20,861
edits
Changes
Jump to navigation
Jump to search
m
{{Construction Site}}
==Consent One should note that these guidances from the Bioethics Committee of the American Academy of Pediatrics apply to the granting of "informed permission" by surrogates for circumcision "diagnosis and treatment of minors==If a boy is to be [[circumcised]]children", then someone must grant effective consent. The boy may not and do it for himself because of his minority status. [[Circumcision]] of boys is a <i>NOT</i> apply to non-therapeutic procedures such as medicallynon-unnecessaryindicated, non-therapeutic[[circumcision]], harmful excision of functional tissue that causes loss of various functionswhich is neither diagnosis nor treatment.
Ross Povenmire (1998-9) argued strongly that parents lack the authority to grant surrogate consent for circumcision where there ==Video=====Circumcision — Your Legal Rights===<youtube>v=8GT03orcHWM</youtube>==Conclusion==Patient autonomy is no an important principle of medical indicatonethics.<ref>{{REFjournalREFbook |last=PovenmireBeauchamp |initfirst=RTom L. |author-linkinit=TL |urllast2=https://www.cirp.org/library/legal/povenmire/Childress |titlefirst2= 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 StatesJames F. |journalinit2=Journal of Gender, Social Policy & the LawJF |datetitle=1998-9Principles of Biomedical Ethics |volumepublisher=7 New York: {{UNI|issue= Oxford University|pages=87-123Oxon}} Press |accessdatedate=2025-05-032001}}</ref>Consent for a non-therapeutic operation offends the principle of autonomy, when granted by a surrogate.
Svoboda, Van Howe & Dwyer (2000) discussed A surrogate's powers to grant consent are more circumscribed than the ethical and legal issues of consent for non-therapeutic circumcisionpowers granted to a competent individual acting on his own behalf.<refname="svoboda2000" />{{REFjournal |last=Svoboda |first= |init=JS |author-link= |last2=Van Howe |first2= |init2=RS |author2-link=Robert S. Van Howe |last3=Dwyer |first3= |init3=JG |author3-link= |etal=no |title=Informed A surrogate's power to grant consent for neonatal circumcision: an ethical treatment is dependent upon the existence of a medical condition in need of diagnosis and legal conundrum |trans-title= |journal=J Contemp Health Law Policy |date=2000 |season=Winter |volume=17 |issue=1 |article= |page= |pages=61-133 |url=https://scholarshipor treatment.law.wm.edu/cgi/viewcontentIn the absence of such a condition, the surrogate lacks the power to consent.cgi?article=1166&context=facpubs |archived= |quote= |pubmedID=11216345 |pubmedCID= |DOI= |doi= |format=PDF |accessdate=2025-05-03}}</ref>
Hill (2002) raised A surrogate must:* Act in the question best interests of who can grant effective consent for such an injurious operation.<ref name="hill2002">{{REFjournal |last=Hill |first= |init=G |author-link=George Hill |etal=no |title=Informed Consent for Circumcision |trans-title= |journal=South Med J |date=2002-08 |season= |volume=95 |issue=8 |article= |page=946 |url=https://wwwthe patient.cirp.org/library/ethics/hill2/ |archived= |quote=In * Protect the case rights of nontherapeutic circumcision of a boy, electing not to have circumcision performed is a reasonablethe patient under Constitutional law, practicable, and viable alternativestatute law, so patients or their proxy representatives must be given all material information about circumcision and its riskscommon law, potential benefits and possible outcomes; they must also be informed about the risks, potential benefits, and possible outcomes of remaining uncircumcisedinternational human rights law. |pubmedID=12190244 |pubmedCID= |DOI=10* Receive [[informed consent]] prior to granting consent.1097/00007611-200208000-00037 |accessdate=2025-05-03}}</ref>
