Female genital mutilation and male circumcision: toward an autonomy-based ethical framework

Abstract

Abstract:The non-therapeutic alteration of children's genitals is typically discussed in two separate ethical discourses: one for girls, in which such alteration is conventionally referred to as "female genital mutilation" (or FGM), and one for boys, in which it is conventionally referred to as "male circumcision." The former is typically regarded as objectionable or even barbaric; the latter, benign or beneficial. In this paper, however, I call into question the moral and empirical basis for such a distinction, and I argue that it is untenable. As an alternative, I propose an ethical framework for evaluating such alterations that is based upon considerations of bodily autonomy and informed consent, rather than sex or gender.

In defence of genital autonomy for children

“…FGA and MGA are both highly problematic practices, with far more overlap between them (both physically and symbolically) than is commonly understood: they should not be discussed, therefore, in hermetically sealed moral discourses’ 4. My own perspective is that the most promising way forward would be to argue for an ‘autonomy-based’ ethical framework,4 9 whereby ‘Children of whatever [sex or] gender should not have healthy parts of their most intimate sexual organs removed, before such a time as they can understand what is at stake in such a surgery and agree to it themselves’ 69…”

“…To change this situation, at least according to one plausible interpretation, it would require that the laws regarding physical assault on a minor be rewritten, potentially creating widespread disturbances and inconsistencies throughout their respective legal systems. This is because, as some scholars have argued, cutting into a child's genitals without a medical diagnosis, and without its informed consent, meets the formal definition of criminal assault under the legal codes of most of these societies 4 17–20. (Please note that this view assumes that parental ‘proxy’ consent is invalid for such procedures, for which arguments have been given elsewhere.…”

“…What this means is that if any particular act of violence—such as the cutting of a child's body in the absence of medical necessity, perhaps especially with the effect of damaging or removing functional tissue—is legally permitted, then fraught decisions have to be made ‘as to where within the continuum of violence the limits are to be fixed’25 [p. 129]. This, in turn, could open the door for interested parties to argue, for any proposed act of cutting, that it is not ‘violent enough’ to warrant the placement of limitations on parental decision making 4. More on this will be said in a subsequent section.…”

“…In part, this is due to ‘the difficulty it presents in terms of specifying an appropriate threshold for harm that could be measured in an objective way’4 [p. 98]. As Van Howe notes, the meaning of ‘harm’, in practice, therefore, will inevitably be left up to the interpretational vagaries of each provider, perhaps in consultation with the child's parents 44.…”

“…This vagueness creates a problem: ‘there are practitioners, especially in cultures where female circumcision is common, who fervently believe that more invasive forms of female circumcision’—that is, forms that even Arora and Jacobs reject—‘do not pose risks of physical or psychological harm’44 [p. 167]. In fact, these providers could easily make selective appeals to studies from the medical literature that appear to show health-based benefits for FGA,4 as well as an absence of serious harms,45 much as some supporters of MGA are prone to do 46 47. When the many purported cultural benefits of FGA are factored in, Van Howe continues, ‘practitioners could easily convince themselves that any harm is more than offset by the many perceived benefits’44 [p. 167].…”