Talk:Bioethics of neonatal circumcision

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The bioethics of male circumcision is being increasingly questioned by bioethics authorities. A page is needed to air this controversy.Robert Blair 05:21, 26 Nov 2004 (UTC)

Contents 1 Is conclusion appropriate? 2 NPOV 3 Revert 4 Recent edit 5 Canadian Children's Rights Council 6 NPOV? 7 Medical views 8 Disputed tag 9 Knee-jerk reverts 10 Function versus medical benefits 11 POV pushing by Jake Waskett 12 What about cases of parental disagreement? 13 Three or two? 14 recent HIV study 15 Female Genital Cutting study 16 Article is a mess

[edit] Is conclusion appropriate?

Forgive me if this is already covered but is it considered NPOV for an encyclopia article to include a conclusion? I know that the conclusion is pretty inclusive and non-judgemental, but I just question its place. Sirkumsize 01:33, 25 Mar 2005 (UTC)

I don't know about its being NPOV, but having a conclusion smacks of original research. An essay has a conclusion to sum up the points the author was trying to make. An encyclopdia article should be a summary of the conclusions that original researchers have already come to in their published work. --Angr 05:39, 25 Mar 2005 (UTC)

[edit] NPOV

Robert Blair, what on earth were you thinking when you made this edit? Are you aware that Wikipedia has an NPOV (neutral point of view) policy? I've made necessary changes to bring it some way towards neutrality. I've removed Van Howe (since it is flawed and far from definitive), and instead have noted the controversy and linked to medical analysis of circumcision. This improves the article because readers now have access to all the information, rather than just Van Howe's tripe. I've also removed the sentence about physician's refusal because it is covered elsewhere in the article. - Jakew 15:31, 1 Feb 2005 (UTC)

[edit] Revert

Robert Blair, why did you revert my edit to the human rights paragraph? I carefully read the links and edited that section for factual accuracy.

• There is nothing in Smith's article to suggest that The Netherlands Institute of Human Rights shares Smith's belief's - it's not a formal statement on her employer's behalf. It should say that it is her opinion.
• Again, Gulbrandsen does not appear to speak for Norwegian Council for Medical Ethics. It's just a letter in a journal, and an individual's interpretation. The paper discusses ritual circumcision only (which should be mentioned explicitly), and doesn't seem to discuss human rights - only ethics.
• Lastly, why did you remove the explanation of the purpose of Attorneys for the Rights of the Child? (", which campaigns against circumcision,"? It's perfectly true, and informative.

I've reverted your revert. - Jakew 00:21, 4 Feb 2005 (UTC)

Jakew, your sentence reads One author's interpretation of a statement by the Norwegian Council for Medical Ethics claims that the Council has determined that ritual child circumcision violates important principles of medical ethics. This seems to be redundantly qualified. (interpretation...claims that) Please correct. And I invoke your "principle of one". "One author" should be "An author", so as not to suggest others in the Council state the opposite. DanP 01:28, 4 Feb 2005 (UTC)

Happy now? - Jakew 01:39, 4 Feb 2005 (UTC)

The Norwegian report is simply reporting the action of a professional body - The Norwegian Council for Medical Ethics. it is not a letter. There is no controversy about it. All of this qualification is unnecessary and inappropriate. - Robert Blair (sig added by Jakew)

It is most certainly a letter, by a single author. Your change is bad, but I cannot currently undo it due to the 3RR. I have made some NPOV changes to the article (please stop this POV pushing. See Wikipedia is not a soapbox). - Jakew 02:20, 4 Feb 2005 (UTC)

It is not a letter. It simply is a report by a reporter of an event. It should be no more controversial than a report of a traffic accident. It was published in a Norwegian medical journal. My change is correct.

Also, there is no controversy about the foreskin being protective. It protects against meatitis, meatal ulceration, and meatal stenosis. This is well documented in the literature. Robert Blair 03:24, 4 Feb 2005 (UTC)

Incorrect. It appears to be a letter, by a Pal Gulbrandsen.

Secondly, there is indeed controversy about the foreskin being protective. While it is true that some authors claim protection against the meatal problems you mention, it is impossible to diagnose these problems in an uncircumcised child. That is to say: there is no way of knowing whether uncircumcised children have fewer problems or not - they just can't be recognised and treated. - Jakew 03:29, 4 Feb 2005 (UTC)

Seems that the pro-mutilation side (even if correct) isn't actually diagnosing higher rates of HIV in the intact men in the US. They are projecting it, even before we are born. If your side can claim broad magical powers of the mutilated penis, why does this not hold when the protection is based on having the whole organ? DanP 14:51, 4 Feb 2005 (UTC)

It is not a letter. Gulbrandsen is a reporter, reporting the news. He does not represent the Norwegian Council on Medical Ethics. This is a news report.

