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

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Male [[circumcision]] is the surgical removal of the [[foreskin]] (prepuce) from the human penis.<ref name=sawyer_2011>{{REFbook
+
<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
 +
|first=
 +
|init=
 +
|year=2008-03
 +
|title=Human Dignity and Bioethics
 +
|url=https://bioethicsarchive.georgetown.edu/pcbe/reports/human_dignity/
 +
|scope=
 +
|location=Washington, DC
 +
|publisher=President's Council on Bioethics
 +
|ISBN=
 +
|accessdate=2025-06-28
 +
}}</ref> Medical doctors have a general duty to respect the [[human rights]] of their patients.
 +
 
 +
<b>Ethics</b> is defined as "the principles of conduct governing an individual or a group".  <b>Medical ethics</b> or <b>bioethics</b> 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 <b>medical ethics</b> or <b>bioethics</b> are applicable to the practice of [[circumcision]].
 +
Male [[circumcision]] is the surgical removal of the [[foreskin]] (prepuce) from the human [[penis]].<ref name=sawyer_2011>{{REFbook
 
  |last=Sawyer
 
  |last=Sawyer
−
  |first=?S
+
  |init=S
 
  |title=Pediatric Physical Examination & Health Assessment
 
  |title=Pediatric Physical Examination & Health Assessment
 
  |pages=555-556
 
  |pages=555-556
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  |isbn=978-1-4496-7600-1
 
  |isbn=978-1-4496-7600-1
 
  |url=https://books.google.com/books?id=W6eRUtlujbkC&pg=PA555
 
  |url=https://books.google.com/books?id=W6eRUtlujbkC&pg=PA555
−
}}</ref> The foreskin has protective, immunological, sensory, and sexual functions. The '''ethics of non-therapeutic child circumcision''' being imposed on unconsenting minors (babies and children) has been a source of ongoing controversy.<ref>{{REFjournal
+
}}</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>
−
  |last=Boyle
+
 
−
  |first=G.J.
+
The concern about the ongoing practice of [[child circumcision]] has spurred the publication of numerous articles in journals of medical ethics.
−
  |author-link=Gregory Boyle
+
 
−
  |last2=Svoboda
+
==Ethics journals  ==
−
  |first2=J.S.
+
<!--
−
  |author2-link=J. Steven Svoboda
+
===JME symposium on circumcision, June 2004===
−
  |last3=Price
+
The ''Journal of Medical Ethics'' published a "symposium on circumcision" in its June 2004 issue.<ref name="symposium2004">{{REFjournal
−
  |first3=C.P.
+
|title=Symposium on Circumcision
−
  |author3-link=Christopher P. Price
+
|journal=Journal of Medical Ethics
−
  |last4=Turner
+
|date=2004
−
  |first4=J.N.
+
|volume=30
−
  |author4-link=J. Neville Turner
+
|issue=3
−
  |year=2000
+
|pages=237-63
−
  |title=Circumcision of healthy boys: Criminal assault?
+
|url=http://jme.bmj.com/content/30/3.toc#Symposiumoncircumcision Symposium on circumcision
−
  |url=http://www.cirp.org/library/legal/boyle1/
+
}}</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:
 +
-->
 +
===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.<ref>{{REFjournal
 +
|title=The issue of male circumcision
 +
|journal=Journal of Medical Ethics
 +
|date=2013
 +
|volume=39
 +
|issue=7
 +
|url=http://jme.bmj.com/content/39/7.toc
 +
}}</ref> The numerous articles represent a diverse variety of views.<ref>{{REFjournal
 +
|last=Foddy
 +
|init=B
 +
|title=The concise argument: Medical, religious and social reasons for and against an ancient rite
 +
|journal=Journal of Medical Ethics
 +
|date=2013
 +
|volume=39
 +
|issue=7
 +
|page=415
 +
|url=http://jme.bmj.com/content/39/7/415.full
 +
|DOI=10.1136/medethics-2013-101605
 +
|pubmedID=23781076
 +
}}</ref><ref>{{REFjournal
 +
|last=Earp
 +
|init=BD
 +
|author-link=Brian D. Earp
 +
|title=The ethics of infant male circumcision
 +
|journal=Journal of Medical Ethics
 +
|date=2013
 +
|volume=39
 +
|issue=7
 +
|pages=418-420
 +
|url=https://www.academia.edu/3430963/The_ethics_of_infant_male_circumcision
 +
|DOI=10.1136/medethics-2013-101517
 +
|pubmedID=23781078
 +
}}</ref>
 +
===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.
 +
 
