Circumcision and Medical Ethics

Ah, the circumcision debate.

I've been reading a lot about it lately, which probably isn't good for me, but oh well. I've analyzed both sides of the issue, I watched Penn and Teller's Bullshit on it, I read the medical literature. My conclusion is physically, it's not necessary-- but it doesn't harm them, either.

Circumcision has been consistently proven to not decrease fertility (clearly, Eritrea has a 95% rate of circumcision and they have a population growth rate of 2.5% with 33.97 births per 1000 population), it has been proven to have no effect or a positive effect on sex enjoyment and ability to have sex repeatedly, with all studies stating it had no effect on sex drive, two studies saying it improved and two studies saying it decreased erectile function, with three more claiming no difference, most studies claiming it prevented premature ejaculation, of seven studies, only one claimed it decreased penile sensation, and absolutely no studies claiming it decreased overall satisfaction.

In other words, no impact on sex. At all. No impact on fertility. Complications are very rare (comes from practice all these years) and they can be performed under local anesthesia to prevent pain (and should be, after all, we numb ears before piercing). There's some evidence that they reduce the risk of STDs, including AIDS, but there haven't been enough studies for me to comfortably say that is the case, and anyway, condoms do a much better job. The truth is, medically, there's not really any reason to bother circumcising, and it's just a body modification which we perform for aesthetic and cultural reasons. At the same time, though, it's not actually doing any long-term damage. I think the closest real comparison we have is the idea of piercing ears. Pierced ears are incredibly common, they show up in many cultures, and piercing usually happens when the person is still a child or a teen (ie not a legal adult). They are socially acceptable, and yet, they are body modification-- it is punching holes in a child's body and forcing the skin to grow back around a metal object to produce a permanent hole. They also hurt like all hell if you don't get numbed first.

So the question-- medically, neonate circumcisions (usually, barring complications) aren't needed; thus, are they ethical? Well, pierced ears aren't considered unethical. I don't think I'd want to pierce a baby's ears myself, but I wouldn't stop someone who did so to their kid, and it's quite common. And since there is no long-term pain or disability, there's nothing unethical about doing it as an initiation into a religion or something. People do all kinds of weird shit to their kids in the name of religion, and body modification is a common religious practice, so as long as the kid's life isn't really impacted, I see no objection to that. Provided, naturally, that the religious official performing the circumcision is trained, licensed, and willing to use anesthetic.

But what about people who simply think the circumcised penis looks better? Is it ethical for a doctor to circumcise a boy?

Honestly? I don't think so. I don't really like the idea of doctors doing it. However, at the same time, I think we should have people who are licensed and trained to perform circumcisions for anyone who wants it for their son or themselves. The trouble with doctors doing it is it becomes about "healing" the kid somehow. I say take medicine out of the equation, except in the sense that a person performing a circumcision should have training and licensing, same as someone who does tattoos or piercings, and more so because a mistake could be problematic. Or perhaps list it as a form of plastic surgery or something. I think it should be made quite clear to parents that it is an aesthetic/religious, not medical, choice for them to make.

But ethically, I see no problem with them making that choice. It's not like FGM, where a woman can no longer enjoy sex because her sexual organs have been cut out. The foreskin is a small and relatively insignificant part of the genitalia. Losing it does not cause lasting pain, it does not decrease sexual abilities, nothing. In other words, yes, it is a body modification, yes, it is unnecessary, no, doctors should never suggest it or encourage it for medical reasons (unless there actually IS a medical reason, like phimosis), though they should answer any questions as free from personal bias as possible. At the same time, I think that it is still firmly the choice of the parents and there is nothing unethical about allowing parents to choose to do so to their son. If it bothers him that much, he can have it restored as an adult, same as the girl whose ears are pierced can let them grow back together.

And me personally? I don't really care. I don't practice a religion that cares about foreskins, and while I find circumcision more aesthetically pleasing myself, my opinion on the appearance of my son's penis is irrelevant, what matters is what his future girlfriends/spouse thinks of it. What I find more attractive shouldn't really apply to my son's genitals. So I'll probably defer to my husband on the subject.

Paternity Testing

Tennessee has proposed a new bill that would require mandatory paternity tests for all newborns.

