The Unkindest Cut

THE VANCOUVER COURIER, Vancouver, B.C., Canada,
Monday, 5 July 2004.

James Loewen: "The idea that we would operate and amputate healthy tissue from a baby, from an unconsenting minor, to supposedly prevent some hypothetical disease, that goes against the Hippocratic oath." Photo by Kristin Bradford

The unkindest cut

By Jessica Werb—contributing writer

When choosing a cause, activist James Loewen didn't take the easy route. Not for this man the company of earnest environmentalists, vegetarians or tree huggers; his is an altogether more lonely existence. The 50-year-old Vancouver-based photographer is, as he terms himself, an "intactivist." To put it bluntly, Loewen wants male circumcision banned.

"We have a law in Canada that prohibits any kind of tampering with female children's genitalia, and I believe that law is biased in that it doesn't protect all children," says Loewen, matter-of-factly. "What our society is very resistant to is understanding that the motivations behind male circumcision and the motivations behind female circumcision are very, very similar."

For just about anyone who has heard the horror stories about the sub-Saharan practice of female circumcision-more often termed female genital mutilation-Loewen's statement is difficult to swallow. The brutality and violation of basic human rights that accompany the removal, with a blunt razor blade, of a young girl's external genitalia, including her clitoris and labia, cannot be denied. Can this gory, excruciating and dehumanizing ritual really be put in the same category as the simple snip, under medical supervision, of a male infant's foreskin?

For Loewen and the small but steadily growing number of other intactivists worldwide, the question is a non-issue. Both procedures, they maintain, constitute an abuse of children's rights.

"[Male and female circumcision] are both based on myth-the myth that the person is somehow benefiting from having this operation, and that the person is somehow cleansed," Loewen says.

Until recently, such statements wouldn't garner more than a raised eyebrow or a nervous giggle. But with the release of a coroner's report this past February into the death of one-month-old Ryleigh McWillis of Penticton, many parents and medical practitioners are taking a closer look at the practice of circumcision.

Ryleigh McWillis bled to death in August 2002, following a routine circumcision. His parents, Tanna and Brent McWillis, were not given any follow-up information after the procedure, and were unaware that anything was awry. When Ryleigh's diaper filled with blood by 5 a.m. the morning after the operation, his parents rushed him to the hospital. It was too late. Blood transfusions, saline and antibiotics were not enough to save Ryleigh's life, and the previously healthy, normal baby died two days after his circumcision.

The McWillis family, moving to Vernon after the tragedy, was disappointed with the coroner's report, which found that Penticton Regional Hospital, where Ryleigh was circumcised, had significantly improved its circumcision education and follow-up care. The media onslaught on the grieving family members following the tragedy has made them wary of speaking to reporters, and they declined an interview with the Courier. Tanna McWillis has said that she would circumcise another child, but that hasn't stopped others from using Ryleigh's tragic death as a call to arms against circumcision.

"Babies die every year of circumcision, of what's totally unnecessary," says Dr. George Denniston, the Port Townsend, Wash.-based founder and president of Doctors Opposing Circumcision. For Denniston and other anti-circumcision lobbyists, fatalities aren't a complication -they're the extreme outcome of an abnormal, unnecessary surgery.

"Every circumcision is a complication," Denniston insists. "You're taking off normal body parts, and so you're depriving someone of a normal body part. That's the complication."

(You can't speak of complications without mentioning the fate of 38-year-old David Reimer, whose botched circumcision in Winnipeg almost four decades ago led to the loss of his penis and a gender re-assignment by Baltimore's Dr. John Money in the notorious John/Joan case. Reimer, who committed suicide in mid-May, was raised as a girl at the recommendation of his doctors, who hailed the experiment a success. But in his teenage years, he discovered what had happened to him and began living as a male. He eventually married and took on the role of stepfather to three children. He committed suicide after becoming separated from his wife and lost his job.)

The rate of circumcision in Canada currently sits at around 17 per cent, according to figures from the Canadian Institute for Health Information. That's much lower than it was before Canada's provincial health authorities-with the exception of Manitoba-gradually stopped funding the procedure between 1984 and 1997. When the operation was publicly funded, about 60 per cent of newborn males were circumcised, with rates as high as 80 per cent in English Canada. In the U.S., where circumcision is funded through Medicaid and private insurance companies, the rate remains higher, at 60 per cent, according to the American Academy of Pediatrics.

While Judaism and Islam command followers to circumcise male children, the majority of babies being circumcised in Canada are given the procedure for other reasons, some of which their parents find difficult to articulate.

"I think it was very important to my husband, because he's circumcised... I don't know why it was so important to him," admits 29-year-old nurse Karen Tetrault of Abbotsford, whose three sons have all been circumcised by Dr. Neil Pollock, a Vancouver physician whose practice focuses solely on circumcision and no-scalpel, no-needle vasectomies. Dr. Pollock provides his services through Pollock Clinics, which has four locations throughout Greater Vancouver.