 +
[[J. Steven Svoboda| Svoboda]] (2017) 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
 +
|journal=AMA Journal of Ethics
 +
|language=en
 +
|volume=19
 +
|issue=8
 +
|pages=815-24
 +
|DOI=10.1001/journalofethics.2017.19.8.msoc2-1708
 +
|pubmedID=28846521
 +
|issn=2376-6980
 +
|last1=Svoboda
 +
|first1=J.S.
 +
}}</ref> 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.<ref name="svoboda2017"/> He states that benefits do not outweigh the risks, and also claims that foreskin removal should be considered a sexual harm.<ref name="svoboda2017"/> 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.<ref name="svoboda2017"/>
 +
 
 +
Reis and Reis's article (2017) explore the role physicians play in neonatal circumcision.<ref name="reis-reis2017">{{REFjournal
 +
|date=2017-08-01
 +
|title=Are Physicians Blameworthy for Iatrogenic Harm Resulting from Unnecessary Genital Surgeries?
 +
|journal=AMA Journal of Ethics
 +
|language=en
 +
|volume=19
 +
|issue=8
 +
|pages=825-833
 +
|DOI=10.1001/journalofethics.2017.19.8.msoc3-1708
 +
|pubmedID=28846522
 +
|issn=2376-6980
 +
|last=Reis-Dennis
 +
|first=S.
 +
|last2=Reis
 +
|first2=E.
 +
}}</ref> 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.<ref name="reis-reis2017"/> However, they still advise against physicians recommending unnecessary, irreversible surgeries, which is a category circumcision falls in frequently.<ref name="reis-reis2017"/>
 +
 
 +
==Principles of medical ethics==
 +
===Cardinal principles===
 +
The five cardinal principles of medical ethics are:
 +
* <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>Non-maleficence</b> (avoiding harm to the patient), and
 +
* <b>Justice</b> (ensuring fair treatment for all patients).<ref name="beautchamp1999">{{REFbook
 +
|last=Beauchamp
 +
|first=
 +
|init=TL
 +
|author-link=
 +
|last2=
 +
|first2=
 +
|init2=
 +
|author2-link=
 +
|year=1999
 +
|title=Contemporary Issues in Bioethics
 +
|url=
 +
|work=
 +
|editor=Beauchamp TL, Walters L
 +
|edition=
 +
|volume=
 +
|chapter=Chapter One
 +
|scope=
 +
|page=
 +
|pages=18-22
 +
|location=New York
 +
|publisher=Wadsworth Publishing Company
 +
|ISBN=0-534-50176-0
 +
|quote=
 +
|accessdate=2025-06-27
 +
|note=
 +
}}</ref>
 +
* <b>Proportionality.</b> (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:
 +
* <b>Provision of futile, ineffective, or unnecessary treatment.</b>
 +
* <b>Misuse of medical resources.</b>
 +
* <b>Surrogate consent.</b> (See below.)
 +
* <b>Informed consent.</b> Informed consent is required by law. See [[Informed consent]].
 +
* <b>Patient exploitation.</b> (See below.)
 +
* <b>Duties to child-patients.</b> 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."<ref name="aapcp1995">{{REFjournal
 +
|last=American Academy of Pediatrics Committee on Bioethics
 +
|first=
 +
|init=
 +
|author-link=
 +
|etal=no
 +
|title=Informed Consent, Parental Permission, and Assent in Pediatric Practice
 +
|journal=Pediatrics
 +
||date=1995-11
 +
|volume=96
 +
|issue=5 Pt 1
 +
|pages=981-2
 +
|url=https://www.cirp.org/library/ethics/AAP/
 +
|archived=
 +
|quote=
 +
|pubmedID=7478854
 +
|pubmedCID=
 +
|DOI=
 +
|doi=
 +
|accessdate=2025-06-30
 +
}}</ref>
 +
* <b>Preservation of the child’s right to an open future.</b><ref>{{REFweb
 +
|url=https://www.doctorsopposingcircumcision.org/for-professionals/medical-ethics/
 +
|title=Medical Ethics and the Non-therapeutic Circumcision of Male Children
 +
|last=Anonymous
 +
|first=
 +
|init=
 +
|author-link=
 +
|publisher=Doctors Opposing Circumcision
 +
|date=2020-08
 +
|accessdate=2025-06-30
 +
}}</ref>
 +
Circumcision ([[MGM]]) of male minors violates every one of these principles of medical ethics.<ref>{{REFweb
 +
|url=https://www.doctorsopposingcircumcision.org/for-professionals/medical-ethics/
 +
|title=Medical Ethics and the Non-therapeutic Circumcision of Male Children
 +
|last=Anonymous
 +
|first=
 +
|init=
 +
|author-link=
 +
|publisher=Doctors Opposing Circumcision
 +
|date=2020-08
 +
|accessdate=2025-06-29
 +
}}
 +
</ref>
 +
 
