View source for Informed consent

'''Informed consent''' is a legal and ethical prerequisite for surgery and other procedures in the [[United States]] and most other nations. 

It is defined as: 
<blockquote>
Assent to permit an occurrence, such as surgery, that is based on a complete disclosure of facts needed to make the decision intelligently, such as knowledge of the risks entailed or alternatives.

The name for a fundamental principle of law that a physician has a duty to reveal what a reasonably prudent physician in the medical community employing reasonable care would reveal to a patient as to whatever reasonably foreseeable risks of harm might result from a proposed course of treatment. This disclosure must be afforded so that a patient—exercising ordinary care for his or her own welfare and confronted with a choice of undergoing the proposed treatment, alternative treatment, or none at all—can intelligently exercise judgment by reasonably balancing the probable risks against the probable benefits.<ref>{{REFweb
 |url=https://legal-dictionary.thefreedictionary.com/Informed+Consent
 |title=Informed consent
 |last=
 |first=
 |accessdate=2020-06-27
}}</ref>
</blockquote>


==Information for parents regarding non-therapeutic circumcision of infant boys.==

This section is for all parents of boys, but is addressed primarily to parents of boys who are located in the [[United States of America]], who appear to be most uninformed or misinformed about the [[foreskin]] and [[circumcision]]. Information is not making it to parents. Studies have shown that doctors provide parents with almost no accurate or useful information about circumcision. After several generations of promotion of and near universal neonatal circumcision in the United States, most Americans are profoundly ignorant of a normal body part and its valuable functions.
=== Surrogate consent ===
Parents act as surrogates for their minor children who are too young to personally grant consent. Surrogate consent ethically is limited to the granting of consent for diagnosis and treatment of disease.<ref name="aap1995">{{REFjournal
 |last=Committee on Bioethics
 |etal=no
 |title=Informed consent, parental permission, and assent in pediatric practice
 |trans-title=
 |language=
 |journal=Pediatrics
 |location=
 |date=1995-02
 |volume=95
 |issue=2
 |article=
 |page=
 |pages=314-7
 |url=http://www.cirp.org/library/ethics/AAP/
 |archived=
 |quote=
 |pubmedID=7838658
 |pubmedCID=
 |DOI=
 |accessdate=2023-09-14
}}</ref>  <ref name="aviva2016">{{REFjournal  
 |last=Committee on Bioethics
 |etal-no
 |title=Informed Consent in Decision-Making in Pediatric Practice
 |trans-title=
 |language=
 |journal=Pediatrics
 |location=
 |date=2016-08
 |volume=138
 |issue=2
 |article=
 |page=e20161484.
 |pages=
 |url=https://publications.aap.org/pediatrics/article/138/2/e20161484/52512/Informed-Consent-in-Decision-Making-in-Pediatric?autologincheck=redirected
 |archived=
 |quote=
 |pubmedID=27456514
 |pubmedCID=
 |DOI=
 |doi=10.1542/peds.2016-1484
 |accessdate=2023-09-14
}}</ref>

===Provision of relevant information===

The [[medical trade association| medical trade associations]], such as the [[American Academy of Pediatrics]], the [[American Congress of Obstetricians and Gynecologists| American College of Obstetricians and Gynecologists]], the [[American Academy of Family Physicians]], and the [[American Urological Association]] have a primary responsibility to their fellows (members) of advancing the profitability of medical practice. Consequently their public statements regarding medically-unnecessary, non-therapeutic [[circumcision]] of boys are strongly biased in favor of promoting the practice, so that their fellows can earn more money for the additional service of [[circumcision]]. The public statements are silent on the [[human rights]] of the child-patient and the multiple physiological [http://www.intactaus.org/information/functionsoftheforeskin/ functions of the foreskin]. They describe "potential" benefits which are imagined benefits that cannot be proved to actually exist. They understate the risks of the surgical procedure, which can include loss of the penis and [[death]]. They are purposefully silent on the [[foreskin]]'s nature and functions, [[Sexual effects of circumcision| sexual]], and [[Psychological issues of male circumcision| psychological]] harms of having the most erogenous<ref name="winklemann1959">{{WinkelmannRK 1959}}</ref> part of the penis amputated. For all of these reasons, their public statements should not be used as a basis for informed consent.

