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Defending an inclusive right to genital and bodily integrity for children

Defending an inclusive right to genital and bodily integrity for
Kate Goldie Townsend
© The Author(s) 2021
IJIR: Your Sexual Medicine Journal;
At the time of writing in mid-2021, policy on child genital cutting
and modication is inconsistent in the UK, US, and most European
states, and there is growing consensus that this inconsistency
should end [110]. The question addressed here, is whether
Western liberal democracies ought to discourage, if not legally
prohibit, all forms of medically unnecessary child genital cutting
and modication, or permit some relatively minor forms. Given the
core political values of Western liberal democracies, including a
commitment to human rights, this piece takes a liberal normative
approach and argues that individual rights to bodily and
especially genital integrity should take priority over group rights
if they come into conict.
The idea of the childs right to bodily integrity has increasingly
been defended in bioethical, philosophical, and legal scholarship
[110]. Some authors argue in favour of the childs right to genital
integrity grounded in the value of genital and sexual autonomy
for all individuals [68]. The aim is to protect all children, whatever
their sex-trait characteristics or associated sex category assign-
ment, and whatever the sociocultural preferences of their parents,
from medically unnecessary (The Brussels Collaboration on Bodily
Integrity [10]denes medically necessaryin the following way:
(1) the bodily state poses a serious, time-sensitive threat to the
persons well-being, typically due to a functional impairment in an
associated somatic process, and (2) the intervention, as performed
without delay, is the least harmful feasible means of changing the
bodily state to one that alleviates the threat.) genital cutting
and modication practices until they reach an age of legal
majority [611]. Once a person has become an adult and is
deemed competent to make considered decisions about practices
that involve surgical risk and typically permanently alter their
sexual anatomy, the state should not seek to prevent them from
pursuing such operations. The position I advocate is fairly simple:
children should be protected from medically unnecessary genital
cutting and/or modication until they are adults; once they
become adults, they should be permitted to have their genitalia
modied should they so choose.
Though simple, this position is at odds with most current policy
in Western liberal societies [4,7,8,1014]. Children with female-
typical sex characteristics in Western (and many other) societies
are legally protected from medically unnecessary genital cutting
and modication, however minorthe cutting may be, and even if
sought by parents for religious reasons. Children with male-typical
sex traits on the other hand, are not legally protected from genital
cutting practices, even when the practice is considerably more
physically invasive than some of the prohibited types affecting
children with female-typical sex traits, for instance, symbolic
nicking [711]. Children with intersex traits or differences of sex
development also lack legal protection from medically unneces-
sary genital cutting and modication, even when the modication
is as if not more physically invasive than prohibited procedures
affecting children with female-typical sex characteristics [8,15],
with a few notable exceptions [8,16].
Different treatment of child genital cutting practices depend-
ing on the sex of the child is morally problematic and could
potentially be ruled unconstitutional in Western states [17]. It is
indicative of cultural bias that bestows preferential treatment on
the practices of Western majority and established minority
groups, even when those practices are materially similar to the
strictly prohibited practices of marginalised minority groups
[4,7,8,1114]. This bias is evident in the genital cutting policies
of international liberal institutions including the World Health
Organisation (WHO) [18,19], and it is transparent in current UK
legislation on Female Genital Cutting (FGC). The Female Genital
Mutilation Act 2003 [20] criminalises the cutting of adult female
genitals for culturalreasons even if the woman has made it
clear that she wants to be cut or sewn [12,20]. Genital
modication practices are permitted if the modication is
necessary for hermental healthbut it is immaterial whether
she or any other person believes that the operation is required
as a matter of custom or ritual([20], section 1). This means that
in practice, the policy mainly affects women from marginalised
cultural and ethnic groups whose cutting practices are under-
stood to be matter[s] of custom or ritual, while (primarily white)
majority group women can have their genitals modied if it is
deemed important for their mental health [8,12,20].
Policy inconsistency of this kind, that infantilises women from
marginalised groups (the UK law explicitly describes them as
girls), is a hangover from a long trend of cultural supremacism
in Western policy-making and political theorising [3,5,8,1214].
Policymakers who target groups practising medically unneces-
sary female child genital cutting (FGC) but remain silent over or
even endorse medically unnecessary male and intersex child
genital cutting (MGC, IGC) fail to consider how all child genital
cutting practices are maintained and driven by culturalnorms
[7,8,1214,18,19]. Shweders[5] contribution to the debate
Received: 18 August 2021 Revised: 3 November 2021 Accepted: 15 November 2021
Department of Politics, University of Exeter, Exeter, United Kingdom. email:
IJIR: Your Sexual Medicine Journal
about genital cutting is very important here; he challenged
Western critics of FGC to take a hard second lookat the practice
and to be slow to judge the people and groups for whom it
remains important. It is an invitation to evaluate the cultural
practices and inherent biases of ones own sociocultural context
and heritage that many scholars pursuing policy parity on child
genital cutting and modication have taken seriously [4,5]. Most
scholars working on the ethico-legal status of child genital
cutting in Western societies have come to agree on one thing:
policy inconsistency such as strict prohibition of so-called
culturalFGC alongside legal permission of multiple forms of
medically unnecessary MGC and IGC cannot be reconciled with a
principle of policy parity for diverse groups, nor defended if
equal childrens rights to bodily integrity are taken seriously.
