
appointment at UND as Assistant Professor of philosophy in 1969 (later
chairman for 3 years) and now as instructor at Bismarck State College,
seems to be silent (or miseducating its physicians, psychologists,
lawyers and citizens) about the reasons and effects of infant male
circumcision.
I ran into this
issue doing research on the rise of patriarchal societies and religious
philosophies, which happened about 5,000 years ago. I found that
genital mutilations seem to have begun in the matriarchal systems out of
which patriarchy arose. The operations ranged from complete removal of
penis and testicles to the various forms of circumcision and
subincisions still carried out today. Some native tribes today say they
do subincisions as a way to imitate the female bleeding they believe is
the source of life and also to make the penis like a vulva. The point
here is that genital bleeding and mutilation is a very old practice, and
the reasons given for them then were based on an outdated understanding
of reproductive physiology and on a socio-religious order democratic
systems cannot condone.
We also know
that the Hebrews adopted the practice of circumcision, probably from the
Egyptians, as a way of showing their relationship and subordination to
Yahweh, the dominant male god introduced to the region, probably by the
Hittites (or a subgroup or the Hittites we now know as the Levites) as
they conquered the whole eastern Mediterranean region in the third and
second millennia BCE. The Old Testament demonstrates the element of submission by
metaphorically stating in Deut. 30:6 that you should “Circumcise
yourselves to the Lord, [that is,] remove the foreskin of your
hearts...or else my [Yahweh’s] wrath will go forth like fire.” Rabbi
Moses Maimonides (1135-1204), a Jewish philosopher, said the practice is
done to help one control his sexual passions by desensitizing the penis
(Guide for the
Perplexed Part III, Chap. 49) and that “No one should
circumcise himself or his son for any reason but pure faith.”
Another factor
in my increasing concern with genital operations came when I was given a
scholarly article presented at the First International Symposium on
Circumcision, 1989, discussing what I had until then dismissed as
unbelievable, namely, female clitoridectomies and infibulations
(suturing up the vulva). Nearly 100 million young girls alive today have
had this done to them in many of the strongly patriarchal societies of
Africa, Mideast and Southeast Asia (in addition to the male
circumcisions done there). See, for example, the article “The Open
Wound” in the Washington Post, 11/22/92. A few of these female
operations are even being done by physicians in North America according
to Fran Hosken, editor of Women’s
International Network News. European physicians, upon discovering we
routinely circumcise males, ask whether we do female mutilations also.
I have since
learned at the Third International Symposium on Circumcision in
Washington, DC, (where I delivered a paper on the origin of male genital
mutilation) of a woman who was taken to the Wahpeton, ND, clinic when
she was three years old and had her clitoris excised by physicians in
the Breckenridge hospital because she was masturbating (some BlueCross
insurance plans covered this operation until 1977!). Now fifty years old
this woman, who lives in Minnesota, is just beginning to be able to
speak out on the horror of the operation and the wreck it has made of
her life. I have also learned that male circumcision is the most common
of all male operations, but still ranks second to episiotomies as the
most often performed operation, another unnecessary genital mutilation.
People here
generally recognize there are no medical reasons to justify the female
mutilations, at least of the African type. In fact, they are the major
cause of death of women in countries where they are routinely done. So
what about the reasons for male circumcision? I had to find out. I wrote
my colleagues at the UND School of Medicine. I finally received replies
from George Johnson, MD, Chairman of Pediatrics, and Dennis Lutz, MD,
Chairman of Ob/Gyn. Though they did not answer all my questions, they
did indicate there are specific medical reasons to justify the
amputation.
The medical
reasons they gave, however, simply do not stand up under scientific
scrutiny. Much to my surprise, when I first began to look into the
reasons for neonatal circumcision, I found most other North Dakota
physicians did not think the operation can be justified on medical
grounds, even those who do them. Many physicians did seem to agree with
Drs. Lutz and Johnson that they are morally justified in amputating
parts of healthy penises, if parents request it, and most medical institutions make sure they
ask the parents whether they want it done. Such solicitation of
unnecessary surgery suggests to the parents it is a healthcare issue and
probably should be done. Others, like Mary Margaret Mooney,
Chair, Department of Nursing, University of Mary, said this moral
justification is greased by financial considerations or by the fact most
physicians are circumcised themselves.
At this point I began to have
serious misgivings not only about the procedure but also about the
course content of the UND School of Medicine, as well as the information
parents are given or are able to get prior to signing the Consent for
Surgery Form. Parents are supposedly giving “informed consent” when
they sign. Every other physician except Lutz and Johnson was telling me
that the reason he or she did circumcisions (if at all) was based on
parents’ choice. The physicians often characterized this choice as
being based on emotion, not reason (as did Roger Allen, M.D.,
neonatologist, on KXMB TV, Minot.) or on custom and ritual. Parents
continued to tell me they request it because they are told it is a good
thing to do.
I have seen
videotaped circumcisions, so I know it is a very painful operation.
