A Perversion of Ethics - New English Review

American Association of Pediatricians (AAP), Sharia Law, and Abandonment of Medical Ethics in Context

by DL Adams (June 2010)

here.)

This press release represents a total abandonment of the recent FGM policy that has caused so much consternation around the world.

While this is a positive development that I applaud, it does not negate the need to understand why the AAP altered their long-standing opposition to FGM/FGC in the first place. The AAP policy was a failure for numerous reasons and the storm of confusion and condemnation that descended upon them was well deserved.

With American physician involvement in FGC/FGM apparently behind us for now, the question of how this mistake could have been made and the specter of further errors remain.

We should remain vigilant for any such policies by any organization in the future that support Sharia law and undermine the foundations of American culture and society (and represent an abandonment of medical ethics). AAP is to be applauded for their retraction but rightfully castigated for its (now abandoned) support of FGC/FGM.

It is important to understand this episode in a larger context, this is the purpose of the following article.

Opposition to FGM and to Sharia law should be a standard moral, ethical, and intellectual position across our culture, but it is not. Only through an understanding of the unspoken themes underlying this unpleasant AAP episode can we get at the roots of the issue. When we get to the core of this episode, in all its parts and in its entirety, it is extremely worrisome and disconcerting. AAP is correct to rescind this odious policy, but it never should have supported FGM and Sharia at all.

Sometimes events occur that produce a reaction of rejection, revulsion and horror across the political and cultural spectrum. Such events illustrate that even amidst bitter political disagreements and differing concepts about the direction that our society should take there remains a core of agreed upon concepts of decency and correctness that most reasonable people can unite in supporting.

The recent announcement by the American Association of Pediatricians (AAP) that they now support the “nicking” of the clitoris of female infants has been condemned by voices across the political and cultural spectrum in the United States and abroad. Americans have no tolerance for child abuse of any kind, be it from physicians, “bio-ethicists”, rogue Catholic priests or anybody else.

Astoundingly, the AAP’s so-called “committee on bio-ethics” suggested that state and federal law should be changed to facilitate appeasement of this abhorrent practice that is rightly shunned in our culture.

“It might be more effective if federal and state laws enabled pediatricians to reach out to families by offering a ritual nick as a possible compromise to avoid greater harm.” (New York Times, May 6, 2010)

The absurdity of this statement has been called out by many observers, particularly Mr. J. Steven Svoboda an attorney with “Attorneys for the Rights of the Child” in an open letter to AAP posted on Mensnewsdaily.com on May 11, 2010:

“The AAP has no business brokering cultural procedures, even those that may support future revenue streams for some of its members. In this time of reduced resources, more than ever, it is imperative that medical organizations such as the AAP focus on what matters most—promoting the safety of our children, and working to eradicate—not condone or justify—harmful, non-beneficial, unethical practices such as FGC and MGC.”

The storm of horror and condemnation in response to this new policy suggests that the politically correct hand of the confused bio-ethicists of AAP has been overplayed. A small sampling of the reaction is in order:

    “I am sure the academy had only good intentions, but what their recommendation has done is only create confusion about whether F.G.M. is acceptable in any form, and it is the wrong step forward on how best to protect young women and girls,” said Rep. Joseph Crowley, Democrat of New York. (Family Security Matters, American Academy of Pediatrics ‘Compromises’ on Female Circumcision, May 17, 2010)

    “FGM, which involves the partial or total removal of the female genitalia is carried out across Africa, some countries in Asia and the Middle East, and by immigrants of practicing communities living around the world. It is estimated that up to 140 million women and girls around the world are affected by it. The US department of health and human services estimated in 1997 that over 168,000 girls and women living in the US have either been, or are at risk of being, subjected to FGM… The statement flies in the face of all international and regional deliberations on the issue, which have concluded that any medically unnecessary procedure to alter female genitalia constitutes a human rights violation and therefore must not be tolerated…The AAP must retract its statement.” (“Why are US Doctors Allowing Genital Mutilation?”, The Guardian (UK), May 11, 2010)

    The reaction was not muted. “Encouraging pediatricians to perform FGM under the notion of ‘cultural sensitivity’ shows a shocking lack of understanding of a girl’s fundamental right to bodily integrity and equality,” says Taina Bien-Aime, executive director of the human rights organization Equality Now. “If foot-binding were still being carried out, would the AAP encourage pediatricians to execute a milder version of this practice?” (Time Magazine, “Has a US Pediatrics Group Condoned Genital Cutting?” May 11, 2010)

NOW has no mention of this issue on their website.