I have revised the text to eliminate the controversy and therefore, I have removed the disputed tags because they are no longer necessary.

Robert Blair 19:03, 4 Feb 2005 (UTC)

It quite clearly is a letter. What possible reason do you have for believing otherwise?

I have removed your hopeless POV pushing, and restored the disputed tags. It is considered very bad form to remove a disputed tag before a dispute has been cleared up - please do not do so again. I reverted rather than editing, because you completely reverted my hard work in NPOVing your previous edit. You're obviously just going to replace my carefully NPOVed text with POV rubbish, so there appears little point in trying. - Jakew 22:29, 4 Feb 2005 (UTC)

1. A google search of the website produces 555 articles by Pal Gulbrandsen. Clearly, he is a staffer/reporter for the journal, not a contributing letter writer.

1. Jacqueline Smith is/was on the staff the Netherlands Institute of Human Rights. Her paper was published in a book produced by the Institute. The book is named To Baehr in Our Minds: Essays in Human Rights from the Heart of the Netherlands. If the Institute did not accept her conclusions, it would not have published the paper.

I don't believe what I'm reading! Are you seriously suggesting that publishers always believe every word they print? Of course they don't: they're essays, not policy statements. - Jakew 01:55, 5 Feb 2005 (UTC)

[edit] Recent edit

I've made a number of changes to the article. Some comments are in the text, but to summarise:

• Introduction: tried to streamline it and ensure that it is NPOV. It's ok to summarise different views here, but we shouldn't make a case either way, or even present all the evidence. An introduction ought to be concise.
• Added comment about AAP Bioethics approval of AAP statement.
• Removed cite of Hill on "parent-centered" view. We should not cite an opponent of that view when describing a view. This is like citing a Creationist group when giving a description of evolution.
• Changed links to original sources, where available.

-Jakew 00:04, 6 Feb 2005 (UTC)

The use of Moses et al. (1998) to refute sexual evidence is inappropriate since this article was published prior to the publication of many recent articles on sexual effects.

Robert Blair 16:36, 10 Feb 2005 (UTC)

It is entirely relevant, as a discussion of the evidence in 1998. Some studies have been published since that time, but none have investigated the question of the alleged sexual nature of the ridged band. I have restored it, added a caveat about Denniston's claim (articles in a non-peer-reviewed journal are less credible), and added other studies. - Jakew 19:29, 10 Feb 2005 (UTC)

[edit] Canadian Children's Rights Council

DanP, would you explain why you feel the article benefits by including views on medical benefits rather than ethics? - Jakew 00:14, 9 Feb 2005 (UTC)

You raise a good point. I took my quote entirely out-of-context, and I can see where it could be interpreted as medical. In the paragraph I meant to quote more appropriately, at issue was the notion that the child-centered-view is not served by the medical debate. There is a lot of overlap, I suppose. I will fix it. DanP 00:52, 9 Feb 2005 (UTC)

[edit] NPOV?

DanP, could you explain why you feel it is POV to state that an article was not peer-reviewed? This is, after all, the truth. - Jakew 20:02, 10 Feb 2005 (UTC)

It is a cheap shot and off-topic. Plus there is an indirect reference to Flesh and Blood: Perspectives on the Problem of Circumcision in Contemporary Society, which presumably is the source for the data (I haven't read it). We should say what an article says, not what it doesn't say. If not, this would open up a new avenue of Wikipedia bias, as we ought to add disclaimer to every instance where an article isn't peer-reviewed. I hope you can agree there is no precedent for that. DanP 20:43, 10 Feb 2005 (UTC)

[edit] Medical views

The medical views section had become bloated, wordy, and unsuited to the needs of a bioethics article. This section has been replaced with an ethical views section. Robert Blair 14:31, 12 Feb 2005 (UTC)

[edit] Disputed tag

I propose to remove the disputed tag after 24 hours unless there are further disputes raised.

