Dear Dr Meaney

I write to you from the unenviable position of one baptised and confirmed in the Catholic faith, and yet circumcised “on the eighth day” in accordance with the ancient Hebrew scripture. As penance for “the sins of the fathers” (as it were), I am compelled to write in defence of the bodily integrity of the newborn — all the more urgently, in the face of biotechnological imperatives to the contrary.

Human induced pluripotent stem cell (hiPSC) research is an exciting new field, promising cures for everything from infertility to cancer to Parkinson’s disease.[i] The isolation of foreskin fibroblasts is considered “the classic first step” in the derivation of hiPSCs,[ii] which boast the potential to be differentiated into virtually any kind of human cell type, including embryoid bodies. Neonatal and juvenile foreskin fibroblasts, in particular, are thus an increasingly valuable commodity across many fields of biomedical research, including virology and immunology.[iii]

Many researchers consider foreskin-derived hiPSCs to be a “non-controversial,” and therefore (?) more “ethical” alternative, to embryonic human stem cells.[iv] I am alarmed to discover that the National Catholic Bioethics Center serves to promote such a fallacious view.

Non-consensual, non-therapeutic male circumcision — the source of presumably all neonatal and juvenile foreskin biospecimens — is both unethical and unlawful. The amputation of healthy, functional, and indeed, highly specialised tissue, is as much an affront to human and children’s rights as it is to foundational principles of modern bioethics — the injunction to “first do no harm,” for example.[v][vi]

Whether or not male genital mutilation is also an affront to the Creation, and thus to its Creator — and whether or not it substantively compromises the child’s (latent) freedom of religious thought and belief — are questions perhaps best disputed by theologians. I would draw their attention to the Catechism:

Except when performed for strictly therapeutic medical reasons, directly intended amputations, mutilations, and sterilizations performed on innocent persons are against the moral law.[vii]

Furthermore:

it is not morally admissible directly to bring about the disabling mutilation or death of a human being, even in order to delay the death of other persons.[viii]

The National Catholic Bioethics Center, on the other hand, advises:

Wherever cells from directly aborted fetuses are used in research or product development, alternative and ethically non-controversial cell sources should instead be pursued, using, for example, cells obtained from routine surgeries like the re­moval of an appendix, or foreskin removal during newborn circumci­sion … [ix]

In recent years, scientists in industry and academia have come to rely on freshly obtained human tissue specimens for certain types of research and experimentation. Sometimes these tissues and organs can be obtained after routine sur­geries like gall bladder removal from adults or foreskin removal during the circumcision of new­borns. The use of such tissues and organs can be morally acceptable if the patient (or the parents of the newborn) provide informed con­sent.[x]

Most bioethicists would dispute this parental right to “routinely” amputate healthy, functional tissue (cf. diseased appendices and gall bladders) from the bodies of their infants and children, other than in (exceptional) cases of genuine medical necessity.[xi] This vexed issue, in and of itself, warrants much closer bioethical scrutiny.

In the particular case of hiPSC research, the requisite standard of “informed consent” for tissue donation is considerably higher than would otherwise apply. As Zheng, a pioneer in the field of hiPSC research, makes clear:

Informed consent is a major ethical concern in derivation and applications of hiPSCs, and hiPSCs can be induced from somatic cells only if cell donors agree to take the cells from their bodies for derivation of hiPSCs. Cell donors in hiPSCs research have rights to know body parts from which their cells will be taken, the methods applied to derive the body cells, and the areas of hiPSCs research involving use of the donated cells.[xii]

Equally clearly, “informed consent” to such an exacting degree is impossible in the case of newborn infants who, as the biologically unique (i.e., distinct from either parent) cell donor, is invested with far-reaching “rights to know.”