What remains to be agreed upon, however, is what Western
states ought to do about their inconsistent policies.
One way to ensure policy parity regarding child genital cutting
would be to permit some forms of FGC that are currently illegal.
Advocates of tolerance for what they regard as minimalforms of
child genital cutting (such as, nicking, pricking, or partial removal
of the clitoral prepuce or hood, and/or cutting or excision of
portions of the labia) argue as follows: parents are permitted to
authorise medically unnecessary intersex child genital modica-
tion and male child prepuce removal (partial or total) in Western
societies whatever their justication and on the condition that
all of the childs parents agree in some societies, for instance in the
UK [9]. As such, justice requires that parents also be permitted to
authorise medically unnecessary FGC for their daughters, as
practised, for example, within various Muslim communities [21], so
long as the cutting is no more harmful than whatever is permitted
for male children.
Defenders of this position characterise it as a harm reduction
approach, the idea being that permitting these relatively minor
forms would dissuade community members from continuing
more intrusive forms of FGC that carry a greater risk of resulting in
lasting complications ([2]: p. 290). This position takes seriously the
fact that some forms of FGC are more materially harmful than
others, and that grouping all non-Western types under the
provocative and demonising title Female Genital Mutilation,asis
standard in Western law and policy, obscures these material
differences [7,8,1820]. In recent work, Duivenbode and Padela
consider the question from a Muslim religious perspective,
arguing that rather than decouplingFGC from Islam, as is
common for opponents of the practice, it would be benecial to
take guidance from Islamic ethical teachings that favour harm
reduction [2]. The authors argue that, despite protestations to the
contrary, there is a meaningful historico-religious association
between Islam and FGC in many communities that should be
acknowledged, rather than avoided, by people engaged in the
debate ([2]: p. 290).
Presenting child FGC in this way may well be successful for its
advocates. The argument that child MGC should be permitted has
been most effective in real-world contexts when framed as a
matter of religious freedom [8,2224]. For instance, in Germany,
the decision to permit infant MGC for religious purposes was
made on the basis that prohibiting it would be a violation of
parentsreligious freedom [24]. Similarly, Iceland recently shied
away from enforcing a ban on MGC after criticisms that it would
violate the religious freedom of some practising groups [23]. The
question of religious freedom is among the most difcult areas to
tread politically speaking, and so recouplingFGC with Islam is a
potentially powerful way to argue that some forms should be
permitted. However, the argument is unconvincing for several
First, the idea that male child prepuce removal is harmlessis
highly controversial [1,4,79,25,26]. The suggestion that the
practice should be used as a default standard for what is
acceptable when considering harm-reduction approaches to FGC
does not go unchallenged. Many authors have raised concern
about the moral and legal status of male genital cutting practices,
emphasising the material and psychological harms that they entail
[1,4,79,25,26]. The view that penile prepuce removal is
harmless assumes that the prepuce itself has no value, meaning
that the only real harm at stake in its removal is the risk of surgical
complications. But it is not standard to take this approach to other
functional body tissues which are attributed their own value. The
value given other body tissue means, for instance, that even when
surgery is medically necessary, there is a moral and legal
imperative to make every effort to preserve healthy tissue [27].
Many men whose genitals were cut as children, teens, or infants
express extreme discontent at having their sexual anatomy altered
before they were able to make the decision for themselves
[2528]. This does not mean, of course, that every person whose
genitals were cut or modied in childhood experiences the same
negative consequences, but it does cast serous doubt on the
assertion that the harms of prepuce removal are minimal.
Second, from a practical point of view the argument has limited
applicability to real-world cases because a great many justica-
tions given for continuing child genital cutting practices simply
are not religious. Routine secular child MGC in the US, for instance,
is practised for various reasons, from parental aesthetic prefer-
ences to the medically controversial belief that prepuce removal
promotes genital health or hygiene [1,7,8,22,24]. Intersex child
genital modication is defended on the assumption that children
have a psychosocial need for their genitals to t a physical sex
binary [8,15,16,22]. Duivenbode argues that the blanket
prohibition of medically unnecessary child genital cutting would
further disadvantage marginalised minority religious groups [29],
but importantly, religion is seldom the only justication cited to
defend child genital cutting practices and is often not cited at all
[30]. If child genital cutting and modication practices were
prohibited out of respect for all childrens right to genital integrity
whatever their sex characteristics, then not only religious groups
would be affected. Parents and medics within dominant and
marginalised groups in Western states would have their value
preferences limited by prohibiting all child genital cutting and
Finally, the underlying claim that collective rights to engage in
other-affecting religious practices should take priority over the
individuals right to bodily integrity is hard to reconcile with the
liberal commitments of Western states. While liberal thought and
policy are increasingly open to group differentiated rights within
culturally diverse societies, the individual remains normatively prior
to the collective when the groups freedom would upset the rights
most prized by liberals; and bodily integrity is key for liberals of all
stripes [1,710]. Duivenbode argues that female and male child
prepuce removal should be permitted in liberal democracies within
an account of value pluralism whereby groups should be free to
practise traditions that cohere with their internal value structures.
