Difference between revisions of "Ethics of non-therapeutic child circumcision"

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<i>Human dignity</i> is the term given to the principle that humans and human life are entitled to respect. The United Nations has developed many [[human rights]] instruments that provide general guidance on protecting human dignity ."<ref>{{REFbook
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<b><i>Human dignity</i></b> is the term given to the principle that humans and human life are entitled to respect. The United Nations has developed many [[human rights]] instruments that provide general guidance on protecting human dignity ."<ref>{{REFbook
 
  |last=President's Council on Bioethics
 
  |last=President's Council on Bioethics
 
  |first=
 
  |first=
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}}</ref> The foreskin has [[Foreskin#Physiological_functions| protective, immunological, sensory, and sexual functions]], which are irreversibly destroyed and cease to function after the [[amputation]] of the foreskin by circumcision, imposing a lifetime loss of functional tissue and loss of function upon the patient. The '''ethics of non-therapeutic child circumcision''' being imposed on unconsenting minors (babies and children) has been a source of ongoing controversy.<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>
 
}}</ref> The foreskin has [[Foreskin#Physiological_functions| protective, immunological, sensory, and sexual functions]], which are irreversibly destroyed and cease to function after the [[amputation]] of the foreskin by circumcision, imposing a lifetime loss of functional tissue and loss of function upon the patient. The '''ethics of non-therapeutic child circumcision''' being imposed on unconsenting minors (babies and children) has been a source of ongoing controversy.<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>
  
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The concern about the ongoing practice of child circumcision has caused the publication of numerous articles in journals of medical ethics.
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The concern about the ongoing practice of child circumcision has spurred the publication of numerous articles in journals of medical ethics.
  
 
==Ethics journals  ==
 
==Ethics journals  ==
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  |url=http://jme.bmj.com/content/30/3.toc#Symposiumoncircumcision Symposium on circumcision
 
  |url=http://jme.bmj.com/content/30/3.toc#Symposiumoncircumcision Symposium on circumcision
 
}}</ref> The symposium published the original version (2003) of the BMA policy statement and six articles by various individuals with a wide spectrum of views on the ethicality of circumcision of male minors. In the introduction, Holm (2004) states:
 
}}</ref> The symposium published the original version (2003) of the BMA policy statement and six articles by various individuals with a wide spectrum of views on the ethicality of circumcision of male minors. In the introduction, Holm (2004) states:
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  |DOI=10.1001/journalofethics.2017.19.8.msoc2-1708
 
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==Principles of medical ethics==
 
==Principles of medical ethics==
 
===Cardinal principles===
 
===Cardinal principles===
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The four cardinal principles of medical ethics are:
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The five cardinal principles of medical ethics are:
 
* <b>Autonomy</b> (respecting a patient's right to make their own decisions),  
 
* <b>Autonomy</b> (respecting a patient's right to make their own decisions),  
 
* <b>Beneficence</b> (acting in the best interest of the patient),
 
* <b>Beneficence</b> (acting in the best interest of the patient),
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The attending physician must provide the surrogate with all material information concerning the proposed benefits, risks, advantages, and drawbacks of the proposed treatment or procedure.<ref name="conundrum"/><ref name="bioethics"/>
 
The attending physician must provide the surrogate with all material information concerning the proposed benefits, risks, advantages, and drawbacks of the proposed treatment or procedure.<ref name="conundrum"/><ref name="bioethics"/>
  
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The Committee on Bioethics of the AAP (1995) states that parents may only grant surrogate informed permission for diagnosis and treatment with the assent of the child whenever appropriate.<ref name="bioethics"/>
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The Committee on Bioethics of the AAP (1995) states that parents may only grant surrogate informed permission for ''diagnosis and treatment'' with the assent of the child whenever appropriate.<ref name="bioethics"/>
  
 
There was an unresolved question whether surrogates may grant effective consent for non-therapeutic child circumcision.<ref name="povenmire">{{REFjournal
 
There was an unresolved question whether surrogates may grant effective consent for non-therapeutic child circumcision.<ref name="povenmire">{{REFjournal
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}}</ref>
 