[[J. Steven Svoboda| Svoboda]] et al. {2000) commented:
<blockquote>
Even more troubling in the common occurrence of parents being presented with the circumcision question for the first time when a mother is in labor at a hospital. Surgeon [[George W. Kaplan]] notes that "all too often the consent to circumcise is included in a sheaf of papers that the mother signs hurriedly on her way to the delivery room. No discussion has been held regarding the merits of the procedure or of the inherent risks." [[George W. Kaplan|Kaplan]] characterizes this practice as "inexcusable". Raising the circumcision issue for the first time upon the mother's arrival at the hospital to give birth amounts to manipulation and coercion. Because the physician and the hospital benefit financially from the parent's decision, such a practice raises grave concerns about unethical profiteering.<ref name="svoboda2002" />
</blockquote>

===Physician behavior===

One study showed that 40% of parents believed that their doctors failed to provide enough information, 46% reported that their doctors failed to give them any medical information at all, and 82.8% of parents regretted their decision they made within the first six months of their son’s life.<ref>{{REFjournal
 |last=Adler
 |init=R
 |last2=Ottaway
 |init2=S
 |last3=Gould
 |init3=S
 |title=[https://pediatrics.aappublications.org/content/107/2/e20.short Circumcision: We have heard from the experts; now let’s hear from the parents]
 |journal=Pediatrics
 |date=2001-02
 |volume=107
 |issue=2
 |page=E20
}}</ref>

Another study found that physicians were less likely to circumcise their own sons.<ref>{{REFjournal
 |last=Topp
 |init=S
 |date=1978-01
 |title=Why not to circumcise your baby boy
 |journal=Mothering
 |volume=6
 |pages=69-77
}}</ref> This suggests that doctors are very well aware that [[circumcision]] is a harmful, [[Pain| painful]], [[Trauma| traumatic]] non-therapeutic surgery (in short, a ritual); but they do not appear to share this knowledge with parents.

A busy physician can supplement their  income by as much as $60,000 per year from circumcision surgeries alone.<ref>{{REFbook
 |last=Fleiss
 |first=Paul M.
 |init=PM
 |author-link=Paul M. Fleiss
 |title=What your Doctor May Not Tell You About Circumcision
 |publisher=Warner books
 |location=New York
 |year=Sept 2002
}}</ref> This [[Financial Incentive| incentive]] can cloud a physician’s judgment when it comes to providing parents with information about circumcision.

Many [[circumcised]] men, some of whom are [[Circumcised doctors|doctors]], experience a strong denial of loss which in turn fuels an emotional compulsion to repeat the [[trauma]] to normalize their loss.<ref>{{VanderKolkBA 1989}}</ref><ref>{{REFjournal
 |last=Goldman
 |init=R
 |author-link=Ronald Goldman
 |url=https://bjui-journals.onlinelibrary.wiley.com/doi/pdf/10.1046/j.1464-410x.1999.0830s1093.x
 |title=The psychological impact of circumcision
 |journal=BJU Int
 |date=1999
 |volume=83
 |issue=Suppl. 1
 |pages=93-103
}}</ref><ref>{{REFjournal
 |last=Maguire
 |init=P
 |last2=Parks
 |init2=CM
 |url=http://www.cirp.org/library/psych/maguire/
 |title=Coping with loss: surgery and loss of body parts
 |journal=BMJ
 |date=1998
 |volume=316
 |issue=7137
 |pages=1086-1088
 |accessdate=2011-03-18
}}</ref><ref>{{REFjournal
 |last=Hill
 |init=G
 |author-link=George Hill
 |url=http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.738.3612&rep=rep1&type=pd
 |title=The case against circumcision
 |journal=J Mens Health Gend
 |date=2007-08-20
 |volume=4
 |issue=3
 |pages=318-323
}}</ref> <ref>{{REFjournal
 |last=Goldman
 |init=R
 |author-link=Ronald Goldman
 |url=https://academic.oup.com/pch/article/9/9/630/2648566
 |title=Circumcision policy: a psychosocial perspective
 |journal=Paediatr Child Health
 |date=2004
 |volume=9
 |issue=9
 |pages=630-633
}}</ref>

===Pain and anesthesia===

[[Image:circumcision_screaming_baby.jpg|right|thumb|Horror of Circumcision.]]