Robert Blair 02:06, 13 Feb 2005 (UTC)

It is more conventional to remove disputed tags once disputes have been resolved. - Jakew 11:03, 13 Feb 2005 (UTC)

I think they have been resolved. Robert Blair 13:54, 13 Feb 2005 (UTC)

[edit] Knee-jerk reverts

Jakew, you need to state a reason for a revert, such as factually inaccurate material. Knee-jerk type shout of POV pushing are not satisfactory. "I don't like it" is not sufficient. You have not provided justification for your revert and I have undone it.

Robert Blair 20:39, 13 Feb 2005 (UTC)

Robert, I've tried time and time again to get you to read Wiki's neutral point of view policy, but you continue to make such POV edits. Not only this, but when I try to work with you, editing for NPOV, you just replace it with your own version without comment. You ignore objections on talk pages. You remove disputed notices in spite of the fact that it is perfectly obvious from the edit history that there is an ongoing dispute. Needless to say, I'm running out of patience with you.

Here is an explanation:

• You replace a carefully balanced description of studies claiming both benefits and harms of circumcision to two literature "surveys" (both by Fleiss) that claim protective roles of the foreskin. Where is the balance? Where is the comment about surveys highlighting increased risks caused by the presence of the foreskin?
• You replace the "alternative view" to Povenmire (re the AAP Bioethics approval of the AAP policy) with a rather irrelevant statement about the AAP.
• You insert the following statement which is a) not correct English, and b) unsupported. "however, are limited to the granting of permission for diagnosis and treatment of disease,[1] but non-therapeutic circumcision is neither."
• You include the comment about AAP "although it appears to be in conflict with their previous declarations." - this is incredibly POV. If you had said "though some argue that is it in conflict..." it might be better. But as it is, you're just pushing your POV.

So let's summarise: you've replaced balanced, NPOV discussion with one-sided "studies" by anti-circ activists that support your POV. You've replaced disagreement with your fellow activists with vague and irrelevant statements. You've included unsupported (and non-English) statements. And you've pushed your POV when discussing those who disagree with you.

POV pushing that deserved to be reverted, and was. If you'd like to propose future changes first on the talk page, I'm happy to help you try to ensure that they are NPOV. But this sort of thing is riduculous. - Jakew 14:01, 14 Feb 2005 (UTC)

Jake, the article has been revised to meet your stated objections. The literature surveys, one by Fleiss and one by Cold, provide information on the functions of the foreskin. This is essential background to any ethical discussion. They do not address whether any particular foreskin should be excised. Information on that is provided by links to other articles as you suggested.

Robert Blair 17:41, 14 Feb 2005 (UTC)

Ok, if you insist, we'll keep Fleiss and Cold (although I have to say because both are written by NOCIRC activists who have been known to be less than scrupulous with the truth somewhat lessens their credibility), but we'll include Moses et al and Schoen in order to balance things.

"Non-therapeutic circumcision of children is a preventable injury." is a POV statement. Injury[2]:

• Damage or harm done to or suffered by a person or thing
• A particular form of hurt, damage, or loss

So clearly if one sees circumcision as harmful, one thinks it an injury. If, however, one regards it as an improvement, it is not. Hence it is POV. I've restored the original phrasing.

I've removed subheadings for views as their description is inherently POV.

I've removed "however, are limited to the..." as it is still not a complete sentence.

- Jakew 18:22, 14 Feb 2005 (UTC)

But it IS an injury, like declawing cats or body piercing. Cuzandor 00:15, 11 May 2006 (UTC)

[edit] Function versus medical benefits

Jakew: you are trying to counterbalance information on loss of function with claimed medical benefits. This is unacceptable. You must counterbalance loss of function with articles that claim no loss of function if you can find them.

It is not appropriate to introduce alleged medical benefits into this article because they are discussed in the medical analysis article. The alternative is to introduce articles showing a net harm caused by circumcision.

Robert Blair 11:44, 16 Feb 2005 (UTC)

Robert, you've already introduced "loss" of function - hence implying a disadvantage of circumcision. The obvious balance for this is articles showing benefits.

Since you feel it is not appropriate to introduce benefits, I'm sure you'll feel that it is equally inappropriate to introduce harms. Hence, I've removed the studies you cite.

Above, you'll find discussion of Fleiss and Cold, and why I chose to include a balance. Medical benefits are clearly relevant to ethics, but as I say, we can remove both. However, including your papers but no balance is simply POV pushing, and is not an option.

Saying "without medical indication" is redundant, as I've commented in the text.