The abuse of children by rogue Catholic priests that is now causing great concern and anger across Europe and which continues to cause great dismay across the US is an important situation to consider in relation to the AAP’s new FGM policy. The relationship between these two cases (Catholic clergy abuse of children and the AAP policy of supporting FGM) may not seem clear upon first glance but is critically important in illustrating why perhaps no schism has yet occurred in the Catholic church on account of these abuses and why the new FGM policy of the AAP is both appalling and dangerous.

The crimes committed by them against children and their parents put them outside their doctrine and directly opposed to it. These rogue clergymen are criminals in the truest sense as they have abandoned both the law of God (as their Church states it) as well as secular law, the law of the State.

Like corrupt politicians in the United States who commit crimes and abuse their authority, abuser priests have abandoned their vows and dishonored the institution and code which they serve. While the institutions these abysmal people were supposed to serve are undoubtedly now damaged because of their actions, the ethics and beliefs upon which these institutions are founded do not in any way support, justify or motivate their criminal behavior. When an American politician is corrupt, is the Constitution that they have sworn to uphold also then corrupt?

When the caretakers of an institution are corrupt and commit heinous crimes does this then mean that the institution which they have abandoned through their actions (totally in opposition to the dictates of their doctrine and law) is also corrupt? The answer must be “no.”

However, there are situations like AAP’s endorsement of FGM which suggest that not only are the caretakers and adherents of an institution questionable, but the institution itself may be corrupted.

Every American doctor is bound by the Hippocratic Oath. This is the oath that binds every practitioner of medicine to healing and, above all, to do no harm.

classical Hippocratic Oath, also here.)

“Above all, I must not play at God… I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.” (section of modern version of Oath.)

There is no medical case that can be made for the “nicking” of a child’s clitoris (or worse). There is only a politically correct or Sharia law case that can support such a policy, a policy of “cultural sensitivity” to those cultures (Islam in particular) that do support such barbaric, misogynist practices.

The policy statement of the AAP states that only because of a desire to prevent further harm to children whose parents wish such a revolting and cruel procedure does the AAP now change its policy to allow for a clitoral “nick.” The logic that is employed is that if American doctors perform a “ritual nick” of the infant’s clitoris then the parents will no longer wish to return to their native (Islamic) countries where such “rituals” are both common and doctrinally obligatory. There is a moral confusion and cowardice in this policy, and failed logic that underlying it, that is stunning to behold.

APP FGM Recommendation #4: “Recommends that its members provide patients and their parents with compassionate education about the physical harms and psychological risks of FGC while remaining sensitive to the cultural and religious reasons that motivate parents to seek this procedure for their daughters.” (AAP Policy Statement, p. 1093.)

Mutilation of the reproductive organs is a crime in the United States. In other “cultures” it is not. Most specifically in Islam, circumcision for male and female infants is both sunna and obligatory according to Sharia law. Sunna is the example of the perfect life of the prophet Mohammed as found in the Sira (Mohammed’s biography) and Hadith. “Sharia law” is the law of Islam, it is based upon the sunna of Mohammed and the commands of the Islamic deity Allah as found in the Koran. The definitive work of Sharia law “Reliance of the Traveller” has been translated to English though, in this case and likely in others, the translation is deliberately false.

E4.1 It is sunna:

E4.3 Circumcision is obligatory (O: for both men and women. For men it consists of removing the prepuce of the penis, and for women, removing the prepuce (Ar. Bazr) of the clitoris (n: not the clitoris itself, as some mistakenly assert). (A: Hanbalis hold that circumcision of women is not obligatory but sunna, while Hanafis consider it a mere courtesy to the husband.)[1]

Dr. Bill Warner of the Center for the Study of Political Islam (CSPI), in a soon to be released study of Sharia law, provides the following as the actual translation of “Reliance of the Traveller”, section e4.3, cited above.

“Circumcision is obligatory (for every male and female) by cutting off the piece of skin on the glans of the penis of the male, but circumcision of the female is by cutting out the clitoris (this is called Hufaad).”[2]

Nonie Darwish, in her book, “Cruel and Unusual Punishment: The Terrifying Global Implications of Sharia Law” provides definitive validation of Dr. Warner’s alternative translation. In discussions of Sharia law, Al-Azhar University is considered the most authoritative source in the Islamic world.

“Many moderate Muslim scholars insist that female circumcision is a societal practice unrelated to Islam. However, Dr. Mohammed al-Musayyar of Al-Azhar University, referring to reliable hadiths, stated,

‘All jurisprudents, since the advent of Islam and for fourteen centuries or more, are in consensus that female circumcision is permitted in Islam. But they were divided as to its status in the Sharia. Some said that female circumcision is required by the Sharia, just like male circumcision. Some said that this is a mainstream practice, while others said that it is a noble act.