Many parents are surprised to hear that anesthetics are used in only a minority of cases.<ref>{{REFjournal
 |last=Stang
 |init=MJ
 |last2=Snellman
 |init2=LW
 |date=1998
 |title=[https://pediatrics.aappublications.org/content/101/6/e5.full Circumcision practice patterns in the United States]
 |journal=Pediatrics
 |volume=101
 |issue=6
}}</ref>

The use of local anesthetics significantly drives up the costs of surgery and the time to execute a circumcision [[amputation]], so may not be used. When anesthetics are used, they can only reduce the [[pain]], not eliminate it. Infants can not be given general anesthesia because of the medical risks involved. In the recent past, anesthesia was rarely used, if ever. Because of this, circumcision has always been an extremely traumatizing experience causing an array of short and long term behavioral and developmental problems<ref>{{REFjournal
 |last=Gunnar
 |init=MR
 |last2=Fisch
 |init2=RO
 |last3=Korsvik
 |init3=S
 |last4=Donhowe
 |init4=JM
 |title=[http://www.cirp.org/library/pain/gunnar/ The effects of circumcision on serum cortisol and behavior]
 |journal=Psychoneuroendocrinolog
 |date=1981
 |volume=6
 |issue=3
 |pages=269-275
}}</ref><ref>{{REFjournal
 |last=Porter
 |init=FL
 |last2=Miller
 |init2=RH
 |last3=Marshal
 |init3=RE
 |title=Neonatal pain cries: effect of circumcision on acoustic features and perceived urgency
 |journal=Child Dev
 |date=1986
 |volume=57
 |pages=790-802
}}</ref><ref>{{REFjournal
 |last=Porter
 |init=FL
 |last2=Porges
 |init2=SW
 |last3=Marshall
 |init3=RE
 |url=http://www.cirp.org/library/pain/porter2/
 |title=Newborn pain cries and vagal tone: parallel changes in response to circumcision
 |journal=Child Dev
 |date=1988
 |volume=59
 |pages=495-505
}}</ref><ref>{{REFjournal
 |last=Emde
 |init=RN
 |last2=Harmon
 |init2=RJ
 |last3=Metcalf
 |init3=D
 |etal=yes
 |url=http://www.cirp.org/library/birth/emde/
 |title=Stress and neonatal sleep
 |journal=Psychosom Med
 |date=1971
 |volume=33
 |issue=6
 |pages=491-497
}}</ref><ref>{{REFjournal
 |last=Gunnar
 |init=MR
 |last2=Connors
 |init2=J
 |last3=Isensee
 |init3=WL
 |first3=Wall L.
 |url=http://www.cirp.org/library/pain/gunnar1988/
 |title=Adrenocortical activity and behavioral distress in human newborns
 |journal=Dev Psychobiol
 |date=1988
 |volume=21
 |issue=4
 |pages=297-310
}}</ref><ref>{{REFjournal
 |last=Anders
 |init=TF
 |last2=Chalemian
 |init2=RJ
 |url=http://www.cirp.org/library/birth/anders/
 |title=The effects of circumcision on sleep-wake states in human neonates
 |journal=Psychosom Med
 |date=1974
 |volume=36
 |issue=2
 |pages=174-179
}}</ref><ref>{{REFjournal
 |last=Marshall
 |init=RE
 |last2=Stratton
 |init2=WC
 |last3=Moore
 |init3=JA
 |etal=yes
 |url=http://www.cirp.org/library/birth/marshall1/
 |title=Circumcision I: effects upon newborn behavior
 |journal=Infant Behavior and Development
 |date=1980
 |volume=3
 |pages=1-14
}}</ref><ref>{{REFjournal
 |last=Marshall
 |init=RE
 |last2=Porter
 |init2=FL
 |last3=Rogers
 |init3=AG
 |etal=yes
 |url=http://www.cirp.org/library/birth/marshall2/
 |title=Circumcision: II: effects upon mother-infant interaction
 |journal=Early Hum Dev
 |date=1982
 |volume=7
 |issue=4
 |pages=367-374
}}</ref><ref>{{REFjournal
 |last=Lee
 |init=N
 |title=[http://www.cirp.org/library/birth/lee1/ Circumcision and breastfeeding]