More than twenty years ago, George Denniston wrote:

The prospect of the commercial exploitation of children through circumcision is one of the most important issues ever to face humanity. Foreskin harvesting and the patenting of foreskin-derived products strike at the core of our beliefs about the very nature of life. Do human bodies and human body parts have intrinsic, or merely utility, value? The last great debate of this kind occurred in the nineteenth century over the issue of human slavery. Abolitionists argued that every human being had “God-given” rights and, therefore, could not be made the personal commercial property of another human being. Today, we are reliving this debate, but rather than entire human beings, specific human body parts are now the focus of corporate appropriation and exploitation. Certainly, none of the boys whose foreskins are being harvested for commercial exploitation receive any share in the profits generated by their unwitting contribution. We have yet to ask whether our most basic birthright should become a source of corporate income. The majority of American parents have yet to consider whether the steady stream of pro-circumcision messages they have been receiving from certain corners of the medical industry is in part attributable to the intense profitability of circumcision to circumcisers, hospitals, insurance companies, pharmaceutical corporations, and now, biotechnology corporations.[xiii]

Non-consensual, non-therapeutic genital cutting is a moral pandemic of global proportions. While the biotechnological commodification of infant foreskin proceeds apace, bioethical scrutiny lags far behind.[xiv] I have written to you in the hope of redressing this dire imbalance, seeking, at bare minimum, bioethical (and theological) consistency. As I have outlined above, the advent of hiPSC technology entails a range of increasingly complex bioethical considerations.[xv] I trust that the NCBC will consider revising its published opinions on the moral acceptability of harvesting infant human foreskins for biomedical research, tissue engineering,[xvi] and other commercial purposes. In conclusion, to quote one of your own:

If promoting the dignity and respect of every human person is a priority for the United States and for Catholic health care, then it is time to better educate the public about this issue and protect those who are the most vulnerable in our society. Doing so is not only a social responsibility; it is a moral imperative as well.[xvii]

Yours sincerely,

Dr Chris Coughran
26 January, 2021

NB Neither Dr Meaney nor any other representative of the National Catholic Bioethics Center has responded to this letter — other than, when pressed, to acknowledge receipt.

[i] Haruhisa Inoue & Yukio Nakamura, eds. Medical Applications of iPS Cells: Innovation in Medical Sciences. (Singapore: Springer, 2019). Etc.

[ii] Fang, et al. Biological characters of human dermal fibroblasts derived from foreskin of male infertile patients. Tissue and Cell 49 (2017) 56–63. Ironically, his intact adult foreskin will be required in order to benefit from such patient-specific therapies as Fang et al. propose.

[iii] Oliveira, et al. Human foreskin fibroblasts: from waste bag to important biomedical applications. Journal of Clinical Urology. Feb. 2018. 1–10.

[iv] Charles A. Goldthwaite. The promise of induced pluripotent stem cells (iPSCs). National Institutes of Health. https://stemcells.nih.gov/info/Regenerative_Medicine/2006chapter10.htm. Also see the US President’s Council on Bioethics’ White paper: alternate sources of pluripotent stem cells. May 2005. https://bioethicsarchive.georgetown.edu/pcbe/reports/white_paper/text.html, in which foreskin harvesting “in the service of the higher goal of healing” is treated, in passing, as ethically acceptable. Authored prior to the publication of the discovery of hiPSC techniques, the white paper presciently suggests — of the reprogramming of somatic cells “so as to restore to them the pluripotency of embryonic stem cells” — that “the obstacles here are not ethical, but technical.”

[v] Tim Hammond & Adrienne Carmack (2017): Long-term adverse outcomes from neonatal circumcision reported in a survey of 1,008 men: an overview of health and human rights implications, The International Journal of Human Rights, DOI: 10.1080/13642987.2016.1260007; Gregory J. Boyle (2015): Circumcision of infants and children: short-term trauma and long-term psychosexual harm, Advances in Sexual Medicine 5: 22–38. Etc.

[vi] https://www.doctorsopposingcircumcision.org.

[vii] United States Catholic Conference. “Catechism of the Catholic Church,” 2297. Digital edition, August 2011. Libreria Editrice Vaticana.

[viii] Ibid, 2296.

[ix] https://www.ncbcenter.org/making-sense-of-bioethics-cms/column-167-the-corpse-raiders?rq=foreskin Emphasis added.