}}</ref>
  
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Regardless of these issues, the unethical general practice of the medical community in the United States is to receive surrogate informed consent or permission from parents or legal guardians for non-therapeutic circumcision of children.<ref name="povenmire"/><ref name="conundrum" />
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Regardless of these issues, the unethical general practice of the medical community in the [[United States]] is to receive surrogate informed consent or permission from parents or legal guardians for non-therapeutic circumcision of children.<ref name="povenmire"/><ref name="conundrum" />
  
 
=== The emerging consensus on surrogate consent for non-therapeutic newborn, infant, and child circumcision ===
 
=== The emerging consensus on surrogate consent for non-therapeutic newborn, infant, and child circumcision ===
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[[Third-party payment]] is a major support to the performance of this injurious 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 $3.6 billion annual business would collapse. The American [[Medical trade association| medical trade associations]], more than those of other nations, have been unwilling to recognize the child's [[human rights]] to [[physical integrity]], to security of the person, and the right to personal autonomy.
 
[[Third-party payment]] is a major support to the performance of this injurious 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 $3.6 billion annual business would collapse. The American [[Medical trade association| medical trade associations]], more than those of other nations, have been unwilling to recognize the child's [[human rights]] to [[physical integrity]], to security of the person, and the right to personal autonomy.
  
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The performance of harmful, medically not indicated circumcision upon a child simply to collect a surgical fee must be regarded as <b>patient exploitation</b>.<ref>Principle 13, [https://www.cfpc.ca/CFPC/media/Resources/Education/CMA-Code-of-Ethics.pdf CMA Code of Ethics]. Ottawa: Canadian Medical Association; updated 2004.</ref>
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The performance of harmful, medically not indicated [[circumcision]] upon a child simply to collect a surgical fee must be regarded as <b>patient exploitation</b>.<ref>Principle 13, [https://www.cfpc.ca/CFPC/media/Resources/Education/CMA-Code-of-Ethics.pdf CMA Code of Ethics]. Ottawa: Canadian Medical Association; updated 2004.</ref>
  
 
==Is circumcision without valid consent battery?==
 
==Is circumcision without valid consent battery?==
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Boyle et al. (2004) have argued that non-therapeutic circumcision of boys is "assault",<ref>{{BoyleGJ SvobodaJS PriceCP TurnerJN 2000}}</ref> but is it actually battery?
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Boyle et al. (2004) argued that non-therapeutic circumcision of boys is "assault",<ref>{{BoyleGJ SvobodaJS PriceCP TurnerJN 2000}}</ref> but is it actually battery?
 
<b>Simple battery</b> is defined as:
 
<b>Simple battery</b> is defined as:
 
<blockquote>
 
<blockquote>
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  |date=1999
 
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  |volume=83 Suppl. 1
 
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  |pages=22-7
 
  |DOI=10.1046/j.1464-410x.1999.0830s1022.x
 
  |DOI=10.1046/j.1464-410x.1999.0830s1022.x
 
  |pubmedID=10349411
 
  |pubmedID=10349411

Revision as of 23:48, 1 July 2025

Human dignity is the term given to the principle that humans and human life are entitled to respect. The United Nations has developed many human rights instruments that provide general guidance on protecting human dignity ."[1] Medical doctors have a general duty to respect the human rights of their patients.

Ethics is defined as "the principles of conduct governing an individual or a group". Medical ethics or bioethics provide guidance on protecting the human dignity of patients in medical treatment.

Male circumcisions are usually performed by medical doctors for profit, so the more specific principles of medical ethics or bioethics are applicable to the practice of circumcision. Male circumcision is the surgical removal of the foreskin (prepuce) from the human penis.[2] The foreskin has protective, immunological, sensory, and sexual functions, which are irreversibly destroyed and cease to function after the amputation of the foreskin by circumcision, imposing a lifetime loss of functional tissue and loss of function upon the patient. The ethics of non-therapeutic child circumcision being imposed on unconsenting minors (babies and children) has been a source of ongoing controversy.[3]

The concern about the ongoing practice of child circumcision has spurred the publication of numerous articles in journals of medical ethics.