Allen Lindemann, M.D., Ob-Gyn in Fargo, said he was taught at UND that
infants do not feel pain. Even though the Medical School now seems to
recognize this pain, the professors who wrote me still understate it. I’ve
found some credible evidence that such early pain imprints one for a
lifetime (for example, see the work of the clinical psychologists in
primal therapy, Thomas Verny who founded the Pre- and Perinatal
Psychological Association of North America and Arthur Janov who wrote Prisoners of Pain and Imprints). Also the natural
function of the foreskin is lost for life. The foreskin is both
protective and sexually sensitive tissue, as much so as the glans penis.
So if there are
no good medical reasons for the operation which outweigh the known and
sometimes serious risks like infection, mutilated and lost penises (a
case occurred in Glendive MT) and even death, then what reasons are good
enough to do this to a helpless, non-consenting infant? These reasons
would have to be similar to those given for other operations if they are
to have any legal and moral justification (and probably applicable to
both sexes).
I have asked
lawyers, physicians and parents whether there is any other operation
that removes or mutilates a healthy, normal body organ they think
could be done to a non-consenting child; and also whether the law can
distinguish the removal of the male prepuce from the female’s. I have
not received any satisfactory answers to these questions.
A case in point:
Roger Minch, attorney and producer of the State Bar Association’s
program “Ask-A-Lawyer” wrote, “the law does not allow one to
mutilate another without consent and the law, on its face, cannot
discriminate between the sexes. However, the law often blindly follows
custom and usage without much reflection.” A published letter to the
Canadian Attorney General from McGill law professor, M. A. Somerville
expresses her failure to understand why male circumcision is not a
blatant sexist practice. The responses from the North Dakota Attorney
General’s Office, the North Dakota Board of Medical Examiners and
other state agencies have been largely silence.
Most people are
so habituated to the situation they do not seriously question the
ethical appropriateness of preputial amputation. Most of us just believe
there are good reasons for doing it. And when faced with facts, for
example, that European countries do not circumcise their boys and do not
have all the maladies that pro-circumcision advocates say will happen,
most people just get defensive. The pain of thinking we may be harming
our young for no good reason is too much to face.
This issue
finally comes down to cultural or philosophical reasons, not medical
ones. Since as a philosopher I have not been able to see the
justification for a person (even if the person is a well-meaning parent)
to cause physical and mental pain and lifelong physical deformity to
another without that person’s consent, I felt it necessary to do what
I can to expose the weaknesses in the rationalizations used to continue
the practice of circumcision. This practice went from 5% in the late
1800’s (ostensibly to stop masturbation and the medical problems it
supposedly caused) to 80% in the 1980’s (now down to 59% nationally).
Bismarck State
College agreed to sponsor a circumcision information seminar (December
4, 1992) despite its controversial nature as any good institution of
learning would. Even so, I think the administrators deserve to be
complimented on how they handled me and this issue and the preparations
for the seminar. This, of course, does not mean anyone associated with
the college agreed or disagreed with me or with Marilyn Milos, RN, the
executive director of NOCIRC I brought here from California. In order to
hear all sides I asked many physicians in several North Dakota cities to
come and give their reasons for continuing to circumcise. However,
finding people to speak for the pro-circumcision side was not easy.
Eventually, after receiving Milos’ published articles, all three
physician, who initially said they would come, refused to debate.
Several
physicians in this state have told me they agree with former
pediatrician and State Health Officer, Dr. Robert Wentz, that “time
has come to stop the practice of routine infant circumcision.” Rhonda
Ketterling, MD, Chair of the North Dakota Board of Medical Examiners,
wrote she is sympathetic with those who “desire to have infant
circumcision become a thing of the past.” Shari Orser, MD, now Chair
of Medcenter’s department of Ob/Gyn, wrote: “the evidence is not
strong enough to support circumcision as a routine...the practice should
be discontinued.”
So why is there
such a contrast between what seems to be the reasonable thing to do,
namely, “Leave the poor little penises alone,” as Dr. Benjamin Spock
says, and the continuing practice of routine infant circumcision in this
state which physicians (such as Drs. Richard Grassy and Charles Severn
in Bismarck, and Craig Shoemaker and Ron Miller in Fargo) tell me is
more than 90% in some hospitals?
I hope this
letter has made clear why I feel something must be done to educate North
Dakotans despite the pain I know awareness is causing. I hope in the
long run less pain will be suffered by all. I hope this letter also
clarifies why I think someone needs to take a hard look at the UND
School of Medicine’s curriculum regarding circumcision. Legislation is
being proposed for the upcoming 1995 session to outlaw this mutilation.
Lawyers are looking into possible class action suits. Time has come to
teach in our educational institutions that routine infant circumcision
is sexual child abuse.
Respectfully
yours,
Duane Voskuil, Ph.D.
Philosophy and Ethics
Bismarck State College
cc. Kermit Lidstrom, President,
Bismarck State College
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