Tetrault's youngest, five week-old Tyler, was circumcised just a few weeks ago. She says Dr. Pollock's procedure, which she wouldn't allow her GP to perform, assuaged any fears she had about pain for her child. Tyler didn't even cry during his circumcision. "For me, my husband is done, and it's important for the boys to look like their dad," Tetrault says, after some reflection. "If they see Daddy change, they might think, 'Hey, why am I different?'... Once I'd done one, then the decision was made to do all of them. If I had kept my littlest one not circumcised, it would have been mean, because Dad and his brothers would have been. I don't think that would have been right."

Pollock, who is also a mohel-the title for someone certified to provide circumcision in a Jewish ceremony called a bris-says that while he doesn't take sides on circumcision, there are plenty of health benefits to the procedure. According to Pollock, the list includes a reduced risk of cervical cancer in female sexual partners, lower risk of cancer to the penis, fewer urinary tract infections, a lower risk of HIV infection and other STDs, and less risk of sexual dysfunction later in life.

These claims are all supported by numerous studies. More than a decade ago, studies in leading medical journals Lancet and New England Journal of Medicine reported that uncircumcised men were more likely to acquire heterosexual HIV. Many more studies since then have found similar results, leading to the theory that the foreskin can tear easily during intercourse, leaving mini-abrasions through which the HIV virus-and others-can enter. Recently, it's been shown that certain specialized cells in the foreskin, Langerhans cells, can trap the HIV virus and promote infection.

In addition, says Pollock, infant circumcision eliminates the need to do circumcision later in life as a result of problems like recurrent "balanitis" or inflammation of the glans, infection, or "phimosis"-constriction of the foreskin. The later a circumcision is done, the more costly, painful and risky it is.

As for the question of inflicting pain on an infant, Pollock, who performs close to 2,000 circumcisions a year, says he has devised a method of painless circumcision using topical freezing creams and local anesthetics. He also says his technique takes just 40 seconds, compared to conventional techniques that can take up to 20 minutes.

Trisha McConnell, a 20-year-old Wal-Mart customer service manager in North Vancouver, also had her one-month-old circumcised at the Pollock Clinic. One day after the procedure, she says that although it was initially frightening, she doesn't think her son was in much distress.

"At first, they had to strap his legs down so he wouldn't kick, and just the look of it upset me a bit. But then they gave him gauze with brown sugar in it and they dipped it in juice. A sugar pacifier, they call it. He was crying, but as soon as he got the sugar, he stopped. Last night, I think it hurt him to pee the first couple of times, but today it doesn't because he's peed a lot and he hasn't cried about it."

McConnell, like Tetrault, says she decided to have her son circumcised because her husband has had the procedure. She had also heard about the health benefits, and didn't think Bradly would suffer from any loss of sensitivity later in life.

But the foreskin, say activists, is not an inconsequential body part. In February 1996, Dr. John Taylor of the University of Manitoba described, in the British Journal of Urology, the intricate array of nerves that line the foreskin, concluding that the foreskin plays an integral part in men's sexual pleasure and function.

Furthermore, says Denniston, the circumcised penis can make intercourse uncomfortable by pulling moisture off the vagina. "In America, women have a lot of dyspareunia, which is painful intercourse. They really don't understand why, and doctors don't understand why."

In addition, without the foreskin, he claims, "the tension in the skin... can increase the risk of getting cracks, allowing STDs of all kinds to go in." Such controversial statements fly in the face of the widely accepted theory that circumcision actually protects against STDs, and that a circumcised penis is more hygienic because it is easier to clean.

"Right now, because we're in a society that has traditionally circumcised, we don't recognize the benefit of the intact genitals," says Loewen. "Those who circumcise cannot justify cutting off healthy erogenous tissue. Circumcision does not prevent AIDS. Look at the North American population that has succumbed to AIDS, the majority of which were circumcised. That doesn't support those doctors who are promoting this."

Even if circumcision does protect against infection and make hygiene easier, it doesn't justify the practice, says Loewen. "There are numerous places on the body that are difficult to clean, but we don't cut them off. Toenails or ears may be more difficult to clean and less pleasurable to clean, but we don't chop them off. It's a myth.

"The idea that we would operate and amputate healthy tissue from a baby, from an unconsenting minor, to supposedly prevent some hypothetical disease, that goes against the Hippocratic oath. It goes against the notion of individual rights... Cutting off a healthy part of the body to prevent disease is ridiculous. I mean, you could prevent diseases of the feet by amputating them, but we recognize the benefit of feet."

James Loewen, who himself was circumcised as a child, is so adamant about the issue that he believes-as does Doctors Opposing Circumcision-that the practice of male infant circumcision should be outlawed. He has written letters to "everyone," as he puts it: health ministers, the prime minister, MLAs and MPs.