Ethics journals

Journal of Medical Ethics circumcision issue, July 2013

The Journal of Medical Ethics devoted the entire July 2013 issue to the controversial issue of non-therapeutic circumcision of male children.[4] The numerous articles represent a diverse variety of views.[5][6]

American Medical Association Journal of Ethics

In August 2017, the American Medical Association Journal of Ethics featured two separate articles challenging the morality of performing non-therapeutic infant circumcision.

Svoboda (2017) argues against non-therapeutic circumcision.[7] He states that this decision should be considered in the context of benefit vs risk of harm, rather than simply risk-benefit due to the non-therapeutic nature of the procedure.[7] He states that benefits do not outweigh the risks, and also claims that foreskin removal should be considered a sexual harm.[7] He also goes on to conclude that non-therapeutic circumcision largely violates the physician's duty to respect a patient's autonomy since many procedures take place before a patient is able to freely give consent himself.[7]

Reis and Reis's article (2017) explore the role physicians play in neonatal circumcision.[8] They state that if physicians outline all the currently known risks and benefits of the procedure to the parents and believes the procedure is indeed medically indicated, they cannot be held accountable for any harm from the procedure.[8] However, they still advise against physicians recommending unnecessary, irreversible surgeries, which is a category circumcision falls in frequently.[8]

Principles of medical ethics

Cardinal principles

The five cardinal principles of medical ethics are:

  • Autonomy (respecting a patient's right to make their own decisions),
  • Beneficence (acting in the best interest of the patient),
  • Non-maleficence (avoiding harm to the patient), and
  • Justice (ensuring fair treatment for all patients).[9]
  • Proportionality. (having benefits that are proportionate to the risks and losses.)

These principles guide healthcare professionals in making ethical decisions in patient care.

Secondary principles

There are also a number of secondary principles of medical ethics that include:

  • Provision of futile, ineffective, or unnecessary treatment.
  • Misuse of medical resources.
  • Surrogate consent. (See below.)
  • Informed consent. Informed consent is required by law. See Informed consent.
  • Patient exploitation. (See below.)
  • Duties to child-patients. The Committee on Bioethics of the American Academy of Pediatrics stated that pediatric health care providers 'have legal and ethical duties to their child patients to render competent medical care based on what the patient needs, not what someone else expresses. Although impasses regarding the interests of minors and the expressed wishes of their parents or guardians are rare, the pediatrician's responsibilities to his or her patient exist independent of parental desires or proxy consent."[10]
  • Preservation of the child’s right to an open future.[11]

Circumcision (MGM) of male minors violates every one of these principles of medical ethics.[12]

There is no disease present in the newborn penis and no medical indication exists for circumcision of the newborn.[13] [14] [15] [16] [17]

Surrogate consent

Patient autonomy is the first principle of medical ethics.[18] Consent for a non-therapeutic operation offends the principle of autonomy, when granted by a surrogate.[19]

Since children, and especially infants, are legally incompetent to grant informed consent for medical or surgical treatment, that consent must be granted by a surrogate — someone designated to act on behalf of the child-patient, if treatment is to occur.[20]

A surrogate's powers to grant consent are more circumscribed than the powers granted to a competent individual acting on his own behalf.[20][21] A surrogate may only act in the best interests of the patient.[20] A surrogate may not put a child at risk for religious reasons.[20] A surrogate may grant consent for a medical procedure that has no medical indication only if it is the child's best interests.[20]

The attending physician must provide the surrogate with all material information concerning the proposed benefits, risks, advantages, and drawbacks of the proposed treatment or procedure.[20][21]

The Committee on Bioethics of the AAP (1995) states that parents may only grant surrogate informed permission for diagnosis and treatment with the assent of the child whenever appropriate.[21]

There was an unresolved question whether surrogates may grant effective consent for non-therapeutic child circumcision.[22]

[20] Richards (1996) argues that parents may only consent to medical care, so are not empowered to grant consent for non-therapeutic circumcision of a child because it is not medical care.[23] The Canadian Paediatric Society (2015) recommends that circumcisions done in the absence of a medical indication or for personal reasons "should be deferred until the individual concerned is able to make their own choices."[24]

Regardless of these issues, the unethical general practice of the medical community in the United States is to receive surrogate informed consent or permission from parents or legal guardians for non-therapeutic circumcision of children.[22][20]

The emerging consensus on surrogate consent for non-therapeutic newborn, infant, and child circumcision

The power of parents and other surrogates to grant consent is dependent upon the existence of a physical or medical condition in a minor child that requires diagnostic and/or treatment.[23] [25] The right to grant surrogate consent cannot exist in the absence of such a condition. The AAP Committee on Bioethics (2016) now states: "A parent’s authority is not absolute but constrained by respect for the child."[26] This may mean that the AAP now recognizes the child as a person with legal rights of his/her own.