The Shafi’i school of Sharia considers circumcision of girls compulsory. The Reliance of the Traveller, a respected manual of Shafi’I jurisprudence states: “Circumcision is obligatory (for every male and female) by cutting off the piece of skin on the glans of the penis of the male, but circumcision of the female is by cutting out the clitoris” (section e4.3). The English translation by Nuh Ha Mim Keller (certified by Al-Azhar University) disguises the true meaning of the Arabic by adding a bogus ending: “For men it consists of removing the prepuce from the penis, and for women, removing the prepuce (Ar. Bazr) of the clitoris (n: not the clitoris itself, as some mistakenly assert).’”[3][4]

It is important to understand the enormity of this: the translation of Reliance of the Traveller, the book of Sharia law, is fraudulent regarding female circumcision and likely in other areas as well. Sharia law states that female and male circumcision is obligatory in Islam, it also states that for females “circumcision is by cutting out the clitoris.”

Unfortunately, the members of AAP’s “committee on bio-ethics” appear to know nothing of the obligatory nature of FGM as it is spelled out in Islamic doctrine and in Sharia law. Ignorance of Sharia law is no excuse.

“For many Muslim religious scholars, male circumcision is considered obligatory, whereas some form of female ‘circumcision’ is considered optional but virtuous.”
(AAP Policy Statement, p. 1089, “Policy Statement-Ritual Genital Cutting of Female Minors”, April 26, 2010; PDF file)

Circumcision of females is a requirement in Islamic law (Sharia) though it is illegal in our American culture. The new AAP policy supporting female genital mutilation is another example of political correctness gone horribly wrong, which in itself is a redundancy.

[Bukhari 7,72,,779] Mohammed said, “Five practices are characteristics of the ancient prophets: circumcision, shaving the pubic hair, cutting the moustaches short, clipping the nails, and depilating the hair of the armpits.”

Or (a slightly different translation of Muslim 003, 0684)

Upon this I said: What makes a bath obligatory for a person? She replied: You have come across one well informed! The Messenger of Allah (may peace be upon him) said: When anyone sits amidst four parts (of the woman) and the circumcised parts touch each other a bath becomes obligatory.

The only response by American physicians to Sharia-mandated mutilation of children should be to absolutely condemn such practices as cruel, misogynist, and contrary to the Hippocratic Oath and American custom and law. The recommendation of a “ritual nick” by AAP’s “committee on bio-ethics” is nothing more than politically correct appeasement viz.,

“There is reason to believe that offering such a compromise may build trust between hospitals and immigrant communities, save some girls from undergoing disfiguring and life threatening procedures in their native countries, and play a role in the eventual eradication of FGC.” (AAP Policy, p. 1092.)
(DLA: “FGC” is “Female Genital Cutting” another term for “Female Genital Mutilation” or FGM).

In addition, a further credible rejection for the mollification of Sharia law adherents would be to state that Article 6 of the US Constitution prevents any American from implementing foreign law that is contrary to the Constitution. The Constitution is the law-of-the-land of the United States as specified in Article 6, Clause 2 of the US Constitution. Refusal to support barbaric foreign practices that are immoral and illegal in the United States is the correct response and is not culturally insensitive. Refusal and condemnation ought to be the only acceptable responses for American physicians to requests from anyone of any “culture” for the mutilation of the female genitalia or any other act of cruelty or mutilation.

The fact that AAP chose appeasement of Sharia law and its adherents by agreeing to a “clitoral nick” rather than condemnation of the procedure altogether in all its forms instead is a total ethical failure of the confused “ethicists” and leadership of AAP.

The case could readily be made that the post war (WW2) birth of the profession of “bio-ethicist” was necessary due to the abuses of German (Nazi) physicians in supporting, actively facilitating (and participating in) the horrors of the Holocaust. There could be no greater illustration of moral and ethical confusion and failure than the case of the Nazi doctors, many of whom were tried in “Doctors’ Trials” at Nuremberg and subsequently hanged for crimes against humanity. In addition to bringing the guilty to justice, the Nuremberg “Doctors Trials” also rehabilitated (or attempted to) the concept of medical ethics.

“What happens when ethics fail?” must now be asked. When ethics represent nothing more than a means by which a particular interest group is mollified or appeased, ethics have failed.

History shows that when the providers of care abandon their oath of healing and succor for the needy and infirm, the consequences are catastrophic. We must call out the AAP, its “committee on bio-ethics” and its membership for the ethical failure that this policy represents, and illuminate the importance of this situation by placing it into a wider historical context.