{{REFjournal |last=Hill |first= |init=G |authorAs explained above and we reiterate, bioethicists Myers & Earp (2020) exhaustively reviewed the evidence for and against the alleged health benefits to a healthy person claimed for non-link=George Hill |etal=no |title=Can anyone authorize the nontherapeutic permanent alteration therapeutic circumcision of a neonate, infant or child's . They balanced this against the [[pain]], [[trauma]], and loss of body? |transtissue 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-titletherapeutic 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.<ref name="myers2020" /> |languageThe present practice in the [[United States]] and elsewhere of parental surrogate consent for non-therapeutic circumcision is entirely unethical<ref name= |journal=Am J Bioeth |location= |date=2003 |season=Spring |volume=3 |issue=2 |article= |page= |pages= |url= |archived= |quote"myers2020" /> and may also be unlawful.<ref name= |pubmedID=14635628 |pubmedCID= |DOI=10.1162"povenmire1998" /152651603766436342 |doi= |accessdate> <ref name=2025-04-30}}<"adler2013" /ref>
https://www.researchgate.net/profile/George-Hill-3/publication/371599857_Can_Anyone_Authorize_the_Nontherapeutic_Permanent_Alteration_of_a_Child's_Body/links/648b8819c41fb852dd0949be/Can-Anyone-AuthorizeThe only person who can ethically and legally grant consent for a non-therapeutic [[circumcision]] is the-Nontherapeutic-Permanent-Alteration-owner of-a-Childs-Bodythe [[penis]] when he has reached the legal age for consent.pdf
* [[Category:Circumcision]][[Category:Human_rights]][[Category:Law]]* [[Category:Medical ethics]]* [[Category:Medical term]][[Category:Australia]] [[Category:USA]]
→Consent for circumcision of minors
A <b>surrogate</b> is one who takes the place of another.<ref>{{REFweb
|url=https://www.merriam-webster.com/dictionary/surrogate
'''{{FULLPAGENAME}}''' is consent for medical and/or surgical treatment that is granted by a substitute for the patient. Surrogate consent is used when the patient is mentally or legally incapable of granting consent.
'''{{FULLPAGENAME}}''' is regulated by law. In the [[United States]], surrogate Surrogate consent is regulated by state law, which varies from state to state.<ref>{{REFweb
|url=https://www.americanbar.org/groups/law_aging/publications/bifocal/vol_36/issue_1_october2014/default_surrogate_consent_statutes/
|title=Decisions by Surrogates: An Overview of Surrogate Consent Laws in the United States
</blockquote>
The [https://scholar.google.com/scholar_case?case=3012582275354260465&hl=en&as_sdt=8000003&scfhb=1 Prince v Massachusetts], 21 U.S. 158, 159-60 (1944) decision said:
<blockquote>
<i>Parents may be free to become martyrs themselves. But it does not follow they are free, in identical circumstances, to make martyrs of their children before they have reached the age of full and legal discretion when they can make that choice for themselves.</i>
</blockquote>
==Consent for circumcision of minors==
If a boy is to be [[circumcised]], then someone must grant effective consent. The boy may not do it for himself because of his minority status. [[Circumcision]] of boys is a medically-unnecessary, non-therapeutic, harmful excision of functional tissue that causes loss of various functions.
Ross Povenmire (1998-9) argued strongly that parents lack the authority to grant surrogate consent for circumcision where there is no medical indication.
<blockquote>
The Supreme Court has sharply curtailed parental discretion, even in the exercise of First Amendment rights, when the exercise of such rights may adversely affect the health of a minor. <i>Prince v. Massachusetts</i> involved the prosecution of the guardian of a minor child under child labor laws. The Court held that "[p]arents may be free to become martyrs themselves. But it does not follow that they are free to, in identical circumstances, to make martyrs of their children before they have reached the age of full and legal discretion when they can make that choice for themselves." Subsequent cases tested and sustained the Prince reasoning.<ref name="povenmire1998">{{REFjournal
|last=Povenmire
|init=R
|author-link=
|url=https://www.cirp.org/library/legal/povenmire/
|title= 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=Journal of Gender, Social Policy & the Law
|date=1998-9
|volume=7
|issue=
|pages=87-123
|accessdate=2025-05-03
}}</ref>
</blockquote>
Svoboda, Van Howe & Dwyer (2000) discussed the ethical and legal issues of consent for non-therapeutic circumcision.