 |journal=J Hum Lact
 |date=2000
 |volume=16
 |issue=4
 |page=295
}}</ref><ref>{{REFjournal
 |last=Anand
 |init=KJS
 |last2=Hickey
 |init2=PR
 |url=http://www.cirp.org/library/pain/anand/
 |title=Pain and its effects in the human neonate and fetus
 |journal=New Engl J Med
 |date=1987
 |volume=317
 |issue=21
 |pages=1321-1329
 |accessdate=2011-03-21
}}</ref><ref>{{REFjournal
 |last=Anand
 |init=KJS
 |last2=Scalzo
 |init2=FM
 |first2=Frank M.
 |url=http://www.cirp.org/library/pain/anand4/
 |title=Can Adverse Neonatal Experiences Alter Brain Development and Subsequent Behavior?
 |journal=Biology of the Neonate
 |volume=77
 |issue=2
 |pages=69-82
 |date=2000-02
 |accessdate=2011-03-21
}}</ref>, including altered perceptions of pain<ref>{{TaddioA etal 1995}}</ref><ref>{{TaddioA KatzJ IlersichAL KorenG 1997}}</ref><ref>{{REFjournal
 |last=LaPrairie
 |init=JL
 |first=Jamie L.
 |last2=Murphy
 |init2=AZ
 |first2=Anne Z.
 |url=http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2766783/
 |title=Neonatal Injury Alters Adult Pain Sensitivity by Increasing Opioid Tone in the Periaqueductal Gray
 |journal=Front Behav Neurosci
 |date=2009-09-30
 |accessdate=2011-03-21
}}</ref>, [[post-traumatic stress disorder]] (PTSD)<ref>{{BoyleGJ GoldmanR SvobodaJS FernandezE 2002}}</ref><ref>{{REFjournal
 |last=Rhinehart
 |init=J
 |url=http://www.cirp.org/library/psych/rhinehart1/
 |title=Neonatal circumcision reconsidered
 |journal=Transactional Analysis J
 |date=1999
 |volume=29
 |issue=3
 |pages=215-221
}}</ref><ref>{{REFbook
 |last=Ramos
 |first=S.
 |init=S
 |last2=Boyle
 |first2=Gregory J.
 |init2=GJ
 |author2-link=Gregory J. Boyle
 |url=https://link.springer.com/chapter/10.1007/978-1-4757-3351-8_14
 |chapter=Ritual and medical circumcision among Filipino boys: evidence of post-traumatic stress disorder
 |editors:Denniston G.C., Hodges F.M., Milos M.F.
 |title=Understanding circumcision: A Multi-Disciplinary Approach to a Multi-Dimensional Problem
 |location=New York
 |publisher=Kluwer Academic/Plenum Publishers
 |year=2001
 |pages=253-270
}}</ref><ref>{{REFjournal
 |last=Menage
 |init=J
 |url=http://www.cirp.org/library/psych/menage/
 |title=Post-traumatic stress disorder in women who have undergone obstetric and/or gynaecological procedures
 |journal=J Reprod Infant Psychol
 |date=1993
 |volume=11
 |pages=221-228
}}</ref>, and a possibly of adult self destructive behavior.<ref>{{REFjournal
 |last=Van der Kolk
 |init=BA
 |author-link=Bessel van der Kolk
 |last2=Perry
 |init2=JC
 |last3=Herman
 |init3=JL
 |url=http://www.cirp.org/library/psych/vanderkolk_1991/
 |title=Childhood origins of self-destructive behavior
 |journal=Am J Psychiatry
 |date=1991
 |volume=148
 |pages=1665-1671
}}</ref><ref>{{REFjournal
 |last=Jacobson
 |init=B
 |last2=Bygdeman
 |init2=M
 |url=https://www.bmj.com/content/317/7169/1346.full
 |title=Obstetric care and proneness of offspring to suicide
 |journal=BMJ
 |date=1998
 |volume=317
 |pages=1346-1349
}}</ref><ref>{{REFjournal
 |last=Salk
 |init=L
 |last2=Lipsitt
 |init2=LP
 |last3=Sturner
 |init3=WQ
 |etal=yes
 |url=http://www.cirp.org/library/psych/salk1/
 |title=Relationship of maternal and perinatal conditions to eventual adolescent suicide
 |journal=Lancet
 |date=1985
 |volume=i
 |pages=624-627
}}</ref>

