Tuesday, August 25, 2009

To Snip or Not to Snip

One of the criticisms that libertarians often make of universal health care proposals is that they put us on a slippery slope toward lifestyle paternalism. If the government's paying for your health care, the logic goes, it has legitimate reason to interest itself in what you're eating, whether you exercise or not, how much you smoke and drink, etc. I've never been entirely persuaded by this criticism, but I have to say that this controversy over CDC promotion of circumcision gives me pause.

I've always found the idea of surgically mutilating a newborn boy without his consent problematic, and I don't see why it's any less problematic just because there may be a public health rationale. It's even more troubling when it's done at the insistence of the government. It is true that we already do things to our bodies at government insistence (routine immunizations, etc.), but in those cases, there's a clearer and more compelling rationale. The misconceptions of those in the immunization-causes-autism crowd aside, preventative injections are relatively simple and do not cause lasting harm, and they address a serious health threat which cannot be easily countered in any other way. Someone who falls ill with a highly infectious disease is, no matter how careful and responsible he or she may be, a threat to the welfare of everyone around who is not already immune. As anyone who's taken a middle school health class or seen the movie Philadelphia can tell you, that's not the case with HIV, which is almost impossible to spread to those around you unless you engage in certain well understood high risk behaviors with them. While circumcision may cut the risk of HIV infection, there are other, less drastic measures that could also accomplish that goal, by reducing the incidence of these behaviors - in the case of risky sexual practices making condoms more readily available, promoting safety and non-promiscuity, etc. For almost every sexually active man who follows safe sex guidelines, they work perfectly in preventing HIV infection, and without nonconsensual mutilation of half the newly-born population.

It is not true, as Hanna Rosin contends, that circumcision is without medical downside - from what I've read, it drastically reduces sensitivity, which has, shall we say, a deleterious effect vis-a-vis enjoyment of the sexual act. The health benefits of circumcision can be duplicated with good hygiene, and as far as I'm concerned, attention to good hygiene is a small price to pay for increased sensitivity. If Rosin believes that decreased sensitivity is a worthwhile tradeoff for the health benefits, she's entitled to that opinion, but as she's not directly affected by the issue of male sexual satisfaction, I'd suggest that hers is not the opinion that ought to be weighed most heavily. And while she may dismiss other objections to the procedure as just so much useless cultural, emotional, and religious baggage, that doesn't change the fact that many people are deeply uncomfortable with it, and will become even more so if it's forced on them. "Laws must deal with people as they are, not as you'd like them to be" is a political lesson that many liberals never quite seem to learn.

In short, circumcision advocates have to come up with a better argument than "it will cut the rate of HIV infection due to sexual transmission" to convince me it ought to be mandatory, or even recommended. After all, mandating castration for every newborn baby would clearly help in the fight against AIDS - rather than slowing the rate of sexual transmission, it would stop it entirely. No sane person advocates such a policy, because almost everyone is in agreement that the downside isn't worth the benefits - but for me at least, neither is the downside of circumcision.

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