Duivenbode is right to stress the importance of respect for all
groups within democratic political societies, but for value pluralism
to remain morally compatible with core liberal principles, there
must be limits to what is permitted when it comes to other-
affecting actions. Many children in democratic (and non-demo-
cratic) societies who are raised within religious value systems grow
up to reject certain aspects of those systems and may seek to leave
the group [31]. According to Möller, religious freedom properly
understood, ought to include the possibility for those raised within
a religious household to distancethemselves from that religion
([32]: p. 470). This freedom restrainton what parents may
legitimately do to their children:
K.G. Townsend
IJIR: Your Sexual Medicine Journal
prohibits irreversible religiously or culturally motivated
changes to the childs body: precisely by virtue of being
irreversible, such changes make it impossible for the child to
ever to [dissociate] from them and to live life free from a
religiously or culturally imposed physical mark.([32]: p. 470)
Möllers argument here is that the physical mark means that the
child will be permanently included in the group even if they come
to reject its values and practices. It goes without saying that the
child could still reject many of their parentsreligious teachings
upon becoming an adult, and maybe endorse different religious
teachings or become an atheist [32]. But, Möller points out, the
physical mark would remain, and they may feel that their genital
and bodily integrity had been unjustiably violated before they
could autonomously endorse or reject the associated values and
practices [32].
Priority rules are necessary within value plural political societies
to avoid slipping into a political space that permits people to do
anything to anybody on the grounds that the action is important
for their collective conception of the good life. When it comes to
liberal societies, the individuals right to bodily integrity must be
prior to the groups collective identity. Childrens rights to bodily
and genital integrity function as liberty-limiting principles if they
come into conict with parental preferences that would violate
those rights. The role of liberty-limiting principles in value plural
liberal societies is to emphasise the limits of moral relativism, and
to stress priority rules that constrain the practices of all groups
majority, minority, dominant, and marginalised.
The idea that people have a right to bodily integrity is common-
place and now universally accepted([33]: p. 569). It is enshrined
in human rights law representing political and institutional
commitments to respecting peoples bodies as sites of their
personal freedom[79]. The right consolidates, politically, a moral
commitment to respecting the body as the point at which the
moral person encounters the empirical world. The moral and
political signicance of the individual right to bodily and genital
integrity concerns the profoundly personal value that bodies and
genitals have for individualsourishing and experience through-
out life. Our (By our,we, and us, I mean all embodied people.)
bodies are crucial to the most important events of our lives, being
born, growing up, making love, having children, falling ill and
dying([34]: p. 1). We use our bodies to express our thoughts and
feelings, to engage with the objective world, to hide from the
social world. In interfering with my body, you interfere with my
subjectivity in the most immediate, direct, and intimate way.
Violations of bodily integrity, then, are violations of a most serious
kind within a liberal normative framework.
A distinction: bodily integrity is complicated with, but distinct from
and irreducible to bodily autonomy [8,30,33,34]. A commitment to
the principle of bodily integrity requires others to respect
individualsbodies, to leave them uncoerced, unpenetrated, and
uncut whether or not the individual is autonomous. The normative
thrust of a commitment to bodily integrity resides in the value and
signicance of the body itself as commanding respectful treatment
by others this value and signicance is present whether or not the
person is autonomous and capable of consenting to interventions
into their body. This matters conceptually and with regards to the
argument against medically unnecessary child genital cutting,
because it means that the right to bodily integrity is not merely
about ensuring that the person is able to exercise rational control
over their body, and it acknowledges the fact that individuals are
seldom in complete control of their bodies. Understanding bodily
integrity as distinct from bodily autonomy appeals to and accounts
for the normative signicance of the body itself as the point at
which a persons integrated subjectivity in all its rational and
irrational components encounters the empirical world. Bodily
integrity as the integrated bodyhelps to explain the legal structure
of the right, the normative weight of the right, and the ambiguous
boundaries of the right([33]: p. 567).
A body-oriented approach to understanding the right to bodily
integrity attributes to the body a value of its own as a site of
moral experience([30]: p. 188), its moral value is distinct from the
person or people who exercise(s) control over it and it cannot
(entirely) be owned or controlled([30]: p. 183). When it comes to
the child, the right to bodily integrity has the character of
protecting their interest in having an intact body, so long as there
is not a medical need to interfere with the body, and carries with it
a duty in others to respect their bodies as the physical boundary
of their integrated subjectivity, and importantly, it emphasises the
idea that the individuals body cannot and should not be owned
or controlled by others.
Dekkers et al. [30] identify a paradox in the moral outlook of
religious groups that are committed to the concept of bodily
integrity, but practise child genital cutting for religious purposes.
