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The 2019 BMA guidance regarding non-therapeutic circumcision of boys is divided into twelve “cards”. Card Four discusses law. [[Human rights]] law is recognised but the BMA fail to understand the significance of [[human rights]] law. The BMA do not clearly state that [[human rights]] law grants rights to children which helps to define the best interests of the child and should be respected and protected.<ref name="bma2019">{{REFdocument
|title=Non-therapeutic male circumcision (NTMC) of children – practical guidance for doctors
|url=https://www.bma.org.uk/media/1847/bma-non-therapeutic-male-circumcision-of-children-guidance-2019.pdf
|contribution=
|last=
|first=
|publisher=British Medical Association
|format=PDF
|date=2019
|accessdate=2021-06-29
}}</ref>
The BMA, a [[medical trade association]], lean toward protecting the alleged right of its members to profit from carrying out non-therapeutic [[circumcision]] on boys, in the face of increasingly severe legal concerns.
[[Category:Medical ethics]]
Correct citations,
Male [[circumcision]] is the surgical removal of the [[foreskin]] (prepuce) from the human [[penis]].<ref name=sawyer_2011>{{REFbook
|last=Sawyer
}}</ref><ref name="bma2006">Committee on Medical Ethics. [https://www.bma.org.uk/advice/employment/ethics/children-and-young-people/non-therapeutic-male-circumcision-of-children-ethics-toolkit The law and ethics of male circumcision: Guidance for doctors]. London: British Medical Association 2006.</ref>
Some medical trade associations formerly took the position that the parents should determine what is in the best interest of the infant or child.<ref name="AAP1999">{{REFjournal
|last=Task force on circumcision
|title=Circumcision policy statement
===United Kingdom===
[[File:Flag of the United Kingdom.svg|thumb|upright=0.3]]
The medical ethics committee of the [https://www.bma.org.uk/ British Medical Association] also reviewed the ethics behind circumcision. Since circumcision has associated medical and psychological risks with no unequivocally proven medical benefits, they advise physicians to keep up with clinical evidence and only perform this procedure if it's in the child best interest.<ref name="bma2006" /> However, they acknowledge the procedure as a cultural and religious practice, which may be an important ritual for the child's incorporation into the group.<ref name="bma2006"/> They recognize that parents have the authority to make choices for their child, and they emphasize it is important for parents to act in their child's best interest.<ref name="bma2006"/> They ultimately report that views vary in their community about the benefits and risks of the procedure, and there is no clear policy for this situation.<ref name="bma2006"/>
====Adult circumcision====
In a paper published June 2006, the [https://www.bma.org.uk/ British Medical Association] Committee on Medical Ethics does not consider circumcision of an adult male to be controversial, provided that the adult is of sound mind and grants his personal consent after receiving all material information regarding the known risks, disadvantages, and potential benefits to be derived from the surgical operation.<ref name="bma2006" />
====Child circumcision====
In the same British Medical Association paper, circumcision of a child to treat a clear and present [[medical indication]] after a trial of conservative treatment also is not considered to be ethically questionable, provided that a suitable surrogate has granted surrogate consent after receiving all material information regarding the known risks, disadvantages, and potential benefits to be derived from the surgical operation.<ref name="bma2006"/>
====Criticism and revision of BMA statement====
Commenting on the development of the 2003 British Medical Association guidance on circumcision, Mussell (2004) reports that debate in society is highly polarized, and he attributes it to the different faiths and cultures that make up BMA.<ref name="mussell2004">{{REFjournal
|last=Mussell
|init=R
|authorlink=
|date=2004-06
|title=The development of professional guidelines on the law and ethics of male circumcision
|url=http://jme.bmj.com/cgi/content/full/30/3/254
|journal=Journal of Medical Ethics
|volume=30
|issue=3
|pages=254-258
|DOI=10.1136/jme.2004.008615
|pubmedCID=1733857
|pubmedID=15173358
|accessdate=
|quote=
}}</ref> He identifies this as a difficulty in achieving consensus within the medical ethics committee. Arguments put forward in discussions, according to Mussell, included the social and cultural benefits of circumcision, the violation of the child's rights, and the violation of the child's autonomy.<ref name="mussell2004"/>
The BMA statement of 2003 took the position that non-therapeutic circumcision of children is lawful in the United Kingdom.<ref name="BMA2003"/> British law professors Fox & Thomson (2005), citing the House of Lords case of R v Brown, challenged this statement. They argued that consent cannot make an unlawful act lawful.<ref name="fox-thomson">{{REFjournal
|last=Fox
|init=M
|last2=Thomson
|init2=M
|title=A covenant with the status quo? Male circumcision and the new BMA guidance to doctors
|journal=Journal of Medical Ethics
|date=2005
|volume=31
|issue=8
|pages=463-469
|url=http://jme.bmj.com/content/31/8/463.full
|DOI=10.1136/jme.2004.009340
|pubmedID=16076971
|pubmedCID=1734197
}}</ref> The BMA issued a revised statement in 2006 and now reports the controversy regarding the lawfulness of non-therapeutic child circumcision and recommends that doctors obtain the consent of ''both'' parents before performing non-therapeutic circumcision of a male minor. The revised statement now mentions that male circumcision is generally assumed to be lawful provided that it is performed competently, is believed to be in the child's best interests, and there is valid consent from both parent or the child if it is capable of expressing a view.<ref name="bma2006" />
====2019 revision of BMA guidance====
|accessdate=2021-06-29
}}</ref>
===United States===
==== American Academy of Pediatrics ====
The American Academy of Pediatrics currently has ''no'' official stance on neonatal circumcision. The previous statement was NOT reaffirmed and so it expired in 2017and has not been reaffirmed.<ref>{{REFjournal
|last=Task Force On Circumcision
|date=2012-09-01
In August 2017, the American Medical Association ''Journal of Ethics'' featured two separate articles challenging the morality of performing non-therapeutic infant circumcision.