 +
There is no disease present in the newborn [[penis]] and no medical indication exists for [[circumcision of the newborn]].<ref>{{GairdnerDM 1949}}</ref> <ref>{{REFjournal
 +
  |last=Wright
 +
  |first=
 +
|init=JE
 +
|author-link=
 +
|etal=no
 +
|title=Non-therapeutic circumcision
 +
|trans-title=
 +
|language=
 +
|journal=MJA
 +
|date=1967-05-27
 +
|volume=1
 +
|issue=21
 +
|pages=1083-6
 +
|url=https://www.cirp.org/library/general/wright4/
 +
|archived=
 +
|quote=
 +
|pubmedID=6028342
 +
|pubmedCID=
 +
|DOI=10.5694/j.1326-5377.1967.tb20877.x
 +
|accessdate=2025-06-27
 +
}}</ref> <ref>{{REFjournal
 +
|last=Preston
 +
|first=
 +
|init=EN
 +
|author-link=
 +
|etal=no
 +
|title=Whither The Foreskin?
 +
|journal=JAMA
 +
|date=1970-09-14
 +
|volume=213
 +
|issue=11
 +
|pages=1853-8
 +
|url=https://www.cirp.org/library/general/preston/
 +
|archived=
 +
|quote=
 +
|pubmedID=5468911
 +
|pubmedCID=
 +
|DOI=10.1001/jama.213.11.1853
 +
|accessdate=2025-06-27
 +
}}</ref> <ref>{{REFbook
 +
|last=Committee on Fetus and the Newborn
 +
|first=
 +
|init=
 +
|year=1971
 +
|title=Standards and Recommendation for Hospital Care of Newborn infants
 +
|url=
 +
|scope=
 +
|location=Evanston, IL
 +
|publisher=American Academy of Pediatrics
 +
|ISBN=
 +
|accessdate=2025-06-27
 +
}}</ref>
 +
<ref name="mansfield1995">{{REFjournal
 +
|last=Mansfield
 +
|first=
 +
|init=CJ
 +
  |author-link=
 +
  |last2=Hueston
 +
  |first2=
 +
|init2=WJ
 +
|author2-link=
 +
|last3=Rudy
 +
|first3=
 +
|init3=M
 +
|author3-link=
 +
|etal=no
 +
|title=Neonatal Circumcision: Associated Factors and Length of Hospital Stay
 +
|journal=J Fam Pract
 +
|date=1995-10
 +
|volume=41
 +
|issue=4
 +
|pages=370-6
 +
|url=https://www.cirp.org/library/procedure/mansfield/
 +
|archived=
 +
|quote=
 +
|pubmedID=7561711
 +
|pubmedCID=
 +
|DOI=
 +
|doi=
 +
|accessdate=2025-06-29
 +
}}</ref>
 +
 