The authors found that there are different views of bodily
integrity, some of which contain the idea that child genital cutting
is permissible because it is thought of as contributing to male
childrens bodily integrity: without it, their bodies are viewed as
imperfect. In their analysis of different perspectives on MGC and
FGC of minors amongst people from Muslim and Jewish
communities, they observe that while many of the people they
interviewed did not consider bodily integrity to be violated by
MGC, they invariably considered FGC to be a violation of bodily
integrity ([30]: p. 188). The interviewees also reported a feeling of
unease and discomfort when witnessing MGC, despite the fact
that in their view it denitely needs to be done(p. 188). Dekkers
et al. claim that:
[t]his fact underscores that, although they rationally do not
speak in terms of bodily integrity or of a violation of the human
body, they intuitively express feelings of ambivalence and
hesitation that can be explained in terms of respect for the
integrity of the body.([30]: p. 188)
This sense of unease is attributable to the moral value of the
body itself.
Dekkers et al. [30] acknowledge the difculty in capturing the
moral signicance of bodily integrity, and gesture towards the fact
that the concept is deployed and interpreted in different ways in
many real-world contexts. Nonetheless, the following is pro-
foundly important for how the right is conceptualised and
deployed: the right to bodily integrity is not reducible to bodily
autonomy, that is, a violation of the right to bodily integrity is not
only a violation of a persons autonomy. This means that a person
who is not autonomous can have their bodily integrity violated. All
of this matters here, because it means that the childs rights to
bodily and genital integrity are grounded in their interest in
having their bodily integrity respected irrespective of whether
they would or would not retrospectively endorse any cutting or
modication of their genitalia as adults. It may well be the case
that some adults who had their genitals cut or modied in
childhood would afrm it as something they are content with
because it coheres with the wider sociocultural values of their
group (majority or minority, dominant or marginalised); but the
practice would still be a violation of their bodily and genital
integrity and simply cannot be justied by appealing to group
rights to religious freedom within a liberal political framework.
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I would like to thank two anonymous reviewers for their comments and the associate
editor for numerous helpful suggestions. I am greatly indebted to Professor Clare
Chambers, Professor Catriona McKinnon, Professor Robert Lamb, Dr Andrew Schaap,
and Dr Sarah Drews Lucas for their feedback on and engagement with my work on
this subject.
KGT is the sole author.
The authors declare no competing interests.
Correspondence and requests for materials should be addressed to Kate Goldie
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K.G. Townsend
IJIR: Your Sexual Medicine Journal
... These policies aim to protect girls and women from the physical and psychological harms of the procedures. But, policy inconsistency regarding different sex trait categories of CGCM in Western societies is increasingly recognised as morally unjustifiable (Svoboda 2006;Möller 2020;Shweder 2000;Dustin 2010;The Brussels Collaboration 2019;Earp 2020;Chambers 2018;Townsend 2020;2021a;2021b;Duivenbode 2021;Duivenbode and Padela 2019). FGC conducted by minority groups originating from some African countries in Western liberal societies (Mestre 2022), is packaged in a narrative that understands the groups to be 'barbaric' and harmfully culturally 'coercive' (Piontek and Albani 2019;Buckler 2022;Mazor 2013;Shweder 2000). ...
... Women are frequently treated as less able to exercise autonomous choice if they belong to a marginalised cultural group within Western societies (Galeotti 2015;2007;Shahvisi 2021). For example, British law states that it is an offence to cut a woman's genitals if she is from a group that traditionally practises 'ritual' FGC, even if she has given explicit consent for the procedure (Townsend 2021a(Townsend , 2021bShahvisi 2021;Chambers 2019). When it comes to cutting 'as a matter of custom or ritual… girl includes woman' and cutting girls' (and women's) genitals for such purposes is strictly prohibited (Female Genital Mutilation Act 2003). ...
... It is also clear from analysis of legislation in the UK that women from these groups are not thought to be sufficiently autonomous to be permitted to have FGC even when they consent (Female Genital Mutilation Act 2003;Shahvisi 2021;Shahvisi and Earp 2019;Townsend 2021b). The idea that women from cultural groups with patriarchal characteristics cannot develop sufficient autonomy to legitimately choose FGC, but that women from dominant Westernised groups should be permitted to have FGCS as a part of their self-development, implies that Westernised women are thought to have been raised in conditions that permit them to develop sufficient autonomy to self-select genital modification. ...
Full-text available
We are all always culturally embedded. But some people in Western multicultural societies are treated as though they are more affected by cultural norms than others (Williams, in: Minorities within minorities, Cambridge University Press, 2005.; Kukathus in Political Theory 20: 105–139, 1992. ; Shahvisi in International Journal of Impotence Research, 2021.; Galeotti in Constellations 14: 91–111, 2007., in European Journal of Political Theory 14: 277–296, 2015; Townsend in Philosophy & Social Criticism 46: 878–898, 2020., in: The child’s right to genital integrity:Protecting the child, resisting harmful practices, and enabling sexual autonomy, 2021a., in International Journalof Impotence Research, 2021b. Members of marginalised cultural groups are treated as more ‘driven’ by culture than their dominant cultural group member counterparts (Honig, in: Is multiculturalism bad for women? Princeton University Press, 1999. I focus on the treatment of genital cutting and modification practices conducted by diverse groups in contemporary Western societies and argue that they should all be understood as culturally ‘influenced’ as reported by Chambers (Sex, culture, and justice: The limits of choice, Penn State University Press, 2008). Further, different legal and moral treatment of genital cutting and modification practices within Western liberal societies is a form of cultural discrimination that hinders productive intercultural dialogue and the integration of diverse groups. I argue that policy on genital cutting and modification should be the same across groups to reduce socio-cultural disadvantage and enable smoother integration in Western democracies.