Boys are born with a healthy foreskin that is free of disease. The medical trade associations and other promoters have put forward various alleged benefits from neonatal circumcision for decades to develop business for their physican-members, but they are not valid. There are no medical indications for a neonatal circumcision.

The validity of surrogate consent for non-therapeutic circumcision of boys has been questioned for decades.[22] [23] [27]

Bioethicists Myers & Earp (2020) 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, 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. The present practice in the United States and elsewhere of parental consent for non-therapeutic circumcision is entirely unethical.[28]

Moreover, non-therapeutic circumcision of boys may also be unlawful,[29] if a court should accept Adler's arguments.

Other views

Povenmire (1988) argued that parents should not have the power to consent to neonatal non-therapeutic circumcision.[22]

Richards (1996) argued that parents only have power to consent to therapeutic procedures.[23]

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.[30]

Somerville argues that because of a lack of credible information about male circumcision in some societies, the ability for the caregiver to grant informed consent on behalf of their child is compromised. This may be especially true of caregivers from a religious or cultural tradition that is particularly biased towards or against circumcising infants.[30]

Canning (2002) commented that "[i]f circumcision becomes less commonly performed in North America ... the legal system may no longer be able to ignore the conflict between the practice of circumcision and the legal and ethical duties of medical specialists."[31]

The Committee on Medical Ethics of the British Medical Association (2003) published a paper to guide doctors on the law and ethics of circumcision. It advises medical doctors to proceed on a case by case basis to determine the best interests of the child before deciding to perform a circumcision. The doctor must consider the child's legal and human rights in making his or her determination. It states that a physician has a right to refuse to perform a non-therapeutic circumcision.[3] The College of Physicians and Surgeons of British Columbia took a similar position.[32]

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".[33]

The Belgian Consultative Committee for Bioethics (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.[34][35] 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 University of Leuven, 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." The committee found that the child's right to physical integrity is greater than a parent's religious right to circumcise.[35]

The Belgian minister of health replied that the Federal Institute for 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.

Patient exploitation

The non-therapeutic circumcision industry in the United States costs more than $3.6 billion annually.[36]

Third-party payment is a major support to the performance of this injurious 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 $3.6 billion annual business would collapse. The American medical trade associations, more than those of other nations, have been unwilling to recognize the child's human rights to physical integrity, to security of the person, and the right to personal autonomy.

The performance of harmful, medically not indicated circumcision upon a child simply to collect a surgical fee must be regarded as patient exploitation.[37]

Is circumcision without valid consent battery?

Boyle et al. (2004) argued that non-therapeutic circumcision of boys is "assault",[38] but is it actually battery? Simple battery is defined as:

At common law, an intentional unpermitted act causing harmful or offensive contact with the "person" of another.[39]

Aggravated battery is defined as:

Aggravated battery is one of the most serious forms of battery . It usually involves a physical act or contact with another person without that person's consent and with an intention to cause harm. Usually, this involves some form of serious injury. Aggravated battery can result in temporary disfigurement, permanent disfigurement, irreparable harm, greater bodily harm, serious risk of death, loss of a limb or body part requiring surgery.

When an individual uses a “ deadly weapon ” during an attack, this will usually be interpreted by most states as aggravated battery. Deadly weapons include guns, knives, rocks, bricks, and even boots. They refer to any weapons that are able to cause harm. A person who has committed an aggravated battery will be charged with a high level misdemeanor or felony.[40]

A scapel actually is a specialized knife, designed to cut human flesh, so a court may regard a scapel as a weapon.