[x] https://www.ncbcenter.org/making-sense-of-bioethics-cms/column-122-consenting-to-the-unconscionable?rq=foreskin Emphasis added.

[xi] J. Steven Svoboda (2015) Growing World Consensus to Leave Circumcision Decision to the Affected Individual, The American Journal of Bioethics, 15:2, 46–48, DOI: 10.1080/15265161.2014.990760. The Brussels Collaboration on Bodily Integrity (2019) Medically Unnecessary Genital Cutting and the Rights of the Child: Moving Toward Consensus, The American Journal of Bioethics, 19:10, 17–28, DOI:10.1080/15265161.2019.1643945

[xii] Zheng, Yue Liang. Some ethical concerns about human induced pluripotent stem cells. Sci Eng Ethics (2016) 22: 1277–1284, at 1281–1282. Emphasis added.

[xiii] Denniston, G. (ed.) Male and Female Circumcisions: Medical, Legal, and Ethical Considerations in Private Practice (New York: Kluwer, 1999), viii.

[xiv] Hodges, F. M. ‘Bodily integrity in the biotech era: placing human rights and medical ethics in historical context.’ In Denniston et al., Flesh and Blood (New York: Kluwer Academic/Plenum Publishers, 2004): 1–15.

[xv] Cf. Katherine Brind’Amour. Ethics and induced pluripotent stem cells. The Embryo Project Encyclopedia (2009) https://embryo.asu.edu/pages/ethics-and-induced-pluripotent-stem-cells: “If [h]iPSCs turn out to be a useful alternative to E[mbryonic] S[tem] C[ell] research, they will avoid the most significant concerns in feminist ethics surrounding the issue. Because no eggs are needed for [h]iPSCs, there is no unequal burden on women for supplying the necessary cells for the technology. The egg donation process is often the most worrisome aspect of ESC research due to concerns for the women’s health during and after the invasive surgery; controversy over appropriate compensation for a sometimes painful and considerable health risk; and ethical disagreement over what essentially becomes the purchase of parts of the human body, or commodification. The use of iPSCs as an alternative to ESCs may eliminate both the health risks to the donor and the issues of appropriate compensation, as individuals would typically donate cells through a non-invasive procedure for research leading to the donor’s own therapeutic use.” Notwithstanding this ethical appeal on behalf of so-called “personalized medicine,” the neonatal foreskin donor is permanently denied access to patient-specific therapies derived from his own, unwittingly donated foreskin cells; see note (ii) above. These ethical issues arise on top of the already vexed one of appropriately informed consent for a medically unnecessary, indeed psychosexually harmful, surgical procedure.

[xvi] Nahm, W. K. et al. Sustained ability for fibroblast outgrowth from stored neonatal foreskin: a model for studying mechanisms of fibroblast outgrowth. Journal of Dermatological Science 28 (2002) 152–15. These authors observe that: “In general, tissue explants and fibroblast cultures are established from freshly harvested neonatal foreskin tissue. … Fibroblasts grown from human neonatal foreskin explants have been used as a vehicle for understanding the basic mechanisms of fibroblast function, cell signaling, fibrogenesis, wound repair, cutaneous aging, topical pharmaceuticals and have been incorporated into bioengineered skin products” (152–153, emphasis added).

[xvii] Father Peter A. Clark. To circumcise or not to circumcise? A Catholic ethicist argues that the practice is not in the interest of male infants. Health Progress Sept.–Oct. 2006: 30–39. https://www.chausa.org/docs/default-source/health-progress/to-circumcise-or-not-to-circumcise-pdf.pdf?sfvrsn=0

It’s a peculiar locker room, this one, sanitized by the advertising industry, ribaldry toned down to pastel shades of polite innuendo. A team of young men sporting turtlenecks closes in on a middle-aged minority of one, wearing a crewneck. Starkly outnumbered, he is compelled to justify his obvious deviation from the norm. “My parents,” he stammers sheepishly, seemingly unable to utter the word circumcision, much less the phrase genital mutilation. Instead, he makes a cutting gesture with his hand, inhaling sharply between his teeth. The others wince, perhaps checking to make sure their own collars are still intact. Ah, the parents … as if this were some exonerating principle. Might makes right, after all. Well, that’s alright then. (Better him than me!)