... In "Defending an inclusive right to genital and bodily integrity for children" [1], Townsend makes an important distinction between bodily autonomy and bodily integrity. While bodily autonomy is plausibly not a right that pre-autonomous minors possess, the principle of bodily integrity, she argues, "requires others to respect individuals' bodies, to leave them uncoerced, unpenetrated, and uncut." ...
... Debates about the ethics of genital cutting, whether female, male, or intersex [5], often focus on the real or perceived consequences of the procedure (e.g., for physical or mental health), with defenders and critics disagreeing about whether a typical instance of each kind of procedure is "harmful enough" to warrant moral condemnation or state interference. In other words, in many cases, scholarly discussions of child genital cutting practices emphasize potential features or consequences of the bodily state brought about by genital cutting, taking the outcomes associated with body modification as the primary measure of harm or wrongdoing [1,6,7]. Thus, commentors typically consider the degree to which state-related aspects such as permanency, loss of healthy tissue or function, or a range of possible surgical complications amount to material harm. ...
... Townsend describes the right to bodily integrity as carrying with it "a duty in others to respect [children's] bodies as the physical boundary of their integrated subjectivity…." [1]. This means that when it comes to genital cutting practices, there is more at stake than the right to inhabit an unmodified state. ...
... Alternatively, should there be categorical restrictions on genital modifications that are not necessary for the child's physical health until they are mature enough to give their own consent? [12][13][14][15] Or does the answer depend on (inevitably disputable, value-laden) 16,17 judgments about the expected level of net benefit or harm in each particular case? ...
... This editorial is an introduction to the first part, which begins by examining tensions and contradictions surrounding current ethicolegal treatment of diverse forms of genital cutting or surgery. 4,9,13,14,51 In particular, authors question why different standards of protection are applied to equally non-consenting children based, in practice, on their sex-typed anatomy. In many countries, it is a criminal offense to engage in medically unnecessary genital cutting or surgery on a minor, no matter how superficial or severe the intended incision or modification and irrespective of motivation, only if the child is categorized as female at birth and has no apparent intersex traits. ...
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We are proud to introduce this special collection of papers on child genital alteration practices spanning the Global North and South and transcending conventional boundaries of sex and gender. It is increasingly recognized that there is an urgent need to evaluate all forms of genital cutting or surgery, especially those carried out on presumptively pre-autonomous persons, in a systematic way. It is necessary both to clarify what is known about these practices medically and scientifically, but also to work through the cultural, legal, and ethical implications of performing such significant operations on persons who are generally presumed to be incapable of providing morally valid consent to them on their own behalf. This edited collection includes nuanced discussions of female, male, and intersex forms of genital cutting or surgery performed on young people in countries and cultures around the world. Although the focus is on genital operations that are widely argued to be both medically unnecessary and non-consensual, an important lesson that emerges from this collection is that both the concept of medical necessity and the criteria for giving ethically valid consent to certain body modifications are not a matter of universal consensus. Rather, they are politicized, moralized, and contested.
... Third, the line between "necessary" and "unnecessary" medical or surgical intervention in relation to genital cutting is ambiguous, open to interpretation, and lacking consistency [45][46][47][48]. The common agreement on necessary surgeries in the context of VSD, is that it is saving lives, preventing serious health risks that cannot be as safely or effectively addressed non-surgically, such as, removing gonads with cancer or a high risk of developing cancer in the near-future, modifying the urethral opening (not necessarily at the tip of the penis) to enable urination, and preventing infections of internal organs. ...
... Following this, two documents relevant to the field of medicine were published in two years. The German Medical Association published a statement on the treatment of patients with VSD in 2015, and, in 2016 the German Association of the Scientific Medical Societies (AWMF) issued new medical guidelines that were participatory and included patient groups and psychosocial professionals [48] (The participatorily developed AWMF S2k guidelines titled "Variants of Sex Development" from 2016 and the reports and studies of the Interministerial Working Group stress the need for readily available counseling for parents of children with VSD. They are currently in the process of revision). ...
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In May 2021, the German parliament passed a long-debated law to protect children with variations of sex development/sex characteristics from medically unnecessary surgeries until they are old enough to decide for themselves. This law joins similar laws passed in other countries in recent years and recognizes the rights of people with variations of sex development to self-determination and bodily autonomy. In this article, we discuss the notion of bodily autonomy and examine details of the German legislation in the context of psychosocial care. We focus on the following questions: (1) How may the law help to preserve the genital integrity and future bodily autonomy of newborns with variations of sex development (VSD)? (2) What are the opportunities and challenges of this law? (3) What strategies are needed to implement the law in ways that include medical professionals’ knowledge and skills, parental cooperation, and protection for the genital integrity as well as the future genital autonomy of newborns with VSD? We make two main arguments. On the one hand, this law has created a space for a new discourse and discussion on VSD in German society and enables the “wait and see” approach. This approach challenges the traditional “psychosocial emergency” policy aimed at quickly “repairing” atypical genitalia. On the other hand, the law is characterized by significant challenges. For example, it does not address the meaning of bodily autonomy in the context of newborns and their families with VSD, and it overlooks the important distinction between genital appearance, genital function, and gender identity. We offer various educational strategies that can be implemented with different target groups in Germany to meet these challenges and ensure the adequate implementation of this law.