OKay, on the one hand, there are a ridiculous number of children out there who are being raised by men who are unaware that their wife/girlfriend cheated on them and did not have their child, which often would indicate a desire for a divorce; also, many men are made to pay child support for children that they are not related to, nor ever made any effort to serve as a father.

Yet I believe that DNA is not important, it's intent. Once a man decides to raise a kid, he should raise that kid, regardless of the kid's actual DNA...

I don't think it should be mandatory. No way. That's a terrible invasion of privacy and automatically assumes fault on the part of the woman, plus it can give men information they don't want to have. I think it should be offered to all fathers (when the mother is not in the room) for free. They refuse it? Fine. They can never contest the paternity of the child again, because they've made that decision at that point that they don't care about DNA (and I applaud them). Even if at a later point the child is determined to be genetically unrelated, doesn't matter, they made that choice.

If they accept the test, and they are confirmed to be the father, great. If not? Well, if they immediately deny responsibility for the child, then they don't have to take it, as long as they never take on the role of father. BUt if they stay with the mother, start to raise the kid, whatever, then the paternity test will become irrelevant.

Also, once a paternity test is completed, all the DNA and records should be destroyed except for a note on the child's birth certificate. LAst thing we want is that shit on record.

Fathers should be offered one chance to know for sure, for free, with or without the mother's consent, if the child is theirs before they bond with the kid or make financial obligations towards them. One chance. That's it. And in exchange, women should get to subpoena men they believe to be the father for a confidential, free paternity test with the DNA information destroyed immediately afterwards. So women won't be left to fend for themselves, as long as they can reel off a list of all the men they slept with about 9 months earlier. Of course, you would have to require that the entire process would be completely confidential unless the man really is the father.


So in summary:

At birth, the man who thinks he is the father is offered a free paternity test. He refuses, he's the father by default, even if later he learns otherwise. He made the decision to be the father.
He accepts and it's positive, he's the father, and can never contest that.
He accepts and it's negative, he's not the father, and he can immediately sever all ties with the kid and the mom and not be held responsible. OR, he can decide to raise the kid anyway, despite that information, and will be considered the legal father even if he's not biologically related-- a relationship he then can't contest.

At any point, a mother can subpoena a guy she suspects of being a father for a paternity test. The entire process is kept discreet and if the man is not the father, he can go on his merry way and not worry about it. If he is, she can request child support from him and insist he take responsibility.

All DNA samples and anything that could be used against a person later is destroyed, as it would otherwise be self-incrimination and illegal to use it at a later point for a purpose other than it was provided for. That would be very important and have to be specifically mentioned in the law in such a way that the entire law would have to be scrapped and rewritten to get past it.

And for Pete's sake, don't make it mandatory (unless someone is attempting to skip out on the paternity checks). Make it free an readily available, sure. But not mandatory. The law should not be intruding into people's lives in that manner.

Home Schooling and the Law

So California is requiring that all homeschooling parents have teaching credentials.

I'm not sure how I feel about this. On the one hand, there are a lot of crazy whackjobs who homeschool their children so the kids don't have to learn about evolution or condoms. On the other, public schools can really suck, and homeschooled kids whose parents were actually trying to help the kid are going to get penalized.

Clearly there should be regulations for homeschooling. You can't just let people homeschool kids any way they want, because kids aren't able to make their own informed decisions and therefore should not be at the mercy of their parents' every whim. But teaching credentials? Nah. What I think they should have is the following:


1. If a parent wants to homeschool, they should have to register with the state, or their kid should be considered to be playing hooky. That's pretty standard.

2. The parent can't have a history of physical or emotional abuse of the child, or any other kids. Also think that's pretty standard.

3. The parent should have a high school diploma, or a GED. I know, seems like a no brainer, but apparently a very small percentage of home school parents in the US never finished high school. That's probably a good sign that they aren't qualified to teach their kids.

4. Once a year, the kid should be tested against the standards for kids in his or her year. They do better or equal to other kids their age, they can continue homeschooling. I think this is also common. These tests should also include more than just reading and writing-- if it's required learning at school, and it's not gym/art/music etc, it should be required at home. So cover English, math, and history, but also science, health (even sex ed), and basic computer studies, which are neccessary to survive in the modern world.