When ethics justify the conversion of healers to killers and abusers (as it did in Nazi Germany) then ethics have more than failed, they have been perverted.

When healers become perpetrators and the facilitators of cruelty, the very foundations of civilization are undermined, and the nature of a society and culture must change for the worse. The failure to condemn FGM in all its forms in this case is indicative of a far deeper problem – but one that is unfortunately common in our post-modern era of moral and ethical confusion and relativism.

Ethics are applied standards. When ethics are reduced and minimized so that they become more about appeasement and expediency than about doing what is right and correct – ethics have failed.

“A member of the academy’s bioethics committee, Dr. Lainie Friedman Ross, associate director of the MacLean Center for Clinical Medical Ethics at the University of Chicago, said the panel’s intent was to issue a ‘statement on safety in a culturally sensitive context.’” [6]

In the post-modernist worldview there is no “right/wrong” conflict there are only conflicts between “closely held beliefs.”

The ethical failure of the AAP in this case is disturbing on many levels perhaps most particularly that it shows the moral and ethical confusion of those who have proclaimed themselves the guardians of the health and welfare of American children and, according to their own self-description, that of all children.

your way of worshipping your gods! We also understand that you like to throw the ripped-out-hearts and the broken bodies down from pyramids – well, you can use any number of pyramids here in the US! We want you to feel comfortable and happy here – you see, we are an inclusive and tolerant society. We don’t judge folks! If you want to do weird, inhuman, criminal, disgusting things, well – it’s okay because it’s your culture!”

We are now so “tolerant” of other “cultures,” no matter how degraded or vile they may be, that our own culture can readily abandon standards and ethics that have made us, for centuries, who and what we are. This is a dangerous trend that must end quickly.

This radical tolerance of facilitating what is wrong to avoid “offending” those who support such things undermines the foundations of our culture. The final result of this radical tolerance must be our own destruction.

The philosopher Karl Popper wrote of the “paradox of tolerance” in The Open Society and Its Enemies:

[7]

one of the key lessons of the Nazi period.

Israel Ignac Feldman and his family were Jews living in Lodz, Poland. They lived there for generations. When the Nazis invaded Poland -and then the Soviets, he was inducted first in the Polish army (to fight Nazis) then the Russian army (again to fight Nazis). His memoir of service in two armies, his life and family in Lodz, and his final move to Canada is stunning both for its matter-of-fact reality and for the horrors that he endured. The insight of Feldman and survivors like him should not be treated lightly.

“Here is where I must tell you dear reader to never, ever forget the Holocaust. I stress upon you these heinous crimes committed by the Nazis were executed by a cultured, modern nation. If you and your children forget, it will be destined to happen again.”
Israel I. Feldman, The Lost Dream, 2007, (Lorne Miller, Toronto), p.86.
(To order this book please communicate directly with Mr. Feldman’s daughter at [email protected])

When ethics fail so also inevitably does the culture.

Eduard Wirths was the chief SS physician at Auschwitz Concentration Camp. He committed suicide while in hiding after the end of WW2. His moral confusion and psychological “doubling”, that allowed him to do mass murder but continue to believe that he was a cultured German, and physician who was mitigating suffering rather than perpetrating it, is instructive.

Robert Jay Lifton, in his 1986 study of Nazi doctors (“The Nazi Doctors”), discusses the psychological “doubling” that he says was an internal response by the Nazi physician killers in order to psychologically justify their involvement in mass killing yet allow for the retention of a sense of a “civilized” self. This type of multiple personality construction allowed many people such as Wirths to be both a functionary in atrocity and barbarism yet (in his mind) a “good family man” during periods of leave from the work of murder and death.

In the case of Nazi concentration camp doctors, the abandonment of concepts of “good/evil” and “right/wrong” were replaced with a new Nazi ideology of racial supremacy and brutality masked as societal necessity. The moral perversion of these people is now clear for all to see. However, their motivations to kill and abuse innocents in their millions was founded on positive concepts (to them) of “rescuing the volk” from a racial “disease” which the Nazis identified as Jews and other groups, including Slavs, Gypsies, homosexuals, political prisoners and prisoners of war among others.

The existence of agreed upon expectations based on “ethics” does not mean that those expectations or the “ethics” that underlie them are right and good. Good can be perverted for insidious purposes, and those motivated by duty and the fulfillment of expectations will go along – though they may know that what they are now being told to do is wrong regardless of the description of “right” or “necessity” that are applied to heinous crimes that, until recently, they had always considered wrong.

“I can say that I have always done my duty and have never done anything contrary to what was expected to me.”[8]
-Eduard Wirths, Chief SS Doctor, Auschwitz;

Another SS doctor at Auschwitz, one who survived the war and was not executed afterwards, demonstrated his deep ethical confusion later in interviews with Robert Jay Lifton.