... The law and ethics of medically unnecessary a genital modification of pre-pubescent children are increasingly debated. [3][4][5][6][7][8] On the one hand, it is widely internationally accepted that such modification, brought about by cutting or removing healthy tissue, is both ethically and legally inappropriate in the case of roughly half of all such children: namely, those whose genitalia at the time of birth are deemed to fall within normative standards for "binary" female classification (i.e. non-intersex b females), virtually all of whom will be raised as girls. ...
... [44][45][46][47][48][49] Many scholars now argue that the current situation, namely, the existence of different ethicolegal standards for medically unnecessary child genital cutting practices depending on the child's sex traits or gender of rearing, is unjust and unsustainable. 1,6,26,27,34,[50][51][52] Such scholarship has, however, so far failed to make a significant difference to law or policy. We will illustrate this conundrum with a close analysis of the most recent major UK guidance on non-therapeutic penile circumcision of minors, from the British Medical Association. ...
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The current legal status and medical ethics of routine or religious penile circumcision of minors is a matter of ongoing controversy in many countries. We focus on the United Kingdom as an illustrative example, giving a detailed analysis of the most recent guidance on the subject, from 2019, from the British Medical Association (BMA). We argue that the guidance paints a confused and conflicting portrait of the law and ethics of the procedure in the UK context, reflecting deeper, unresolved moral and legal tensions surrounding child genital cutting practices more generally. Of particular note is a lack of clarity around how to apply the “best interests” standard—ordinarily associated with time-sensitive proxy decision-making regarding therapeutic options for a medically unwell but incompetent patient, such as a young child dealing with disease or disability—to a parental request for a medically unnecessary surgery to be carried out on the genitalia of a well child. Challenges arise in measuring and assigning weights to intended sociocultural or religious/spiritual benefits, and even to health-related prophylactic benefits, and in balancing these against potential physical, functional, and psychosexual risks or harms. Also of concern are apparently inconsistent safeguarding standards applied to children based on their birth sex categorization or gender of rearing. We identify and discuss recent trends in British and international medical ethics and law, finding gradual movement toward a more unified standard for evaluating the permissibility of surgically modifying healthy children’s genitals before they can meaningfully participate in the decision.
... A more consistent approach would oppose all medically-unnecessary, non-voluntary genital cutting of children, regardless of sex in both North and South, while tolerating medicalised cutting in consenting adults with the same proviso. (39)(40)(41)(42)(43)(44)(45) ...
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Dear Editor, Kimani et al. (1) oppose medicalisation of non-therapeutic female genital cutting (FGC) in Global-South communities, regardless of consent/voluntariness or cutting severity, including non-tissue-removing forms ("ritual-nicking") and forms anatomically indistinguishable (2) from "cosmetic" FGC, already medicalised in the Global North (3,4) (e.g., clitoral "unhooding" [WHO Type-1a] and cosmetic labiaplasty [WHO Type-2a], increasingly performed on minors, as with ~20% of U.S. labiaplasties 2016-2019). (5) Other medicalised Global-North cutting includes non-consensual intersex "normalisation" (6-8) and non-therapeutic penile circumcision (over 1 million/year in U.S.). (9,10)
... In response to my suggestion that there should be a universal age at which people should be legally considered able to make decisions to alter their genitalia [1], Max Buckler argues that older children and teenagers should have their autonomous decision-making capacities assessed individually and be treated on a case-by-case basis when it comes to such procedures [2]. He claims that there is an important difference between "coercive cultural acts" and those sought out by older children for their "own desire" [2]. ...
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This review seeks to integrate scholarly discussions of nonconsensual medicalized genital procedures, combining insights from the literature on obstetric violence with critiques based on children’s rights. In both literatures, it is increasingly argued that such interventions may constitute, or be experienced as, violations of patients’ sexual boundaries, even if performed without sexual intent. Within the literature on obstetric violence, it is often argued that clinicians who perform unconsented pelvic exams (i.e., for teaching purposes on anesthetized patients), or unconsented episiotomies during birth and labor, thereby violate patients’ bodily integrity rights. Noting the intimate nature of the body parts involved and the lack of consent by the affected individual, authors increasingly characterize such procedures, more specifically, as sexual boundary violations or even “medical sexual assault.” Separately, critics have raised analogous concerns about medically unnecessary, nonconsensual genital cutting or surgery (e.g., in prepubescent minors), such as ritual “nicking” of the vulva for religious purposes, intersex genital “normalization” surgeries, and newborn penile circumcision. Across literatures, critics contend that the fundamental wrong of such procedures is not (only) the risk of physical or emotional harm they may cause, nor (beliefs about) the good or bad intentions of those performing or requesting them. Rather, it is claimed, it is wrong as a matter of principle for clinicians to engage—to any extent—with patients’ genital or sexual anatomy without their consent outside of certain limited exceptions (e.g., is not possible to obtain the person’s consent without exposing them to a significant risk of serious harm, where this harm, in turn, cannot feasibly be prevented or resolved by any less risky or invasive means). An emerging consensus among scholars of obstetric violence and of children’s rights is that it is unethical for clinicians to perform any medically unnecessary genital procedures, from physical examination to cutting or surgery, without the explicit consent of the affected person. “Presumed” consent, “implied” consent, and “proxy” consent are thus argued to be insufficient.