See also

External links

References

  1. ↑ REFbook President's Council on Bioethics (2008-03): Human Dignity and Bioethics. Washington, DC: President's Council on Bioethics. Retrieved 28 June 2025.
  2. ↑ REFbook Sawyer S: Pediatric Physical Examination & Health Assessment. Jones & Bartlett Publishers. Pp. 555-556. ISBN 978-1-4496-7600-1.
  3. ↑ a b Committee on Medical Ethics. The law and ethics of male circumcision: Guidance for doctors. London: British Medical Association 2006.
  4. ↑ REFjournal The issue of male circumcision. Journal of Medical Ethics. 2013; 39(7)
  5. ↑ REFjournal Foddy B. The concise argument: Medical, religious and social reasons for and against an ancient rite. Journal of Medical Ethics. 2013; 39(7): 415. PMID. DOI.
  6. ↑ REFjournal Earp BD. The ethics of infant male circumcision. Journal of Medical Ethics. 2013; 39(7): 418-420. PMID. DOI.
  7. ↑ a b c d REFjournal Nontherapeutic Circumcision of Minors as an Ethically Problematic Form of Iatrogenic Injury. AMA Journal of Ethics. 1 August 2017; 19(8): 815-24. PMID. DOI.
  8. ↑ a b c REFjournal Reis-Dennis, S., Reis, E.. Are Physicians Blameworthy for Iatrogenic Harm Resulting from Unnecessary Genital Surgeries?. AMA Journal of Ethics. 1 August 2017; 19(8): 825-833. PMID. DOI.
  9. ↑ REFbook Beauchamp TL (1999): Chapter One, in: Contemporary Issues in Bioethics. Beauchamp TL, Walters L (ed.). New York: Wadsworth Publishing Company. Pp. 18-22. ISBN 0-534-50176-0. Retrieved 27 June 2025.
  10. ↑ REFjournal American Academy of Pediatrics Committee on Bioethics. Informed Consent, Parental Permission, and Assent in Pediatric Practice. Pediatrics. November 1995; 96(5 Pt 1): 981-2. PMID. Retrieved 30 June 2025.
  11. ↑ REFweb Anonymous (August 2020). Medical Ethics and the Non-therapeutic Circumcision of Male Children, Doctors Opposing Circumcision. Retrieved 30 June 2025.
  12. ↑ REFweb Anonymous (August 2020). Medical Ethics and the Non-therapeutic Circumcision of Male Children, Doctors Opposing Circumcision. Retrieved 29 June 2025.
  13. ↑ REFjournal Gairdner DMT. The fate of the foreskin: a study of circumcision. British Medical Journal. 1949; 2(4642): 1433-7. PMID. PMC. DOI. Retrieved 28 October 2019.
  14. ↑ REFjournal Wright JE. Non-therapeutic circumcision. MJA. 27 May 1967; 1(21): 1083-6. PMID. DOI. Retrieved 27 June 2025.
  15. ↑ REFjournal Preston EN. Whither The Foreskin?. JAMA. 14 September 1970; 213(11): 1853-8. PMID. DOI. Retrieved 27 June 2025.
  16. ↑ REFbook Committee on Fetus and the Newborn (1971): Standards and Recommendation for Hospital Care of Newborn infants. Evanston, IL: American Academy of Pediatrics. Retrieved 27 June 2025.
  17. ↑ REFjournal Mansfield CJ, Hueston WJ, Rudy M. Neonatal Circumcision: Associated Factors and Length of Hospital Stay. J Fam Pract. October 1995; 41(4): 370-6. PMID. Retrieved 29 June 2025.
  18. ↑ REFbook Beauchamp TL, Childress JF: Principles of Biomedical Ethics. New York: Oxford University Press.
  19. ↑ REFjournal Myers A, Earp BD. What is the best age to circumcise? A medical and ethical analysis PDF. Bioethics. 2020; 34(7): 645-63. PMID. DOI. Retrieved 28 June 2025.
    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.
  20. ↑ a b c d e f g h REFjournal Svoboda JS, Van Howe RS, Dwyer JG. Informed Consent for Neonatal Circumcision: An Ethical and Legal Conundrum. J Contemp Health Law & Policy. 2000; 17: 60-133.
  21. ↑ a b c REFjournal Committee on Bioethics. Informed consent, parental permission, and assent in pediatric practice. Pediatrics. 1995; 95(2): 314-317. PMID. Reaffirmed May 2011.