 +
==Autonomy==
 +
Patient autonomy is the first principle of medical ethics.<ref>{{REFbook
 +
|last=Beauchamp
 +
|first=Tom L.
 +
|init=TL
 +
|last2=Childress
 +
|first2=James F.
 +
|init2=JF
 +
|title=Principles of Biomedical Ethics
 +
|publisher=New York: {{UNI|Oxford University|Oxon}} Press
 +
|date=2001
 +
}}</ref> Consent for a non-therapeutic operation offends the principle of autonomy, when granted by a surrogate.<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
 +
|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=2025-06-28
 +
}}</ref>
 +
 
 +
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.<ref name="conundrum">{{REFjournal
 +
|last=Svoboda
 +
|first=J. Steven
 +
|init=JS
 +
|author-link=J. Steven Svoboda
 +
|last2=Van Howe
 +
|first2=Robert S.
 +
|init2=RS
 +
|author2-link=Robert S. Van Howe
 +
  |last3=Dwyer
 +
  |first3=James G.
 +
|init3=JG
 +
  |author3-link=James G. Dwyer
 +
  |title=Informed Consent for Neonatal Circumcision: An Ethical and Legal Conundrum
 +
  |url=https://scholarship.law.wm.edu/cgi/viewcontent.cgi?article=1166&context=facpubs
 +
  |pages=60-133
 +
|journal=J Contemp Health Law & Policy
 +
|volume=17
 +
|date=2000
 +
}}</ref>
 +
 
 +
A surrogate's powers to grant consent are more circumscribed than the powers granted to a competent individual acting on his own behalf.<ref name="conundrum" /> <ref name="aapcp1995" /> A surrogate may only act in the best interests of the patient.<ref name="conundrum"/>  A surrogate may not put a child at risk for religious reasons.<ref name="conundrum"/> A surrogate may grant consent for a medical procedure that has ''no'' [[medical indication]] ''only'' if it is the child's best interests.<ref name="conundrum"/>
 +
 
 +
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="aapcp1995" />
 +
 
 +
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="aapcp1995" />
 +
 
 +
There was an unresolved question whether surrogates may grant effective consent for non-therapeutic child circumcision.<ref name="povenmire">{{REFjournal
 +
  |last=Povenmire
 +
|init=R
 +
|authorlink=
 +
|date=
 +
|note=1998–1999
 +
  |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 and the Law
 +
|volume=7
 +
|issue=1
 +
|pages=87-123
 +
|pubmedID=16526136
 +
  |url=http://www.cirp.org/library/legal/povenmire/
 +
|accessdate=2013-11-25
 +
}}</ref>
 +
 
 +
<ref name="conundrum"/>  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.<ref name="richards">{{REFjournal
 +
|last=Richards
 +
|init=D
 +
|authorlink=
 +
|date=1996-05
 +
|title=Male Circumcision: Medical or Ritual?
 
  |journal=Journal of Law and Medicine
 
  |journal=Journal of Law and Medicine
−
  |volume=7
+
  |volume=3
 +
|issue=4
 +
|pages=371-376
 +
|url=http://www.cirp.org/library/legal/richards/
 +
|accessdate=2008-04-11
 +
}}</ref> 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."<ref name="mayan2021">{{REFjournal
 +
|last=Mayan
 +
|first=Madhur
 +
|init=
 +
|author-link=
 +
|last2=Hamilton
 +
|first2=Robert J.
 +
|init2=
 +
|author2-link=
 +
|last3=Juurlink
 +
|first3=David N.
 +
|init3=
 +
|author3-link=
 +
|last4=Austin
 +
|first4=Peter C.
 +
|init4=
 +
|author4-link=
 +
|last5=Jarvi
 +
|first5=Keith A.
 +
|init5=
 +
|author5-link=
 +
|etal=no
 +
|title=Circumcision and Risk of HIV Among Males From Ontario, Canada
 +
|journal=J Urol
 +
|location=
 +
|date=2023-06-08
 +
|volume=
 
