A disconcerting issue has hit the political radar: male circumcision. Is it a medical procedure or child abuse? 

As furor over female genital mutilation grows, so does the criticism of male circumcision.

This June, Arizona eliminated Medicaid funding for infant circumcision, following the lead of six other states: California, Oregon, Washington, Nevada, North Dakota and Mississippi. In July, a North Dakota court ruled that an adult male could sue the doctor who circumcised him even though the parents had consented and there was no "botch." Flatt v. Kantak became the latest in a series of circumcision cases that test the legal status of the procedure.

Circumcision has been under attack for the last few years. In 1999, the American Academy of Pediatrics revised its guidelines to state, "the benefits are not significant enough for the AAP to recommend circumcision as a routine procedure." In 2000, the American Medical Association modified its policy to read, "Existing scientific evidence demonstrates potential medical benefits...however, these data are not sufficient to recommend routine neonatal circumcision."

Yet most male babies in North America continue to be circumcised. Advocates loudly proclaim its advantages for men, including an HIV-protective effect for men, and its benefits for women — those with circumcised partners are said to have a reduced risk of cervical cancer.

Yet the central question keeps returning: is the removal of any part of a healthy sexual organ justified?

The passionate debate has implications far wider than medicine. One is equality under the law. Female genitalia mutilation is already a criminal act under Title 18 United States Code Section 116, which reads, in part, "whoever knowingly circumcises, excises, or infibulates the whole or any part of the labia majora or labia minora or clitoris of another person who has not attained the age of 18 years shall be fined under this title or imprisoned not more than five years, or both." [Emphasis added.]

Procedures necessary to health are excluded.

To remove any part of healthy male genitalia would seem to be an act parallel in law to female genital mutilation. Indeed, the plaintiff in Flatt v. Kantak will probably argue along these lines.

What does this mean for Jewish ritual circumcision, called Brit Milah — a sign of the Jewish covenant with God? The U.S. Code against mutilating female genitalia makes no exception for religion or culture. It states, "no account shall be taken of the effect on the person on whom the operation is to be performed of any belief on the part of that person, or any other person, that the operation is required as a matter of custom or ritual."

If variations of Islamic religion and culture do not justify mutilating women, then can religion justify non-therapeutic male circumcision? Nothing in international or domestic law would seem to allow the discriminatory banning of only female genital mutilation. Indeed, for decades, international law has come down against routine circumcision. For example, the U.N.'s Universal Declaration of Human Rights (1948) speaks of the "human rights" involved in "the ethics of circumcision," which are "the rights to security of person, to freedom from torture and other cruel and unusual treatment, and to privacy."

Those who claim that the mutilation of female genitalia cannot be likened to circumcision should read the many anti-circumcision sites that offer horror stories. Mothers Against Circumcision claim that these "side effects" are not uncommon and that circumcision has inherent and universal disadvantages, such as a diminishment of sexual pleasure.

Circumcision is also a moral issue. The organization Doctors Opposing Circumcision decries the procedure as "painful," "tragic," "contra-indicated" and states "that no one has the right to forcibly remove sexual body parts from another individual." DOC claims that circumcision violates the physician's Golden Rule — First, Do No Harm — as well as all seven principles of the A.M.A. Code of Ethics.

These are merely some of the political and moral questions surrounding circumcision. For better or worse, the parameters of this issue may well be determined in the courts through lawyers' arguments and judges' decisions. Which brings us back to Flatt v. Kantak.

Unfortunately, this case muddies the discussion by introducing other significant issues. For example, since the parents consented, the case implicitly asks whether parents have a right to make decisions about their children's bodies. Or is the real issue "informed consent"? Do doctors need to fully reveal all the possible side effects of, current thinking on, and alternatives to circumcision, so that it is no longer "routine"?

On the other hand, if circumcision is legally shown to be a form of criminal harm, then the "informed consent" of parents may be irrelevant: doctors, nurses, hospitals and mohels might be held criminally liable, alongside parents, for child abuse.

As medical associations one-by-one refuse to support routine circumcision, the procedure is losing ground — medically, morally, politically and legally. This process is being sped along by aggressive groups like The National Organization of Circumcision Information Resource Centers, a "non-profit educational organization committed to securing the birthright of male and female children and babies to keep their sexual organs intact."

The ensuing debate will help define medical ethics for a new generation.

Wendy McElroy