  22. ↑ a b c d REFjournal Povenmire R. Do Parents Have the Legal Authority to Consent to the Surgical Amputation of Normal, Healthy Tissue From Their Infant Children?: The Practice of Circumcision in the United States. Journal of Gender, Social Policy and the Law. 7(1): 87-123. PMID. Retrieved 25 November 2013.
  23. ↑ a b c d REFjournal Richards D. Male Circumcision: Medical or Ritual?. Journal of Law and Medicine. May 1996; 3(4): 371-376. Retrieved 11 April 2008.
  24. ↑ REFjournal Mayan, Madhur, Hamilton, Robert J., Juurlink, David N., Austin, Peter C., Jarvi, Keith A.. Circumcision and Risk of HIV Among Males From Ontario, Canada. J Urol. 8 June 2023; PMID. DOI. Retrieved 29 June 2025.
    Quote: We found that circumcision was not independently associated with the risk of acquiring HIV among men from Ontario, Canada.
  25. ↑ REFjournal Committee on Bioethics. Informed consent, parental permission, and assent in pediatric practice. Pediatrics. February 1995; 95(2): 314-7. PMID. Retrieved 26 May 2023.
  26. ↑ REFjournal Committee on Bioethics. Informed Consent in Decision-Making in Pediatric Practice. Pediatrics. August 2016; 138(2): e20161484.. PMID. DOI. Retrieved 27 May 2023.
  27. ↑ REFjournal Hill G. Can anyone authorize the nontherapeutic permanent alteration of a child's body? PDF. The American Journal of Bioethics. 2003; 3(2): 16-8. PMID. DOI. Retrieved 11 July 2023.
  28. ↑ REFjournal Myers A, Earp BD. What is the best age to circumcise? A medical and ethical analysis PDF. Bioethics. 2020; 34(7): 645-63. PMID. DOI. Retrieved 27 May 2020.
    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.
  29. ↑ REFjournal Adler PW. Is Circumcision Legal?. Richmond J. L. & Pub. Int.. 2013; 16(3): 439.
  30. ↑ a b REFbook Somerville M: Altering Baby Boys’ Bodies: The Ethics of Infant Male Circumcision, in: The ethical canary: science, society, and the human spirit. New York, NY: Viking Press. Pp. 202-219. ISBN 0-670-89302-1. Retrieved 12 February 2007.
  31. ↑ REFjournal Canning DA. Informed consent for neonatal circumcision: an ethical and legal conundrum. J Urol. 2002; 168(4 Pt 1): 1650-1651. PMID. DOI.
  32. ↑ REFweb College of Physicians & Surgeons of British Columbia (2007). Circumcision (Infant Male). Retrieved 6 December 2013.
  33. ↑ REFjournal Fox M, Thomson M. A covenant with the status quo? Male circumcision and the new BMA guidance to doctors. Journal of Medical Ethics. 2005; 31(8): 463-469. PMID. PMC. DOI.
  34. ↑ REFweb Comité Consultif de Bioéthique de Belgique (8 May 2017). Opinion no. 70 of 8 May 2017on the ethical aspects of nonmedical circumcision, SPF Santé Publique. Retrieved 3 November 2019.
  35. ↑ a b REFnews (2017)."Ethics committee rules against infant circumcision".
    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.
  36. ↑ REFweb Bollinger, Dan (2012). High Cost of Circumcision: $3.6 Billion Annually Icons-mini-file pdf.svg, https://www.academia.edu, Academia. Retrieved 12 November 2021.
    Quote: As the 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 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. }}
  37. ↑ Principle 13, CMA Code of Ethics. Ottawa: Canadian Medical Association; updated 2004.
  38. ↑ REFjournal Boyle GJ, Svoboda JS, Price CP, Turner JN. Circumcision of Healthy Boys: Criminal Assault?. J Law Med. February 2000; 7: 301-310. Retrieved 29 May 2024.
  39. ↑ REFweb Anonymous. Battery, The Free Legal Dictionary. Retrieved 20 June 2025.
  40. ↑ REFweb (February 2025). aggravated battery, Legal Information Institute. Retrieved 29 June 2025.
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