So far, he says, the best response he's received was from Svend Robinson, who forwarded Loewen's comments to other officials, encouraging them to look at the issue. Given Robinson's current hiatus following recent charges of theft, Loewen may have to find another sympathetic ear.

The trouble with garnering sympathy for his cause is that it's seen by many as an affront to religious freedoms. With anti-Semitism apparently on the rise-following the recent spate of anti-Semitic vandalism in Ontario and Quebec-any discussion of a circumcision ban cannot help but stir up feelings of persecution. As one prominent member of the Vancouver Jewish community, who declined to be interviewed for this piece, explained, "I don't want to take part in an article that could be seen as anti-Jewish."

For Jews, circumcision is arguably the most important ritual of the religion. In Genesis, Chapter 17, the scripture states that God commands: "Every man child among you shall be circumcised. And ye shall circumcise the flesh of your foreskin; and it shall be a token of the covenant betwixt me and you. And he that is eight days old shall be circumcised among you ... And the uncircumcised man child whose flesh of his foreskin is not circumcised, that soul shall be cut off from his people; he has broken my covenant."

With such a heavy-handed commandment, it's easy to understand why even the most reform and liberal of Jews have difficulty with the concept of abandoning circumcision.

"God asked that Abraham circumcise himself and his sons through the generations as a sign of the covenant," says Rabbi Dina-Hasida Mercy, an independent rabbi with the Jewish Chaplaincy Society who provides rabbinical support from a Reform perspective.

"That's all that is asked for of Abraham, whereas God has made a number of heavy-duty promises to him. And it is still considered the sign of the covenant."

She adds: "As a mother, I hate it. But as a rabbi and as a Jew, I do it and I recommend to people that they do it also."

Nevertheless, there is a slow but growing movement questioning circumcision within Reform Jewish communities, particularly in the U.S., but also in Canada.

Brought up in a Conservative Jewish community and married to a circumcised gentile, Brenda Birch made the difficult choice not to circumcise her now 10-year-old son, Isaac, despite her ongoing involvement in the Jewish community.

"As a young woman, I was around a couple of women who witnessed their sons being circumcised, and I saw the difficulty that they went through in the process. The agony, really," recalls the 45-year-old organizational development consultant, who lives in Vancouver. "I was quite disturbed by it myself, and that started me thinking about it, even before [I became pregnant] ... The first thing that a male Jewish child experiences eight days after they're born is a huge sort of assault on their body."

When Isaac was born, Birch contemplated the true meaning of being Jewish, and the issue of freedom of choice for the child.

"A huge decision is being made for a young person that doesn't include them in the process. Women don't have any kind of physical process that happens to make them Jewish or not Jewish," she says. "My connection to being Jewish has changed throughout my life, but it's always been a connection to the theology. A connection to the philosophy, the community, the humanistic voice... If you have circumcision being the thing that defines you as being Jewish, then you've missed what being Jewish is really about."

Birch's views are, naturally, not exactly representative of those in the wider Jewish community. She admits that while most of the people she has discussed her decision with have respected it, "none of them has agreed with it."

But as more Jews begin questioning circumcision, Canada will likely see an increasing number of young boys like Isaac. The Reform Jewish community may well acknowledge a change to the conventional circumcision ritual. The Brit Shalom ceremony, which is gaining ground in the U.S. and, in particular, San Francisco, is one such option. Dr. Mark Reiss, Jewish vice-president of DOC, explains that for little girls, the traditional ceremony for infants is a naming ceremony, bringing the baby into the "covenant of Israel." The ceremony for little boys is the circumcision, and then the naming ceremony. "What we've done is eliminate the circumcision, and have a naming ceremony similar to the naming ceremony for little girls. An Orthodox rabbi certainly is not going to accept this as a covenant ceremony," he admits. "But many Reform rabbis do."

Reiss maintains a list of what he calls "celebrants of Brit Shalom" who will conduct such a ceremony. Currently, there are over 30, including one Canadian, in Ontario. For Vancouverites seeking to take part in such a ceremony, there is a celebrant just across the U.S. border, in Bellingham, Wa.

For James Loewen, the issue surpasses all religious or cultural traditions. "Circumcision is curious surgery, because it's surgery that's looking for reasons to exist," he says. "When you consider that your body is being cut to someone else's specifications, somebody who supposedly knows better than nature, and that person can affect your physical self, and your sexuality and your psyche to this degree, that has profound ramifications to spirituality and psycho-sexual development."

But Loewen is optimistic that that's starting to change. "The majority of children are being raised genitally intact. When the few that are still being circumcised come of age, they are going to be bloody mad about it."

Citation:

Jessica Werb. The Unkindest Cut. The Vancouver Courier, Vancouver, B.C., Canada, Monday, 5 July 2004.

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