It appears that the major reason to administer analgesia to infants undergoing circumcision may be to minimize parents' feeling of guilt and to get their consent for a profitable [[amputation]].

==Video==
[[Intaction]] (2022) has provided an introductory video.
<youtube>v=DcfyCpRUlFY</youtube>

==Informed consent for non-therapeutic circumcision of minor boys==

A treatment decision should be guided by the best interests of the child, and must balance the potential benefit over the potential harm or risk.<ref> {{REFjournal
 |last=Bioethics Committee, Canadian Paediatric Society
 |first=
 |author-link=
 |etal=no
 |title=Treatment decisions for infants and children
 |trans-title=
 |language=
 |journal=CMAJ
 |location=
 |date=1986-09-01
 |volume=135
 |issue=
 |pages=447-8
 |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1491550/pdf/cmaj00125-0033.pdf
 |archived=
 |quote=
 |pubmedID=3742387
 |pubmedCID=1491550
 |DOI=
 |accessdate=2020-07-23
}}</ref>

A [[circumcision]] of a boy may be therapeutic or non-therapeutic. Therapeutic circumcision may be justified only in rare cases when the [[foreskin]] is deformed, diseased, or damaged by irreparable [[trauma]] and the apparent benefit to the patient exceeds the risks and harms.

However, the vast and overwhelming majority of circumcisions of children are performed to excise healthy, functional tissue from the body of a child who is too immature to grant consent.

The Bioethics Committee of the [[American Academy of Pediatrics]] (1995) considered the power granted to parents to grant surrogate consent for diagnosis and treatment of a child. The Committee says that a parent may give "informed permission" for investigation and treatment of disease. The difference between informed consent and informed permission is unclear. When a child is ill, it is the practice to allow a parent to grant informed permission for diagnostic tests and appropriate treatment.<ref name="aap1995" /> 

Infant boys are born with a healthy [[foreskin]]. No disease or deformity is present to be diagnosed or treated. [[Circumcision]] of an infant boy is neither a diagnostic procedure nor a treatment for disease. The limited parental surrogate powers to grant informed permission recognized by the Bioethics Committee do not extend to the granting of permission or consent for the non-therapeutic circumcision of a minor child.<ref name="aap1995" /> 

If the medical industry had actually followed this sound ethical guidance, then the [[circumcision]] of male infants would have ended abruptly. The medical industry has chosen to ignore this advice and allow parents to grant consent for non-therapeutic circumcision of male children, so that the physician income derived from circumcision may be maintained.

