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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.
It is defined as:
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 conesntconsent
|last=
|first=
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=Continuing limits on the widespread use of pediatric assent/refusal makes this review and restatement of AAP policy important.
|pubmedID=27456514
|pubmedCID=
|DOI=
|doi=10.1542/peds.2016-1484
|accessdate=2023-09-14
}}</ref> <ref>{{REFjournal
|last=Katz
|first=
|init=AL
|author-link=
|last2=Webb
|first2=
|init2=SA
|author2-link=
|last3=Macauley
|first3=
|init3=RC
|author3-link=
|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=no
|title=Informed Consent in Decision-Making in Pediatric Practice Technical Report
|trans-title=
|language=
|journal=Pediatrics
|location=
|date=2016-08
|volume=138
|issue=2
|page=e20161485
|url=https://publications.aap.org/pediatrics/article/138/2/e20161485/52519/Informed-Consent-in-Decision-Making-in-Pediatric
|archived=
|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.
|pubmedID=27456510
|pubmedCID=
|DOI=10.1542/peds.2016-1485
|accessdate=2024-07-09
}}</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" />
|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
}}</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
|issue=3
|pages=318-323
}}</ref><ref>{{REFjournal
|last=Goldman
|init=R
|date=2009-09-30
|accessdate=2011-03-21
}}</ref>, [[posttraumatic post-traumatic stress disorder]] (PTSD)<ref>{{BoyleGJ GoldmanR SvobodaJS FernandezE 2002}}</ref><ref>{{REFjournal
|last=Rhinehart
|init=J
|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>
<br>
[[15 Square]] has provided a video.
<youtube>v=xjqxeTg7JUc</youtube>
==Informed consent for non-therapeutic circumcision of minor boys==
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">{{REFjournal |last=Bioethics Committee, American Academy of Pediatrics. |first= |author-link= |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 |pages=314-7 |url=http://www.cirp.org/library/ethics/AAP/ |archived= |quote= |pubmedID=7838658 |pubmedCID= |DOI= |accessdate=2020-07-23}}</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 [[circumcision 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 surrogate 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:
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.
|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=
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}}
* [[Pain]]
* [[Risks and complications]]
* [[Wrongful circumcision]]
* [[Trauma]]
|accessdate=2022-08-25
}}
* {{REFweb |url=https://intactamerica.org/assent-vs-consent/ |title=Assent vs Consent (in Regards to Bodily Autonomy and Circumcision) |last=Garrett |first=Connor |init= |author-link=Connor Judson Garrett |publisher=Intact America |date=2024-03-03 |accessdate=2024-07-11}}
{{REF}}
[[Category:Parental information]]
[[Category:Medical ethics]]