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

|title=Informed conesntconsent

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 Information for infants and children |transparents regarding non-title= |language= |journal=CMAJ |location= |date=1986-09-01 |volume=135 |issue= |pages=447-8 |url=https://www.ncbi.nlm.nihtherapeutic circumcision of infant boys.gov/pmc/articles/PMC1491550/pdf/cmaj00125-0033.pdf |archived= |quote= |pubmedID=3742387 |pubmedCID=1491550 |DOI= |accessdate=2020-07-23}}</ref>

A This section is for all parents of boys, but is addressed primarily to parents of boys who are located in the [[circumcisionUnited States of America]] of a boy may , who appear to be therapeutic most uninformed or non-therapeutic. Therapeutic circumcision may be justified only in rare cases when misinformed about the [[foreskin ]] and [[circumcision]]. Information is deformed, diseased, not making it to parents. Studies have shown that doctors provide parents with almost no accurate or damaged by irreparable trauma useful information about circumcision. After several generations of promotion of and near universal neonatal circumcision in the apparent benefit to the patient exceeds the risks United States, most Americans are profoundly ignorant of a normal body part and harmsits valuable functions.=== Surrogate consent ===However, the vast and overwhelming majority of circumcisions of Parents act as surrogates for their minor children who are performed to excise healthy, functional tissue from the body of a child who is too immature young to personally grant consent. The Bioethics Committee of Surrogate consent ethically is limited to the American Academy granting 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 bettween 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">{{REFjournal |last=Committee on Bioethics Committee, American Academy of Pediatrics. |first= |author-link=

|accessdate=20202023-0709-2314}}</ref>  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="svoboda2002aviva2016">{{REFjournal |last=SvobodaCommittee on Bioethics |first=J. Steven |init=JS |author-link=J. Steven Svoboda |last2=Van Howe |first2=Robert S. |init2=RS |author2etal-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 Conundrumin Decision-Making in Pediatric Practice

|language=English |journal=J Contemp Health Law PolicyPediatrics

|date=20002016-0908 |volume=17138 |issue=12 |article= |page=e20161484. |pages=61-133 |url=https://scholarshippublications.lawaap.eduorg/pediatrics/article/138/2/cgie20161484/viewcontent.cgi52512/Informed-Consent-in-Decision-Making-in-Pediatric?article=1255&contextautologincheck=jchlpredirected

|quote=Continuing limits on the widespread use of pediatric assent/refusal makes this review and restatement of AAP policy important. |pubmedID=27456514

|accessdatedoi=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 practice10.<ref name="svoboda2002" 1542/></blockquote> Adler (2013) considered the legality of non-therapeutic circumcision of boyspeds. 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, haveabsolute 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=4392016-86 |url=https://scholarship.richmond.edu/cgi/viewcontent.cgi?article=1265&context=jolpi1484 |accessdate=20202023-0709-2514}}</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, however it still does not recognize the child as a human being with rights under domestic and international law.<ref>{{REFjournal

|first=Aviva L. |init=AL

|last2=MacauleyWebb |first2=Robert C. |init2=SA

|last3=MercurioMacauley |first3=Mark C. |init3=RC

|last4=Mercurio |first4= |init4=MR |author4-link= |last5=Moon |first5= |init5=MR |author5-link= |last6=Okun |first6= |init6=AL |author6-link= |last7=Opel |first7= |init7=DJ |author7-link= |last8=Statter |first8= |init8=MB |author8-link= |etal=yesno |title=Informed consent Consent in decisionDecision-making Making in pediatric practicePediatric Practice Technical Report

|article= |page=e20161484 |pages=e20161485 |url=https://publications.aap.org/pediatrics/article/138/2/e20161484e20161485/5251252519/Informed-Consent-in-Decision-Making-in-Pediatric

|quote=A formulation of Kant’s categorical imperative notes that we are obliged to act out of fundamental respect for other persons by virtue of their personal autonomy.

|DOI=10.1542/peds.2016-1484 1485 |accessdate=20222024-0107-2409

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 purposely 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">{{REFjournal |last=Winkelmann |init=RK |author-link= |title=The erogenous zones: their nerve supply and significance |journal=Mayo Clin Proc |date=WinkelmannRK 1959-01-21 |volume=34 |issue=3 |pages=39-47 |url=http://www.cirp.org/library/anatomy/winkelmann/ |quote= |pubmedID=13645790 |pubmedCID= |DOI= |accessdate=2020-07-21}}</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:

}}</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.

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>{{REFjournal |last=Van der Kolk |init=BA |url=http://www.cirp.org/library/psych/vanderkolk/ |title=The compulsion to repeat the trauma: re-enactment, revictimization, and masochism |journal=Psychiatr Clin North Am |date=VanderKolkBA 1989 |volume=12 |issue=2 |pages=389-411}}</ref><ref>{{REFjournal

}}</ref><ref>{{REFjournal

The use of local anesthetics significantly drives up the costs of surgeryand 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

}}</ref>, including altered perceptions of pain<ref>{{REFjournal |last=Taddio |init=A |last2=Goldbach |init2=M |last3=Ipp |init3=E |TaddioA etal=yes |url=http://www.cirp.org/library/pain/taddio/ |title=Effect of neonatal circumcision on pain responses during vaccination in boys |journal=Lancet |date=1995 |volume=345 |pages=291-292 |accessdate=2011-03-21}}</ref><ref>{{REFjournal |last=Taddio |init=A |last2=Katz |init2=J |last3=Ilersich |init3=AL |last4=Koren |init4=G |url=http://www.cirp.org/library/pain/taddio2 |title=Effect of neonatal circumcision on pain response during subsequent routine vaccination |journal=Lancet |date=TaddioA KatzJ IlersichAL KorenG 1997 |volume=349 |issue=9052 |pages=599-603 |accessdate=2011-03-21}}</ref><ref>{{REFjournal

}}</ref>, [[post -traumatic stress disorder ]] (PTSD)<ref>{{REFjournal |last=Boyle |init=GJ |author-link=Gregory J. Boyle |last2=Goldman |init2=R |author2-link=Ronald Goldman |last3=Svoboda |init3=JS |author3-link=J. Steven Svoboda |last4=Fernandez |init4=E |url=http://www.cirp.org/library/psych/boyle6/ |title=Male circumcision: pain, trauma and psychosexual sequelae |journal=J Health Psychol |date=BoyleGJ GoldmanR SvobodaJS FernandezE 2002 |volume=7 |issue=3 |pages=329-343}}</ref><ref>{{REFjournal