I've commented out "to grow and develop free from preventable illness or injury", since without the comment that anti-circ activists consider circumcision to be an injury, it is irrelevant and out of place.

I've also tidied up the quotes.

Otherwise, I've no other major objections to your edits. - Jakew 13:03, 16 Feb 2005 (UTC)

[edit] POV pushing by Jake Waskett

Jake:

When you use a heading like "Mainstream view", you indicate that that view is more favoured than the others and the other views are fringe views. That is not accurate because some very responsible people and organizations are taking up something other than what you call the mainstream view. Such POV pushing is completely unacceptable under WikiPolicy.

Robert Blair 01:06, 27 Feb 2005 (UTC)

Ok, I see what you mean. Equally, "traditional parent-centered" and "child-centered" are unacceptable, since they imply that one is centered on the child's best interests, and the other is not (in truth, both are based on different interpretations of "best interests"). I'm removing the headings altogether until we can agree on headings that we're both ok with. - Jakew 18:24, 27 Feb 2005 (UTC)

The article needs headings to make it readable.

Parent-centered simple indicates that the parents' feelings are put first.

Child-centered means that the child's best interests are put first.

They are descriptive, not POV pushing.

If you don't like that please suggest some other neutral descriptive heading.

Robert Blair 00:54, 28 Feb 2005 (UTC)

Robert, temporarily removing headings so that we can find some we both agree on is hardly POV pushing. Please try to keep your edit summaries realistic.

Yes, I agree that headings will improve the article, but not if they're misleading or POV.

The problem lies in the fact that every point of view on the subject puts the child's best interests first. I challenge you to find me a parent who doesn't act in what they perceive to be in their child's best interests.

The difference between the positions is that what you call the "child-centered" view assumes that non-circumcision is always in the best interests of the child. In other words, it takes best interests out of the hands of those close to the child - parents, medical professionals, and so on, and assumes that the only one competent to make that judgement is the ethicist proposing the view. Maybe we should talk about "Parent-incompetent" and "Parent-competent" views. - Jakew 12:20, 28 Feb 2005 (UTC)

[edit] What about cases of parental disagreement?

One of the problems of granting parents the right to decide whether a male child may be circumcised is that parents do not always agree. Who is to decide when parents do not agree? Michael Glass 06:38, 19 July 2005 (UTC)

Isn't this just a special case of parental disagreement in general? - Jakew 09:54, 19 July 2005 (UTC)

Yes it is, but this does not make it any easier to deal with. Michael Glass 02:04, 21 July 2005 (UTC)

[edit] Three or two?

The following line was recently removed on the basis of being "incoherent" only to be restored by me.

• Infant circumcision is ethical, provided the patient chooses it

I don't see anything incoherent about this. Essentially, it's a statement to the effect that someone should be able to choose to have a circumcision, but that this choice should not be made for them in their infancy by their guardians. I suppose you can (and, most likely, do) disagree with it, but that's not really important. Al 18:06, 31 May 2006 (UTC)

It's a rhetorical device; infants can't choose things. Jayjg ^(talk) 18:08, 31 May 2006 (UTC)

Of course they can, what they can't do is say what they choose. Thats like saying eskimos can't choose anything because they don't know your language. 201.23.64.2 01:15, 4 June 2006 (UTC)

Actually it isn't. The Eskimo have their own language. Unfortunately, the vast majority of people don't speak it. That issue is entirely separate, and is really irrelevant. I'm fairly certain that infants can't consent to a medical procedure. Anyone without language skills doesn't have the same cognitive ability that someone with language possesses. It's not that these infants can't speak English, or can't write in French, but rather that they have no concept of language. Without that, they have no ability to comprehend the world in a way that would allow them to consent to a medical procedure. . . .wow. that was long :) Mike.lifeguard 15:18, 27 November 2006 (UTC)

[edit] recent HIV study

I ran across a reference to this recent study in the BBC News today [3]. It should probably be mentioned somewhere in our section on the HIV debate. (Recall also that our section on the HIV debate should be to summarize what the medical community says on the subject, pro or con, not to argue about it ourselves.) --Delirium 02:21, 11 July 2006 (UTC)

Anti-circumcision activists claim that the foreskin is an important erogenous zone and that its loss results in decreased sensation and plesasure. This can explain the decreased HIV infection rate: If a man's pleasure is decreased, he will find sex less pleasurable. Finding sex less pleasurable, he will be less diven to have sex as often. Having sex less often, he is less likely to have unprotected sex with an infected partner. If the rate of unprotected sex with infected partners decreases, so too will the incidence of HIV infection. This is of course, completely OR, but food for thought nonetheless.Christopher 03:02, 12 July 2006 (UTC)