  |issue=
 
  |issue=
−
  |pages=301–310
+
|article=
−
}}</ref><ref name="RACPSumm">{{REFweb
+
|page=
−
  |url=http://www.racp.edu.au/download.cfm?DownloadFile=A453CFA1-2A57-5487-DF36DF59A1BAF527
+
  |pages=
−
  |title=Policy Statement On Circumcision
+
|url=https://www.auajournals.org/doi/pdf/10.1097/JU.0000000000002234
−
  |accessdate=2007-02-28
+
|quote=We found that circumcision was not independently associated with the risk of acquiring [[HIV]] among men from Ontario, Canada.
−
  |date=2004-09
+
|pubmedID=34551593
 +
|pubmedCID=
 +
|DOI=10.1097/JU.0000000000002234
 +
|accessdate=2025-06-29
 +
}}</ref>
 +
 
 +
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 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.<ref name="richards"/> <ref name="aapcp1995" /> 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."<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=
 +
|pubmedID=27456514
 +
|pubmedCID=
 +
|DOI=
 +
|doi=10.1542/peds.2016-1484
 +
|accessdate=2023-05-27
 +
}}</ref> 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 association| 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.<ref name="povenmire"/> <ref name="richards" /> <ref name="hill2003">{{REFjournal
 +
|last=Hill
 +
|first=
 +
|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
 +
|volume=3
 +
|issue=2
 +
|pages=16-8
 +
  |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.pdf
 +
  |quote=
 +
|pubmedID=14635628
 +
|pubmedCID=
 +
|DOI=10.1162/152651603766436342
 
  |format=PDF
 
  |format=PDF
−
  |publisher=[[Royal Australasian College of Physicians]]
+
  |accessdate=2023-07-11
−
  |quote=
+
}}</ref>
−
  |archiveurl=https://web.archive.org/web/20080720092409/http://www.racp.edu.au/download.cfm?DownloadFile=A453CFA1-2A57-5487-DF36DF59A1BAF527
+
 
−
  |archivedate=2008-07-20
+
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.<ref>{{REFjournal
−
}}</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>
+
|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=2020-05-27
 +
}}</ref>
 +
 
 +
Moreover, non-therapeutic circumcision of boys may also be unlawful,<ref name="Adler">{{REFjournal
 +
|last=Adler
 +
|first=Peter W.
 +
|init=PW
 +
|author-link=Peter W. Adler
 +
|url=https://scholarship.richmond.edu/cgi/viewcontent.cgi?article=1265&context=jolpi
 +
|title=Is Circumcision Legal?
 +
|volume=16
 +
|issue=3
 +
|journal=Richmond J. L. & Pub. Int.
 +
|page=439
 +
|date=2013
 +
}}</ref> if a court should accept Adler's arguments.
 +
<!--
 +
==Medical trade association views==
 +
[[Medical trade association| Medical trade associations]] are advocates for the business, financial, professional, and legal interests of medical doctors. When one issues a statement regarding [[circumcision]], in most but not all cases, it will exhibit [[bias]] in favor of [[financial incentive| fee-earning]] circumcision.  
  