Svoboda argued argues against non-therapeutic circumcision.<ref name="svoboda2017">{{REFjournal
|date=2017-08-01
|title=Nontherapeutic Circumcision of Minors as an Ethically Problematic Form of Iatrogenic Injury
==Other views==
Povenmire (1988) argued argues that parents should not have the power to consent to neonatal non-therapeutic circumcision.<ref name="povenmire"/>
Richards (1996) argued argues that parents only have power to consent to therapeutic procedures.<ref name="richards"/>
[[Margaret A. Somerville|Somerville]] (2000) argues that the nature of the medical benefits cited as a justification for infant circumcision are such that the potential medical problems can be avoided or, if they occur, treated in far less invasive ways than circumcision. She states that the removal of healthy genital tissue from a minor should not be subject to parental discretion, or that physicians who perform the procedure are not acting in accordance with their ethical duties to the patient, regardless of parental consent.<ref name="Somerville2000">{{REFbook
}}</ref>
Fox and Thomson (2005) state that in the absence of "unequivocal evidence of medical benefit", it is "ethically inappropriate to subject a child to the acknowledged risks of infant male circumcision." Thus, they believe, "the emerging consensus, whereby parental choice holds sway, appears ethically indefensible".<ref name="fox-thomson"/> <!--[[Brian J. Morris|Morris]] et al. (2014) argued that "...failure to circumcise a baby boy may be unethical because it diminishes his right to good health."<ref>{{REFjournal |last=FoxMorris |init=MBJ |authorlink=Brian J. Morris |last2=ThomsonBailis |init2=MSA |last3=Wiswell |init3=TE |title=A covenant with Circumcision rates in the status quoUnited States: rising or falling? Male circumcision and What effect might the new BMA guidance to doctorsaffirmative pediatric policy statement have? |journal=Journal of Medical EthicsMayo Clinic Proceedings |date=20052014-05 |volume=3189 |issue=85 |pages=463677-469686 |urlDOI=http://jme10.bmj.com1016/content/31/8/463j.full |DOI=10mayocp.1136/jme2014.200401.009340001 |pubmedID=16076971 |pubmedCID=173419724702735}}</ref>-->
The Belgian Federal Consultative Committee for Bioethics (''[[:fr:Comité consultatif de Bioéthique de Belgique|Comité Consultatif de Bioéthique de Belgique]]'') (2017), after a three-year study, has ruled that circumcision of male children for non-therapeutic purposes is unethical in Belgium.<ref> {{REFweb
|work=The Bulletin
|date=2017
|quote=As circumcision is irreversible and therefore a radical operation, we find the [[physical integrity]] of the child takes precedence over the belief system of the parents.}}</ref> The process is irreversible, has no medical justification in most cases, and is performed on minors unable to give their own permission, according to the committee. Paul Schotsmans of the {{UNI|University of Leuven|UCLouvain}}, on behalf of the committee, noted "the child’s right to [[physical integrity]], which is protected by the Convention on the Rights of the Child, and in particular its protection from physical injury."<ref name="bulletin2017"/> The Belgian minister of health replied that the Federal Institute federal institute for Health Tnsurance health insurance cannot check and know whether in (individual cases) a [[circumcision]] is medically justified or not and that she will continue to reimburse circumcision of minors as the safety of the child is her primary concern and she wants to avoid botched circumcisions by non-medical circumcisers.<!--<ref>{{REFweb
|url=https://www.standaard.be/cnt/dmf20170920_03084394
|title=De Block blijft besnijdenis terugbetalen
|language=nl-BE
|access-date=2019-06-14
}}</ref>-->
<!--
==HIV in southern and eastern Africa==
{{Main|Circumcision and HIV}}
Rennie et al. (2007) remark that the results of three randomised controlled trials in sub-Saharan Africa, showing reduced risk of [[HIV]] among circumcised men, "alter the terms of the debate over the ethics of male circumcision."<ref name="rennie2007">{{REFjournal
|last=Rennie
|first=Stuart
|init=S
|authorlink=
|last2=Muula
|first2=Adamson S.