Svoboda et al. (2000) examined the ethics and legality of informed consent for non-therapeutic neonatal circumcision. With regard to ethics, they concluded:
<blockquote>
Amputating a highly sensitive and functional part of the body is extremely intrusive and should be undertaken only in situations of extreme urgency. Neonatal circumcision as it is routinely performed in this country clearly does not satisfy this criterion. It is therefore unethical and unlawful, and no parental permission should be effective.<ref name="svoboda2002">{{REFjournal
 |last=Svoboda
 |first=J. Steven
 |init=JS
 |author-link=J. Steven Svoboda
 |last2=Van Howe
 |first2=Robert S.
 |init2=RS
 |author2-link=Robert S. Van Howe
 |last3=Dwyer
 |first3=James G.
 |init3=JG
 |author3-link=
 |etal=no
 |title=Informed Consent for Neonatal Circumcision: An Ethical and Legal Conundrum
 |trans-title=
 |language=English
 |journal=J Contemp Health Law Policy
 |location=
 |date=2000-09
 |volume=17
 |issue=1
 |pages=61-133
 |url=https://scholarship.law.edu/cgi/viewcontent.cgi?article=1255&context=jchlp
 |archived=
 |quote=
 |pubmedID=
 |pubmedCID=
 |DOI=
 |accessdate=2020-07-22
}}</ref>
 </blockquote>

Regarding legality, they concluded:
<blockquote>
Consent to neonatal circumcision has not been directly considered by the the courts; therefore our analysis, out of necessity, relies on established legal precedents of cases that share common elements with neonatal circumcision. With near uniformity, these precedents indicate that any consent given for neonatal circumcision would not be valid. Court decisions are in part influenced by the culture in which they occur. However, circumcision has been gradually falling out of favor in the last few decades. When the balance of public opinion shifts to opposing the practice, the legal system will become more accepting of lawsuits and lobbying for the protection of baby boys. Consequently, the legal system will no longer be able to ignore the conflict between the practice and the legal and ethical duties of medical professionals. In the meantime, the medical community should personally reexamine the ethics of the practice.<ref name="svoboda2002" />
</blockquote>

Adler (2013) considered the legality of non-therapeutic circumcision of boys. He concluded in part:
<blockquote>
This article has addressed whether circumcision is legal, and has shown that it is not. To summarize the law, boys, like girls and adults, have
absolute rights under the common law to personal security and bodily integrity, and to freedom or the autonomy to make important and irreversible decisions about their bodies that can be delayed, like circumcision, for themselves. …

… A physician's legal duty is to provide competent medical care to pediatric patients independent of their parents' desires. Thus, physicians cannot take orders from parents to operate on children for reasons having nothing to do with medicine. Parents' religious rights in turn are subordinate to their sons' absolute rights to [[genital integrity]] and autonomy, and parents cannot risk harming their children, let alone actually harm them for religious reasons. Furthermore, physicians and parents have a legal duty to ''protect'' boys from circumcision.<ref name="adler2013">{{REFjournal
 |last=Adler
 |first=Peter W.
 |init=PW
 |author-link=Peter W. Adler
 |title=Is circumcision legal?
 |journal=Richmond Journal of Law and the Public Interest
 |date=2013
 |volume=16
 |issue=3
 |pages=439-86
 |url=https://scholarship.richmond.edu/cgi/viewcontent.cgi?article=1265&context=jolpi
 |accessdate=2020-07-25
}}</ref>
</blockquote>

A court of appeals in Cologne, Germany [[Cologne circumcision court judgment]] ruled in 2012 that non-therapeutic male circumcision is an assault on the child, an injury to the child, and a violation of the child's rights under the [https://www.btg-bestellservice.de/pdf/80201000.pdf Basic Law of Germany]. No American court has so ruled. Until such time as an American court issues such a ruling, non-therapeutic circumcision of children in America, driven by the [[Financial Incentive| financial incentive]] is expected to continue. 

At the present time, ethics and law notwithstanding, non-therapeutic circumcisions of boys are performed with parental consent. Parents will be offered medically-unnecessary, non-therapeutic circumcision and encouraged to grant consent, the sole beneficiary being the bank accounts of the hospital and the doctor. The information supplied below is intended to inform and assist parents of boys.