It is widely accepted that children enjoy some form of a right to bodily integrity. However, there is little agreement about the precise nature and scope of this right. This paper offers a conceptual analysis of the child's right to bodily integrity, in order to further elucidate the relationship between the child's right to bodily integrity and considerations of autonomy. Following a discussion of Leif Wenar's work on the structure and justification of rights, I first explain how the adult's right to bodily integrity can be distilled into separate elements that may plausibly be justified by different moral considerations. In particular, I claim that this analysis suggests that whilst the adult's right to bodily integrity is not wholly reducible to bodily autonomy, autonomy nonetheless remains entwined with our understanding of this right in a number of ways. On the basis of this discussion, I go on to outline three important complexities that arise when we consider the child's right to bodily integrity, before particularly focusing on the question of how third parties should determine whether or not to perform a physical interference upon a child who lacks decision-making capacity. Here, I raise some objections to Earp and Mazor's recent attempts to answer this question, before briefly defending an ‘autonomy-based interests’ account of permissible interference, an account that shares in what I take to be the spirit, if not the precise letter, of these earlier views.
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Purpose of Review To summarize and critically evaluate the moral principles invoked in support of zero tolerance laws and policies for medically unnecessary female genital cutting (FGC). Recent Findings Most of the moral reasons that are typically invoked to justify such laws and policies appear to lead to a dilemma. Either these reasons entail that several common Western practices that are widely regarded to be morally permissible and are currently treated as legal—such as intersex “normalization” surgery, female genital “cosmetic” surgery performed on adolescent girls, or infant male circumcision—are in fact morally impermissible and should be discouraged if not legally forbidden; or the reasons are being applied in a biased and prejudicial manner that is itself unethical, as well as inconsistent with Western constitutional requirements of equal treatment of individuals before the law. Summary In the recent literature, only one principle has been defended that appears capable of justifying a zero tolerance stance toward medically unnecessary FGC without relying on, exhibiting, or perpetuating unjust cultural or moral double standards. This principle holds that, in countries whose ethicolegal traditions are shaped by a foundational concern for individual rights, respect for bodily integrity, and personal autonomy over sexual boundaries, all non-consenting persons have an inviolable moral right against any medically unnecessary (or medically deferrable) interference with their genitals or other private anatomy. In such countries, therefore, all non-consenting persons, regardless of age, race, ethnicity, parental religion, assigned sex, gender identity, or other individual or group-based features, should be protected from medically unnecessary genital cutting, regardless of the severity of the cutting or the expected level of benefit or harm.
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There are now legally prohibited forms of medically unnecessary female genital cutting—including the so-called ritual nick—that are less severe than permitted forms of medically unnecessary male and intersex genital cutting. Attempts to discursively quarantine the male and female forms of cutting (MGC, FGC) from one another based on appeals to health outcomes, symbolic meanings, and religious versus cultural status have been undermined by a large body of recent scholarship. Recognizing that a zero-tolerance policy toward ritual FGC may lead to restrictions on ritual MGC, prominent defenders of the latter practice have begun to argue that what they regard as “minor” forms of ritual FGC should in fact be seen as morally permissible—even when non-consensual—and should be legally allowed in Western societies. In a striking development in late 2018, a federal judge ruled that the longstanding U.S. law prohibiting “female genital mutilation” (FGM) was unconstitutional on federalist grounds, while separately acknowledging the logical relevance of arguments concerning non-discrimination on the basis of sex or gender. In light of such developments, feminist scholars and advocates of children’s rights now increasingly argue that efforts to protect girls from non-consensual FGC must be rooted in a sex and gender-neutral (that is, human) right to bodily integrity, if these efforts are to be successful in the long-run.
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In recent years, the dominant Western discourse on “female genital mutilation” (FGM) has increasingly been challenged by scholars. Numerous researchers contest both the terminology used and the empirical claims made in what has come to be called “the standard tale” of FGM, also termed “female genital cutting” (FGC). The World Health Organization (WHO), a major player in setting the global agenda on this issue, maintains that all medically unnecessary cutting of the external female genitalia, no matter how slight, should be banned as torture and a violation of the human right to bodily integrity. However, the WHO targets only non-Western forms of female-only genital cutting, raising concerns about gender bias and cultural imperialism. Here, we summarize ongoing critiques of the WHO’s terminology, ethicolegal assumptions, and empirical claims, including the claim that non-Western FGC as such constitutes an extreme form of discrimination against women. To this end, we highlight recent comparative studies of medically unnecessary genital cutting of all types, including those affecting adult women and teenagers in Western societies, individuals with differences of sex development (DSD), transgender persons, and males. In so doing, we attempt to clarify the grounds for a growing critical consensus that current anti-FGM laws and policies may be ethically incoherent, empirically unsupportable, and legally unsustainable.