“He spoke of having in the camp (Auschwitz) an active sense of the ‘special calling in me to be a physician.’”[9]

The abuse of children for “cultural sensitivity” reasons is a catastrophic abandonment of the Hippocratic Oath and must be condemned with vigor. We have seen what happens when societies facilitate the failure of those whose mission is charity, compassion, and caring for the suffering.

When the providers of care and comfort support the perpetrators of evil rather than their victims, all are potentially at risk and the foundations of our culture teeter on the brink. A vigorous “This is wrong!” response is required.

“Yet none of them – not a single former Nazi doctor I spoke to – arrived at a clear ethical evaluation of what he had done, and what he had been part of. They could examine events in considerable detail, even look at feelings and speak generally with surprising candor – but almost in the manner of a third person. The narrator, morally speaking, was not quite there.”[10]

Nations, cultures and peoples developed ethics and the standards of “right/wrong” and “good/bad” dichotomies to protect the essence of what those cultures mean, represent and how they should develop into the future.

It is wrong to cut the clitoris of any female infant because the parents adhere to Sharia law* (please see “*” end note). In the United States such things are considered vile and beyond the moral and ethical acceptance/tolerance of our people and it certainly should also be so for our physicians. Those physicians who support such practices should be corrected and educated so they know that abuse of children is contrary to both their Hippocratic Oath and our American culture. For those who support such practices there are dozens of countries to which they can abscond – ours is not one of them.

In this time of the rise of multiculturalism, post-modernism, and moral relativism it appears difficult for many in our country to comprehend an argument founded upon critical thought, ethics and concepts of “right/wrong.” They say that such things are personal matters only and that disagreements can never be definitively (or objectively) based but must always be simply matters of opinion.

If our cultural opinions, traditions, and rules do not have more value to us than those of other cultures then we do not have a culture of our own – it is that simple.

[11].

“Here I recall the cautionary words of a French-speaking, Eastern European survivor physician: ‘The professor [dla: referring to Lifton] would like to understand what is not understandable. We ourselves who were there, and who have always asked ourselves the question and will ask it until the end of our lives, we will never understand it, because it cannot be understood.’”[12]

almost impossible to comprehend. We can take it in small parts and understand each individual failure, compromise and acceptance of barbarism and evil and in that way the full horror of the thing becomes clear.

The failure of the AAP lies in its abandonment of their foundational oath “to do no harm.” If the leadership of AAP cannot see that the abuse of infant girls to mollify some adherents of Sharia law is wrong, then the AAP should be abandoned and dissolved.

No American organization of healers should support repellent and cruel traditions of other cultures simply because they are practiced in and sanctioned by another culture. Our own culture and the ethics of our people demand that our belief in the protection of the innocent, and a rigid adherence to the Hippocratic Oath to “do no harm” be upheld and not undermined – or abandoned (as it was in Nazi Germany and elsewhere today and throughout human history).

It is through the failures of the guardians of what is right that what is wrong becomes ascendant.



[1] Nuh Ha Mim Kelller, Reliance of the Traveller: A Classic Manual of Islamic Sacred Law, ( Amana, 1994), pp. 58-59.

[2] Dr. Bill Warner, “Sharia law for Non-Muslims”, (CSPI, 2010), p. 8. Soon to be released. (http://www.cspipublishing.com/)

[3] Muhammed al Mussayar, Panorama Show, Al-Arabiya TV, February 12, 2007, as quoted in Nonie Darwish, Cruel and Unusual Punishment: The Terrifying Global Implications of Sharia Law, (Thomas Nelson, 2008), p.76.

lying to non-believers is sunna, and Sharia law compliant.

[5] Ibid, W52.1 (a), p.966.

[6]New York Times, “Group Backs Ritual Nick as Female Circumcision Option”, May 6, 2010.

[7] Karl Popper, The Open Society and Its Enemies: Volume One, The Spell of Plato, (Routledge, 1945:2003), p. 293.

[8] Robert Jay Lifton, The Nazi Doctors, (Basic, 1986), p. 384. (Available online here)

[9] Ibid., p.318.

[10] Ibid., p.8.

“Guidance for Effective Discipline”, April, 1998.
Also: “Because of the negative consequences of spanking and because it has been demonstrated to be no more effective than other approachesfor managing undesired behavior in children, the American Academyof Pediatrics recommends that parents be encouraged and assistedin developing methods other than spanking in response to undesiredbehavior.”

[12] Lifton, The Nazi Doctors, p. 13.

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DL Adams is an American historian.