The Bioethics Committee (2016) of the [[American Academy of Pediatrics]] updated its guidance on informed consent in pediatric practice,<ref name="aap1995" /> however it still does not recognize the child as a human being with rights under domestic and international law.<ref>{{REFjournal
 |last=Katz
 |first=Aviva L.
 |init=
 |author-link=
 |last2=Macauley
 |first2=Robert C.
 |init2=
 |author2-link=
 |last3=Mercurio
 |first3=Mark C.
 |init3=
 |author3-link=
 |etal=yes
 |title=Informed consent in decision-making in pediatric practice
 |trans-title=
 |language=
 |journal=Pediatrics
 |location=
 |date=2016-08
 |volume=138
 |issue=2
 |article=
 |page=e20161484
 |pages=
 |url=https://publications.aap.org/pediatrics/article/138/2/e20161484/52512/Informed-Consent-in-Decision-Making-in-Pediatric
 |archived=
 |quote= A parent’s authority is not absolute but constrained by respect for the child.
 |pubmedID=27456510
 |pubmedCID=
 |DOI=10.1542/peds.2016-1484 
 |accessdate=2022-01-24
}}</ref>

Wasserman et al. (2019) recognized children as persons entitled to respect. 
<blockquote>
Respect is something we owe to others to demonstrate that we recognize them as persons rather than objects. Patients (including children) are persons even if they do not reason well, particularly if have a kind of agency that is capable of expressing preferences. Once way to respect persons is to acknowledge that their preferences matter, something that may require soliciting those preferences, even in cases in which it would be ethically wrong to give them what they prefer. This is because it is disrespectful, and perhaps even dehumanizing to treat preference-expressing patients as mere bystanders or obstacles to their own care.<ref name="wasserman2019">{{REFjournal
 |last=Wasserman
 |first=Jason Adam
 |init=JA
 |author-link=
 |last2=Navin
 |first2=Mark Christopher
 |init2=MC
 |author2-link=
 |last3=Vercier
 |first3=Christian John
 |init3=CJ
 |author3-link=
 |etal=yes
 |title=Pediatric assent and treating children over objection
 |journal=Pediatrics
 |location=
 |date=2019-11
 |volume=114
 |issue=5
 |article=
 |page=
 |pages=e20190382
 |url=https://publications.aap.org/pediatrics/article/144/5/e20190382/38213/Pediatric-Assent-and-Treating-Children-Over
 |quote=
 |pubmedID=1666301
 |pubmedCID=
 |DOI=10.1542/peds.2019-0382 
 |accessdate=2022-01-25
}}</ref>
</blockquote>

Although this may be an advance, Wasserman et al., speaking for the [[AAP]], still do not recognize the [[human rights]] of children.

== Correct age for circumcision ==
Hill (2003) asked if anyone can grant consent for medically not indicated, non-therapeutic circumcision of infants.<ref>{{REFjournal
 |last=Hill
 |first=George
 |init=G
 |author-link=George Hill
 |title=Can anyone authorize the nontherapeutic permanent alteration of a child's body?
 |journal=The American Journal of Bioethics
 |date=2003
 |season=Spring
 |volume=3
 |issue=2
 |pages=16-8
 |url=https://muse.jhu.edu/article/44133
 |quote=The question is whether anyone, parents included, has the right to remove the extremely sensitive genital tissue from an infant for any reason other than unquestionably urgent medical necessity.
 |pubmedID=14635628
 |pubmedCID=
 |DOI=10.1162/152651603766436342
 |accessdate=2023-05-24
}}</ref>