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Purpose of Review The aim of this first review out of a three-part series is to provide an overview of the practices of genital cutting including male circumcision, genital alteration of children with ambiguous genitalia, and clitoral hood reduction in Western societies; and type IV FGC in Southeast Asia. Examination of these procedures provides context for the practice of Khafd, female genital cutting (FGC), in the Dawoodi Bohra community. Recent Findings In 2018, a Sri Lankan Parliamentary Sectoral Oversight Committee on Women and Gender (PSOCWG) heard the confidential testimonies of 15 women. Subsequently, a circular to medical professionals advised them to refrain from FGC. In September 2018, there was a call by multiple Islamic organizations to medicalize the practice and remove the circular that doctors should refrain from FGC. Summary In this review, the WHO terminology for FGC classification is evaluated, and criticisms published online from the Dawoodi Bohra perspective are underscored. Practices pertinent to Khafd are scrutinized. Western practices, male circumcision, genital surgeries for children with ambiguous genitalia, and clitoral hood reduction, are described to further contextualize Khafd. Position statements from professional medical societies on male circumcision are reviewed. Type IV genital cutting is widely practiced in Southeast Asian Muslims and is largely medicalized. The review paper highlights two studies. Interviews with 262 Malay women from Malaysia comprise the first study. The second is a qualitative study conducted by Islamic Relief Canada, an advocacy organization aimed to end the practice, with data collected from Indonesian women in 2013. Interestingly, all of the above practices of genital cutting adhere to social norms and are largely accepted within the communities that practice these different forms of genital cutting.
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We seek to clarify and assess the underlying moral reasons for opposing all medically unnecessary genital cutting of female minors, no matter how severe. We find that within a Western medicolegal framework, these reasons are compelling. However, they do not only apply to female minors, but rather to non-consenting persons of any age irrespective of sex or gender. Keeping our focus exclusively on a Western context for the purposes of this article, we argue as follows: Under most conditions, cutting any person’s genitals without their informed consent is a serious violation of their right to bodily integrity. As such, it is ethically impermissible unless the person is non-autonomous (incapable of consent) and the cutting is medically necessary.
Neonatal male circumcision is closely tied to Jewish identity and is socially normative in Israel. Soon after the mass arrival of secular, uncircumcised Jewish immigrants from the former Soviet Union in the early 1990s, the state sponsored mass circumcision campaigns for adolescents and adult men enabling them to join the Jewish collective, socially and religiously. Some two decades later, these men break the silence exposing their traumatic experiences in the wake of this body-altering surgery. This paper builds on the narratives of these men, belonging to Generation 1.5 of Russian Israelis, emerging in online forums, media features, live events and personal interviews. Driven by social pressure and the need to belong, most young men (and their parents) consented to the operation without proper counselling and unaware of its ramifications. Men share their intimate memories of the rapid surgical procedure, painful recuperation, and their belated regrets, both aesthetic and sexual. The willingness to expose their lingering trauma signals evolving concepts of masculinity and vulnerability among these former Soviet men. Their voices join the local and international movement opposing medically-unnecessary genital surgeries of any kind – on men, women and intersex people.
In the UK, male genital cutting is in principle legal and may even be ordered by a court, whereas female genital cutting is a criminal offence. The coherence of this approach was recently questioned by Munby P in Re B and G (children) (No 2); the present article continues this inquiry and demonstrates that the justifications that the courts have provided for the differential treatment of male and female cutting—relating to the harm involved in the respective practices, possible medical benefits of male cutting, the absence of a religious motivation with regard to female cutting, and patriarchal power structures enabling female but not male cutting—are insufficient. It proposes a different foundation for the categorical rejection of female genital cutting and argues that such practices are wrong as a matter of principle. This provides a convincing basis for the rejection of all forms of female genital cutting, including comparatively mild ones such as ritual nicks, and furthermore leads to the conclusion that male cutting, too, must be regarded as categorically impermissible.
Recent events, including the arrest of physicians in Michigan, have renewed bioethical debates surrounding the practice of female genital cutting (FGC). The secular discourse remains divided between zero-tolerance activists and harm-reduction strategists, while Islamic bioethical debates on FGC similarly comprise two camps. "Traditionalists" find normative grounds for a minor genital procedure in statements from the Prophet Muhammad and in classical law manuals. "Reformers" seek to decouple FGC from Islam by reexamining its ethico-legal status in light of the deficiencies within narrations ascribed to the Prophet, the health risks posed by FGC, and contemporary perspectives on human rights, and thereby delegitimize the practice. This paper argues that alignment between secular and Islamic views can be found in a harm-reduction strategy by demonstrating that the impetus to reduce harms is found within Prophetic statements on FGC. From an Islamic ethico-legal standpoint, it is justified to acknowledge the permitted status of FGC procedures that do not harm-in other words, the ritual nick-and at the same time the prohibited status of procedures that lead to credible medical and psychological harms. Bringing these multiple perspectives and data points into conversation forges a common ground to delegitimize and eradicate harmful genital procedures among Muslim communities.