<blockquote>
Given the foregoing, one might wonder how parental permission for
routine circumcision could ever be effective, even if physicians comply
with the requirements of informed permission. Like all surgical
procedures, circumcision should not be subject to authorization by a
surrogate for an incompetent patient unless it is medically necessary.
While there is some dispute in the American medical community today as
to whether routine circumcision provides any medical benefit, absolutely
no one in the medical community seriously maintains that it is medically
necessary or that it corrects an existing injury, disease or malfunction.<ref name="svoboda2000">{{REFjournal
|last=Svoboda
|first=
|init=JS
|author-link=J. Steven Svoboda
|last2=Van Howe
|first2=
|init2=RS
|author2-link=Robert S. Van Howe
|last3=Dwyer
|first3=
|init3=JG
|author3-link=James G. Dwyer
|etal=no
|title=Informed consent for neonatal circumcision: an ethical and legal conundrum
|trans-title=
|journal=J Contemp Health Law Policy
|date=2000
|season=Winter
|volume=17
|issue=1
|pages=61-133
|url=https://scholarship.law.wm.edu/cgi/viewcontent.cgi?article=1166&context=facpubs
|archived=
|quote=
|pubmedID=11216345
|pubmedCID=
|format=PDF
|accessdate=2025-05-04
}}</ref>
</blockquote>
Boyle et al. (2000) argued strongly that non-therapeutic [[circumcision]] of boys is unlawful and constitutes "criminal assault".
<blockquote>
Unless a medical procedure is necessary to preserve life or health, it should be postponed until the child is sufficiently mature to make a decision for himself or herself. If the child is incapable, because of intellectual disability, of making an informed decision, then under Marion's Case (involuntary hysterectomy of an intellectually handicapped 14-year-old girl), the consent of the Family Court or court exercising parens patriae jurisdiction, and in some cases a State or Territory statutory guardianship body, is necessary.61 Wherever proposed treatment is not unequivocally beneficial to the child, parental assent is insufficient.<ref>{{REFjournal
|last=Boyle
|first=
|init=GJ
|author-link=Gregory J. Boyle
|last2=Svoboda
|first2=
|init2=JS
|author2-link=J. Steven Svoboda
|last3=Price
|first3=
|init3=CP
|author3-link=Christopher P. Price
|last4=Turner
|first4=
|init4=JN
|author4-link=
|etal=no
|title=Circumcision of Healthy Boys: Criminal Assault?
|trans-title=
|journal=Journal of Law and Medicine (Melbourne)
|date=2000-02
|volume=7
|pages=301-10
|url=https://www.cirp.org/library/legal/boyle1/
|archived=
|quote=
|pubmedID=
|pubmedCID=
|DOI=
|doi=
|accessdate=2025-05-04
}}</ref>
</blockquote>
Hill (2002) raised the question of who can grant effective consent for such an injurious operation.
<blockquote>
The question is not whether circumcision is "mutilation." 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.<ref name="hill2002">{{REFjournal
|last=Hill
|first=
|init=G
|author-link=George Hill
|etal=no
|title=Informed Consent for Circumcision
|trans-title=
|journal=South Med J
|date=2002-08
|volume=95
|issue=8
|page=946
|url=https://www.researchgate.net/profile/George-Hill-3/publication/371599857_Can_Anyone_Authorize_the_Nontherapeutic_Permanent_Alteration_of_a_Child's_Body/links/648b8819c41fb852dd0949be/Can-Anyone-Authorize-the-Nontherapeutic-Permanent-Alteration-of-a-Childs-Body.pd
|archived=
|quote=
|pubmedID=12190244
|pubmedCID=
|DOI=
|format=PDF
|accessdate=2025-05-04
}}</ref>
</blockquote>
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.