[edit] Female Genital Cutting study

This is in regards to the recently added powerpoint link; on slide 36, there are no units so I am unsure, but it appears that this study shows that male circumcision seems to increse a womans risk of contracting HIV. Am I interpreting this correctly? If so, I would sure like to see a copy of this study that has been published in a peer reviewed joural, preferably with no magenta background. Christopher 05:18, 25 September 2006 (UTC)

The RR (relative risk) for male circumcised vs neither circumcised is 0.97, which is a very slight protective effect. However, the finding was not statistically significant (95%CI: 0.66-1.42).

Elsewhere in the literature, one study has shown increased risk:

• Chao A, et al. Risk factors associated with prevalent HIV-1 infection among pregnant women in Rwanda. Int J Epidemiol 1994; 23(2):371-80

And four have shown decreased risk:

• Fonck K, et al. Pattern of sexually transmitted diseases and risk factors among women attending an STD referral clinic in Nairobi, Kenya. Sex Transm Dis. 2000 Aug;27(7):417-23
• Hunter DJ, et al. Sexual behavior, sexually transmitted diseases, male circumcision and risk of HIV infection among women in Nairobi, Kenya. AIDS. 1994 Jan;8(1):93-9
• Kapiga SH, et al. The incidence of HIV infection among women using family planning methods in Dar es Salaam, Tanzania. AIDS. 1998 Jan 1;12(1):75-84
• (news article on most recent study)

Studies to investigate the effect of FGC on HIV have, with the exception of Stallings, found no difference.

As an aside, while our anon editor confidently asserts that this study "controlled for all possible confounding factors", the source says otherwise: "There are several important risk factors which were not collected in the 2003-04 THIS which might be explanatory confounders of this perplexing conundrum, including ethnic group, age at time of circumcision and type of circumcision" (37) "As no biological mechanism seems plausible, we conclude that it is due to irreducible confounding" (38) This latter statement also contradicts another of the anon's arguments. Even if the text did not violate WP:NPOV and WP:NOR, misrepresenting sources is clearly unacceptable. Jakew 10:26, 25 September 2006 (UTC)

So that is what the 95%CI meant.Christopher 15:41, 25 September 2006 (UTC)

Yep, it's the confidence interval. Jakew 16:03, 25 September 2006 (UTC)

— Possible single purpose account: Jakew (talk • contribs) has made few or no other contributions outside this topic.. Tit for tat 13:58, 27 September 2006 (UTC)

[edit] Article is a mess

This article is a mess. Half of it is original research, a quarter quotes sources that aren't directly relevant, but are introduced in original synthesis, and the other quarter aren't presented neutrally.

I can see three options:

1. Delete it
2. Drastically cut it down (to 1-2 paragraphs), then merge this into circumcision
3. Make a list (here) of all suitable sources, then perform a neutral, source-based rewrite.

Comments? Jakew 10:01, 28 September 2006 (UTC)

Merge it into circumcision? No. Circumcision is already a juggernaught, it needs to be broken into more subpages itself. Merging this page before that point would be counterproductive. I can't imagine that we can't find enough sources for a good article: we should find sources to back up the currently unsourced claims and delete any claims that can't be sourced.Christopher 12:50, 28 September 2006 (UTC)

"we should find sources to back up the currently unsourced claims" - with respect, I think that's a mistake. That's how opinion pieces are written, with the framework existing first, and the sources slotted into the holes. To achieve a balanced, thorough article we need to use an approach more like a systematic review, carefully identifying every relevant article, then building the article's structure from the sources. Harder work, I must admit, but I think that it's essential with controversial subjects.

I take your point regarding merging, though. Jakew 13:01, 28 September 2006 (UTC)

I find it easier to add references than to rewrite an article. If sources can't be easily found, then the claim has to go, but we should at least make an effort to provide sources before we delete.Christopher 20:02, 28 September 2006 (UTC)

Alright, I don't think it's essential that we're in complete agreement on this, since we clearly agree on the immediately pressing task: identifying sources. I therefore propose that we focus on that and postpone this discussion until such time as it is needed. Agree? Jakew 12:21, 29 September 2006 (UTC)