It is not long before a darker-skinned older man, powerfully built but also wearing a crewneck, intervenes. “My son has a turtleneck. So our necks look different. It’s no problem,” he reassures the turtleneck gang, as if to say: never fear, we’re blending right in. The man has a Maori accent, but in another version of this ad, could well be Jewish, Muslim, African, or indeed, Indigenous Australian. Look, Boss! See: we’re not so attached to our (barbaric) traditional cultural practices. We can accommodate ourselves to your mainstream bodily ideals. Intact, indeed, is the new black.

An older white Australian, also sporting the crewneck of yesteryear, withdraws tersely from the locker-room scene, his concerns — no matter how valid or profound — fading into obscurity and irrelevance. No justice, then, for the “stolen foreskin” generations of Australian men, their suffering to remain unacknowledged — even, as the case may be, by themselves. “I’m comfortable,” boasts the crewnecked protagonist, not wholly convincingly. Body dysmorphia is an understandable, relatively minor consequence of non-consensual, non-therapeutic genital mutilation. Instead of sympathy, the advertisers seek to arouse, at least among the cavalier, smug laughter at the expense of a distinct social minority.

One assumption remains beyond question. Nobody in this ad disputes the sovereign right of parents, whatever their cultural background, to surgically alter the genitals of their male offspring. That’s a given in Australia, where the tails of canines are better protected, under state and territory legislation, than the juvenile human penis. Female genitals are a different story, since the “FGM” misnomer (regrettably enshrined in statutory law) plays a key ideological role, effectively delimiting the scope of our collective multicultural tolerance. It seems that mainstream Australians (the target of this Bonds advertisement) will accept any form of non-consensual, non-therapeutic surgical alteration — provided, of course, that the offending organ happens to be a penis, and that parental consent, no matter how ill-informed, has been “freely” given. Or provided, conversely, that it happens to somebody else.

Bonds will never advertise “very comfy undies” for female survivors of genital mutilation. For male survivors, I doubt there is any such thing — although lanolin-infused offerings have been marketed over the years (not by Bonds) to help alleviate keratinisation of the glans, an inevitable (but again, relatively minor) consequence of foreskin amputation. No new pair of underpants will ever smooth over the legal, bioethical, social and psychosexual complexities spawned by cultural, religious, and/or quasi-medical regimes of genital mutilation.

Bonds and their marketing gurus, of course, will beg to differ. No doubt the advertisement will be hailed (as it has been styled by its creators) as socially progressive — and this despite its patent ethnocentrism, ageism and sexism. It reinforces notions of parental sovereignty, and the expendability of male genitalia, at the expense of children’s rights. It is unlikely to deter parents of Jewish or Muslim faiths — principal drivers of the (declining) practice in Australia — from circumcising their boys. If anything, it may make survivors more wary of locker rooms.

By casting derision on the circumcised penis — alluding to the incontrovertible fact of its physical diminution, for example, as well as the psychosocial consequences thereof — the advertisers make a pitch for the mainstream Aussie dollar. But by ultimately giving its “seal of approval” to penises in both the natural and the cut state (granted, circumcised men must be lied to about the effects of their condition) the underwear manufacturer safely hedges its bets. All of this will be cold comfort to the traumatised survivor of non-consensual, non-therapeutic genital mutilation. Even adult males who elect to undergo circumcision — for medical, aesthetic, cultural or religious reasons — could understandably take offence at the advertisement’s snide tone.

“Genital autonomy” denotes, in part, the (incipient) right of legally competent persons to modify their own genitals as they see fit. The freedom to exercise this right should not be constrained by xenophobic tastemakers, no matter how financially powerful, or how “creative” (or amusing) they think they are. Public discourse on genital cutting warrants a much greater degree of cultural sensitivity than facetious locker-room scenarios dreamed up by advertising executives with, as it were, no skin in the game.