<blockquote>
On the other hand, human rights scholars have increasingly objected to the medically unnecessary genital cutting of any person—whether female, male, or intersex—who either does not or cannot consent to the cutting. Such objections were recently summarized in an international consensus statement published in the <i>American Journal of Bioethics</i>, in which the authors argued
that under most conditions, “cutting any person’s genitals without their informed consent is a
serious violation of their right to bodily integrity. As such, it is impermissible unless the person
is non-autonomous (incapable of consent) and the cutting is medically necessary” and
thus “cannot reasonably be deferred.”<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=2025-05-04
}}</ref>
</blockquote>
Professor Peter W. Adler, J.D., (2013) argues strongly that child [[circumcision]] is unlawful:
<blockquote>
Legal scholars, foreign medical associations, intactivist organizations, and increasing numbers of menis claim the opposite, namely that circumcision is painful, risky, harmful, irreversible surgery that benefits few men, if any. These opponents of circumcision argue that, in any event, boys have a right to be left genitally intact, like girls under federal law, and to make the circumcision decision for themselves as adults.
These opponents of circumcision can point to a June 2012 decision by a court in Cologne, Germany, which held that non-therapeutic circumcision for religious reasons is criminal assault. The German court reasoned that circumcision causes grievous bodily harm, and that boys have a fundamental right to genital integrity that supersedes their parents' religious rights.<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
|format=PDF
|accessdate=2025-05-04}}
</ref>
==Guidance from the Bioethics Committee of the American Academy of Pediatrics==
}}</ref>
The Committee on Bioethics seeks to modify surrogate consent in pediatric medicine to granting of "informed permission" with assent by the child when appropriate. These statements address consent for treatment of disease in pediatric patients, however they have relatively little to say about non-therapeutic procedures such as [[circumcision of the newborn]]. The 1995 statement did say:
<blockquote>
Such 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.<ref name="bioethics1995" />
</blockquote>
This statement would cover doctors who refuse to perform harmful non-therapeutic circumcision on boys, however it is not clear if that it ever has been applied to refusal to perform injurious [[circumcision]].
The 2016 statement identifies the harm principle and states:
The harm principle may be seen as a more realistic standard to apply in pediatric surrogate medical decision-making. The intent of the harm principle is not to identify a single course of action that is in the minor’s best interest or is the physician’s preferred approach, but to identify a harm threshold below which parental decisions will not be tolerated and outside intervention is indicated to protect the child.<ref name="bioethics2016" />
</blockquote>
The harmful, injurious effect wounding of child [[circumcision ]] brings harm, not only to the child, but also to a societyfilled with wounded males, however circumcision brings in huge amounts of money, so the Bioethics Committee is effectively muzzled with regard to [[circumcision]].<ref name="bollinger2012">{{REFweb
|url=https://www.academia.edu/6442587/High_Cost_of_Circumcision_3.6_Billion_Annually
|title=High Cost of Circumcision: $3.6 Billion Annually
}}</ref>
The perceived need desire to protect physician income derived from non-therapeutic [[circumcision ]] induces an element of [[bias]] into the statements of the Bioethics Committee.
A circumcision for religious reasons is not medical treatment, so a surrogate may not consent to a religious circumcision. Furthermore, consent for a religious circumcision would violate the boy's religious right to chose his religion when he is of age.
A non-therapeutic [[circumcision]] exposes the patient to the surgical risks of [[infection]], [[bleeding]], and [[Documented severe complications of circumcision| surgical mishap]] without any health treatment or benefit, so it is not in the best interests of the patient. Furthermore, a surrogate may only consent to therapeutic procedures.
{{SEEALSO}}
* [[Ethics of non-therapeutic child circumcision]]
* [[Human rights]]
* [[Informed consent]]
{{LINKS}}
* {{REFweb
|url=https://intactamerica.org/circumcision-cosmetic-surgery-on-newborns/
|title=The World’s Oldest Cosmetic Surgery Is Still Performed on Newborns—Without Consent
|last=Alissa
|first=
|init=K
|author-link=Kristel Alissa
|publisher=Intact America
|date=2025-04-24
|accessdate=2025-05-16
}}
{{REF}}