|init2=AS
|last3=Westreich
|first3=Daniel
|init3=D
|date=2007-06
|title=Male circumcision and HIV prevention: ethical, medical and public health tradeoffs in low-income countries
|journal=Journal of Medical Ethics
|volume=33
|issue=6
|pages=357-361
|pubmedID=17526688
|url=http://jme.bmj.com/cgi/content/full/33/6/357
|accessdate=
|pubmedCID=2598273
|quote=
|DOI=10.1136/jme.2006.019901
}}</ref> However, the methodology of the African RCTs has been severely criticised, thereby invalidating claims that circumcision reduces the sexual transmission of [[HIV]].<ref>{{REFbook
|last=Boyle
|first=Gregory J.
|init=GJ
|author-link=Gregory Boyle
|year=2013
|chapter=Critique of African RCTs into Male Circumcision and HIV Sexual Transmission.
|editors=[[George C. Denniston]], [[Frederick M. Hodges]], [[Marilyn Fayre Milos]]
|title=Genital Cutting: Protecting Children from Medical, Cultural, and Religious Infringements
|location=Dordrecht, The Netherlands
|publisher=Springer Science+Business Media
|DOI=10.1007/978-94-007-6407-1_15
|isbn=978-94-007-6406-4
}}</ref>
Supporters of circumcision argue that using circumcision and other available means to halt the spread of [[HIV]] is in the common good (but overlook the fact that [[HIV]] is transmitted in the seminal fluid). Rennie et al. argue that "it would be unethical to not seriously consider one of the most promising—although also one of the most controversial—new approaches to [[HIV]]-prevention in the 25-year history of the epidemic."<ref name="rennie"/> However, there clearly remains a risk of transmitting or acquiring [[HIV]] while engaging in unprotected sex and other high risk behaviors (circumcised or not).
The [[World Health Organization]] (2007) states that provision of circumcision should be consistent with "medical ethics and [[human rights]] principles." They state that "[i]nformed consent, confidentiality and absence of coercion should be assured. ... Parents who are responsible for providing consent, including for the circumcision of male infants, should be given sufficient information regarding the benefits and risks of the procedure in order to determine what is in the best interests of the child."<ref>WHO/UNAIDS Technical Consultation. [http://www.who.int/entity/hiv/mediacentre/MCrecommendations_en.pdf Male Circumcision and [[HIV]] Prevention: Research Implications for Policy and Programming]. Montreux, 6–8 March 2007</ref> However, since babies and children are not sexually active, sexually-transmitted [[HIV]] infection is not a relevant concern. Critics of non-therapeutic circumcision argue that advocating circumcision to prevent [[HIV]] infection may detract from other efforts to prevent the spread of the virus such as using condoms. If the adult chooses to remain celibate or if a couple remain monogamous, or if [[HIV]] is eliminated by the time the child is an adult, the sexual reduction surgery would not have been needed. Moreover, they argue that circumcising a child purportedly to partially protect him from [[HIV]] infection in adulthood may be seen as granting permission to engage in dangerous sexual practices. Obviously baby boys do not need such protection and can choose for themselves as consenting adults if they want a circumcision.<ref name="Somerville"/> This stance, however, does not take into account the fact that adult men may already have contracted [[HIV]] before getting circumcised.<ref>{{REFjournal
|last=Harmon
|first=Katherine
|init=K
|title=Can male circumcision stem the AIDS epidemic in Africa?
|url=http://www.nature.com/news/can-male-circumcision-stem-the-aids-epidemic-in-africa-1.9520
|journal=Nature News
|language=en
|DOI=10.1038/nature.2011.9520
|date=2011
}}</ref>
The UK National Health Service ([[NHS]]) has stated that the African studies have "important implications for the control of sexually transmitted infections in Africa", but that in the United Kingdom practising safe sex including condom use is the best way to prevent sexually-transmitted disease when having sex.<ref>{{REFweb
|url=https://www.nhs.uk/news/lifestyle-and-exercise/circumcision-and-stis/
|title=Circumcision and STIs
|date=2009-03-26
}}</ref>-->
==Surrogate consent==
|format=
|quote=As they saying goes, follow the money. Now you know why neither the [[American Academy of Pediatrics]], American Medical Association, [[American Academy of Family Physicians]], or the [[American Congress of Obstetricians and Gynecologists| American College of Obstetricians and Gynecologists]] haven’t condemned this unnecessary surgery, and why their physician members are quick to recommend the procedure to expectant parents.
}}</ref> [[Third-party payment]] is a major support to the performance of this medically-unnecessary surgery. If parents could not grant consent for non-therapeutic circumcision, then no one could grant consent for the non-therapeutic circumcision of a child, so the $2 billion annual business would collapse. The American [[medical trade association| medical trade associations]], more than other nations, have been unwilling to recognize the child's right to bodily integrity, to security of the person, and the right to personal autonomy.
|pubmedID=10349411
}}
{{REF}}
[[Category:Human rights]]