5. When the kid reaches middle school material (ie stuff they could theoretically have forgotten since they were in school, as opposed to your basic reading and writing and times tables), the parents should have to get a special Parent Teaching Certification. I'm not talking about holding them to the levels of normal teachers. I'm talking about giving them a test that covers the material they want to teach to the kid. They pass the test, they can teach that material. If they don't, community college classes or back to school. That way you won't get people who are unqualified teaching their kids, but it's also not like they have to know Calculus and have a master's degree to teach middle-school algebra.

6. If the kid is mentally disabled (beyond a learning disability or ADHD, I mean really disabled), the parent should have some kind of degree in working with people with disabilities. Those kids need pretty specialized education, and allowing them to be homeschooled, especially since there's no real way to measure their progress like with most kids, is asking for the system to be abused. Similarly, if the kid is blind, the parent should be able to read and create (write?) Braille and if the kid is deaf, the parent should be fluent in sign language. Now, of course, sometimes you get people who are just too disabled to ever really learn anything. If that truly is the case, like they'll never pass a toddler's mental level, then I understand not making them go into a SPED program that basically will babysit them all day. That would have to be decided on a case-by-case basis. But someone with, say, Down's Syndrome can benefit a great deal from a teacher who actually understands how to work with them, rather than an unqualified parent.


And that would be it. Check on the kid once a year (every six months if you want to be paranoid) to make sure something's sticking, make sure their parent is actually remotely qualified to teach the stuff and not some hick who plans to plop their kid in front of the TV all day, and keep track of who's getting homeschooled. That's all you really need. Do it right, and your homeschool kids won't be able to get a worse education than the public school ones, and it'll probably be better. And hey, to address the social aspect, let homeschool kids join sports teams and clubs at the local high school if they want and offer lots of community programs.

But making parents have the same credentials as teachers seems a bit silly. An education course (usually part of the requirement) makes sense if you need to learn how to effectively teach many different children the same thing all at once and maximize learning. For a parent who teaches one or two kids at once, and always the same kids, it's easy to learn what teaching style the kid needs. What's more, effective teaching strategies for 25 kids are going to be very ineffective for 2 kids. This just serves to make it very challenging for parents to homeschool without addressing the real problems with homeschooling, ie, that it can be abused without anyone knowing, and that no one was enforcing the old rules.

Also, maybe, just maybe, California should try to fix the problems in the public school system before wasting time trying to micromanage home schoolers, who on average are more successful than public-school graduates?

Just saying.

If you think this sounds socialist, decent sex ed would cut back on the problem all together...

I was reading an article today about teen mothers in Denver, Colorado who are fighting for the right to have excused absences after they give birth to bond with their children and recover.

I don't think high school girls who get pregnant should ever keep their children. Either abort, or if you aren't comfortable with that, arrange for an adoption. Keeping a child at that young an age is selfish and foolish and I intend to teach my daughters that they are NOT going to be ready to care for a child until they are financially independent and gainfully employed. It has nothing to do with age or marital status, it has to do with financial ability to care for a child independently without being a drain on society.

That said... If a girl DOES keep her child, we have to do something for her. Otherwise she'll just drop out of school, and thus, not be able to properly care for her child. Maternity leave is important for their health and the health of the child-- I would say two months after discharge from the hospital, with work packets to keep up with the course load; one month if she gives the kid up for adoption, to heal. Maybe get volunteer tutors to help, or something (And if they don't come back after that, treat it the same way you would treat a normal teenager who skipped school-- go after the parents). Then, have a childcare facility attached to the school, but, have the caretakers of the children in the daycare be a few supervisory staff members/teachers and then students, who are taking a class in parenting skills and childcare. A teaching daycare, basically. Provide a free service to the teen moms (and teachers) in exchange for a unique opportunity to teach students what it is like to care for children, under the supervision and guidance of professionals. That way, kids who take the class won't want to have kids for a LONG time and mothers can come visit their kids, breastfeed them, etc, during study hall and lunch (they could eat lunch with the kids). Teen dads could even come visit their kids and play with them.

And yeah, wealthier families would put the kids into professional daycares rather than have high schoolers care for them, but the point would be that there would be a chance for girls (or teachers) who can't afford regular childcare to have care for their kids. You could even have slots for children whose mothers are working adults in other jobs, but can't afford normal daycare, for a fee that is greatly reduced from the normal cost of childcare. Basically have the same idea as a teaching hospital, just have it be for childcare.

What do you think?