Bioethicists Myers & Earp (2020) answered Hill's question. They exhaustively reviewed the evidence for and against the alleged health benefits to a healthy person claimed for non-therapeutic [[circumcision]] of a neonate, infant or child. They balanced this against the [[pain]], [[trauma]], and loss of body tissue and function. They concluded the claimed health benefits are insufficient to support surrogate consent for non-therapeutic circumcision. Given this, ''only'' the subject can grant consent for a non-therapeutic circumcision, and then ''only'' after he reaches the right age for circumcision, which does not occurs until a male reaches the age of consent in his jurisdiction which may vary from 16 to 18 years of age. No other person may grant consent for the non-therapeutic circumcision of a minor boy. The present practice in the [[United States]] and elsewhere of allowing parental surrogate consent for non-therapeutic circumcision is entirely unethical because it exceeds the powers granted to surrogates.<ref name="myers2020">{{REFjournal
 |last=Myers
 |first=
 |init=A
 |author-link=Alex Myers
 |last2=Earp
 |first2=
 |init2=BD
 |author2-link=Brian D. Earp
 |etal=no
 |title=What is the best age to circumcise? A medical and ethical analysis
 |trans-title=
 |language=
 |journal= Bioethics
 |location=
 |date=2020
 |volume=34
 |issue=7
 |pages=645-63
 |url=https://www.researchgate.net/profile/Brian-Earp-2/publication/337720859_What_Is_the_Best_Age_to_Circumcise_A_Medical_and_Ethical_Analysis/links/5f815f61a6fdccfd7b555395/What-Is-the-Best-Age-to-Circumcise-A-Medical-and-Ethical-Analysis.pdf
 |archived=
 |quote=Based on a careful consideration of the relevant evidence, arguments and counterarguments, we conclude that medically unnecessary penile circumcision-like other medically unnecessary genital procedures, such as 'cosmetic' labiaplasty-should not be performed on individuals who are too young (or otherwise unable) to provide meaningful consent to the procedure.
 |pubmedID=32068898
 |pubmedCID=
 |DOI=
 |doi=10.1111/bioe.12714 
 |format=PDF
 |accessdate=2023-09-17
}}</ref>


{{SEEALSO}}
* [[Human rights]]
* [[Litigation over circumcision]]
* [[Pain]]
* [[Risks and complications]]
* [[Trauma]]

{{LINKS}}
* {{REFweb
 |url=https://www.emedicinehealth.com/informed_consent/article_em.htm#what_is_informed_consent
 |title=Informed Consent
 |last=Wagner
 |first=Richard 
 |author-link=
 |publisher=emedicinehealth
 |accessdate=2020-06-22
}}
* {{REFweb
 |url=http://www.cirp.org/library/ethics/
 |title=The Bioethics of the Circumcision of Male Children
 |last=
 |first=
 |date=2013-10-07
 |accessdate=2020-07-21
}}
* {{REFweb
 |url=https://avoiceformen.com/featured/is-circumcision-legal-does-it-matter/
 |archived=
 |title=Is circumcision legal? Does it matter?
 |trans-title=
 |language=English
 |last=Costanza
 |first=Gary
 |author-link=Gary Costanza
 |publisher=
 |website=avoiceformen.com
 |date=2016-02-28
 |accessdate=2020-07-23
 |format=
 |quote=
}}
* {{REFweb
 |url=https://www.homerbirthcenter.com/wp-content/uploads/2019/09/CIRCUMCISION-ARTICLE.pdf
 |archived=
 |title=The case against circumcision
 |trans-title=
 |language=English
 |last=
 |first=
 |author-link=
 |publisher=Mothering Magazine
 |website=homebirthcenter.com
 |date=
 |accessdate=2020-07-24
 |format=
 |quote=
}}
* {{REFweb
 |url=http://www.circumcisiondebate.org/ethics
 |archived=
 |title=The ethics of circumcision
 |trans-title=
 |language=
 |last=
 |first=
 |author-link=
 |publisher=The Circumcision Debate
 |website=http://www.circumcisiondebate.org
 |date=
 |accessdate=2020-07-24
 |format=
 |quote=
}}
* {{REFweb
 |url=https://physiciansforinformedconsent.org/
 |title=Physicians for Informed Consent
 |accessdate=2022-08-25
}}

{{REF}}

[[Category:Parental information]]
[[Category:Medical ethics]]

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[[Category:From IntactWiki]]

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