The American Academy of Pediatrics slipped on the slipperiest of ethical slopes when earlier this year it attempted to balance multi-culturalism with pragmatism and traditional medical ethics. The topic was the genital mutilation of young girls in a form of (so-called) “female circumcision” practiced by some Muslims, in which the clitoris is cut and mutilated in order to make future sexual activity less enjoyable, thus ensuring a female’s “virtue.” The AAP argued that its members could ethically agree to inflict a lesser “nick”—a ritual drawing of blood— to fulfill a patient’s parents’ request for the ritual cutting, because to do otherwise might lead to greater harm to a girl’s genitalia if the parents sought a full-fledged mutilation abroad or elsewhere.
This policy effectively repealed the ancient ethical standard of “First, do no harm” by employing the versatile rationalization, “If I don’t do it, someone else will.” Predictably, women’s rights advocates were horrified. Equality Now proclaimed in May…
“…FGM [Female Genital Mutilation] is a form of gender-based violence and discrimination that is performed on girls to control their sexuality in womanhood, guarantee their acceptance into a particular community, and safeguard their virginity until marriage. Taina Bien-Aime, Equality Now’s Executive Director explains, ‘Encouraging pediatricians to perform FGM under the notion of ‘cultural sensitivity’ shows a shocking lack of understanding of a girl’s fundamental right to bodily integrity and equality. The AAP should promote awareness-raising within FGM-practicing immigrant communities about the harms of the practice, instead of endorsing an internationally recognized human rights violation against girls and women.’
The current policy is a regression from the AAP’s 1998 policy statement Female Genital Mutilation and raises great concern because it denotes a clear shift in addressing the issue. The World Health Organization and the International Federation of Gynecology and Obstetrics have unequivocally opposed FGM as a “medically unnecessary” practice, and it is widely recognized that all types of FGM are a form of gender-based violence. Stemming from this perspective, the AAP’s 1998 statement sees the practice as a human rights violation, opposes all forms of FGM, and cautions pediatricians about their role in “perpetuating a social practice with cultural implications for the status of women.” In contrast, the new 2010 statement no longer uses the term ‘female genital mutilation’ but refers to the practice as ‘female genital cutting (FGC) or ritual genital cutting,’ makes no reference to the discriminatory aspect of FGM, and selectively opposes only those forms of FGM that in its view ‘pose the risk of physical or psychological harm.”
The Academy reversed its position at the end of last month, directing its members to refuse to perform any ritual female genital mutilation, “nick” or worse, and to attempt to educate the parents. The reversal was cheered in a New York Times editorial, but also raised the shadow of anti-Muslim bias and racism. If this is the AAP’s position on female circumcision, some have asked, why does the Academy allow its members to perform male circumcisions, a ritual operation in the Jewish faith that causes an infant pain, may reduce sexual pleasure later in life, and that has dubious medical benefits at best? In a larger sense, isn’t the AAP’s decision, like U.S. laws banning some religious customs as cruel or harmful while allowing others, just a form of racial and religious discrimination? Is this a matter of having to draw the line somewhere, or is this somewhere no lines should be drawn at all? Along the spectrum of ritual ear-piercing, male circumcision, female genital mutilation, Christian Science and polygamy, where is it ethical for American institutions and cultural norms to say “no”?
Laws, rules and professional standards matter, because they define what out culture regards as right and wrong. What we choose to permit will become “right,” what is forbidden becomes branded as “wrong.” This is what the advocates of the “they’re going to do it anyway, so we might as well let them” argument refuse to acknowledge, whether the topic is underage sex, illegal downloading of music files, recreational drugs, prostitution or gambling. These are the voices that temporarily carried the day at the American Academy of Pediatrics.
Freedom of Religion should not include freedom to break the law. When religious rituals constitute objectively determined abuse, physical or emotional harm, the government should not hesitate to proscribe them, and professions should not feel guilty or politically incorrect by opposing them either. If there is an inconsistency in permitting male circumcision while forbidding clitoral mutilation, the proper response is to consider banning the former, not giving a pass to the latter in the pursuit of “consistency.”
For an excellent post about this issue and a fascinating thread of comments encompassing a full range of views on it, I highly recommend that you read the Volokh Conspiracy here.