−
Some medical associations take the position that the parents should determine what is in the best interest of the infant or child.<ref name="AAP1999">{{REFjournal
+
Some [[Medical trade association| medical trade associations]] formerly took the position that the parents should determine what is in the best interest of the newborn, infant, or child.<ref name="AAP1999">{{REFjournal
 
  |last=Task force on circumcision
 
  |last=Task force on circumcision
 
  |title=Circumcision policy statement
 
  |title=Circumcision policy statement
Line 52: Line 524:
 
  |pubmedID=10049981
 
  |pubmedID=10049981
 
  |pubmedCID=
 
  |pubmedCID=
−
}}</ref> Others say that circumcision is an infringement of the child's autonomy and should be delayed until he is capable of making the decision himself.<ref name="KNMG2010">[http://circumstitions.com/Docs/KNMG-policy.pdf Non-Therapeutic Circumcision of Male Minors]. Utrecht: Royal Dutch Medical Association, 2010.</ref>
+
}},</ref> however the [[AAP]] has now abandoned all previous position statements on male [[circumcision]] in 2017.
  
−
==Medical societies views==
+
Medical ethics says that circumcision is an infringement of the child's autonomy and should be delayed until he is capable of making the decision himself.<ref name="KNMG2010">[http://circumstitions.com/Docs/KNMG-policy.pdf Non-Therapeutic Circumcision of Male Minors]. Utrecht: Royal Dutch Medical Association, 2010.</ref> A circumcision operation may be performed at any age, so an [[intact]] male, who has reached the legal age of consent, may elect to have a [[circumcision]] whenever he wishes.<ref name="myers2020" />
−
===Australia and New Zealand===
+
 
 +
===[[Australia]] and [[New Zealand]]===
 
[[File:Flag of Australia (converted).svg|thumb|upright=0.3]]
 
[[File:Flag of Australia (converted).svg|thumb|upright=0.3]]
  
 
The [https://www.racp.edu.au/ Royal Australasian College of Physicians] (2010) released a statement indicating that neonatal male circumcision "generally considered an ethical procedure", provided that 1) the child's decision makers, typically the parents, are acting in best interest of child and have been given full knowledge and 2) the procedure is performed by a competent provider, with sufficient analgesia, and does not unnecessarily harm the child or have substantial risks.<ref name="racp2010">[https://www.racp.edu.au/docs/default-source/advocacy-library/circumcision-of-infant-males.pdf Circumcision of Male Infants.] [[Royal Australasian College of Physicians]]. September 2010.</ref> They argue that parents should be allowed to be the primary decision-makers because providers may not understand the full psychosocial benefits of circumcision.<ref name="racp2010" /> Additionally, this procedure does not present substantial harm compared to its potential benefits, so parents should be allowed full decision-making capacity as long as they are educated properly.<ref name="racp2010"/>
 
The [https://www.racp.edu.au/ Royal Australasian College of Physicians] (2010) released a statement indicating that neonatal male circumcision "generally considered an ethical procedure", provided that 1) the child's decision makers, typically the parents, are acting in best interest of child and have been given full knowledge and 2) the procedure is performed by a competent provider, with sufficient analgesia, and does not unnecessarily harm the child or have substantial risks.<ref name="racp2010">[https://www.racp.edu.au/docs/default-source/advocacy-library/circumcision-of-infant-males.pdf Circumcision of Male Infants.] [[Royal Australasian College of Physicians]]. September 2010.</ref> They argue that parents should be allowed to be the primary decision-makers because providers may not understand the full psychosocial benefits of circumcision.<ref name="racp2010" /> Additionally, this procedure does not present substantial harm compared to its potential benefits, so parents should be allowed full decision-making capacity as long as they are educated properly.<ref name="racp2010"/>
  
−
This statement also recognizes that waiting until the boy is of sufficient age to make his own decision would better respect his autonomy, but points out that this may interfere with a child's religious inclusion that circumcision was meant to confer.<ref name="racp2010"/> With neonatal male circumcision, they acknowledge that the child may later on disagree with the parents' decision <ref name="racp2010"/> but using the same reasoning, an uncircumcised child may also disagree with his parents' decision not to have him circumcised in infancy.<ref name="racp2010"/>
+
This statement also recognizes that waiting until the boy is of sufficient age to make his own decision would better respect his autonomy, but points out that this may interfere with a child's religious inclusion that [[circumcision]] was meant to confer.<ref name="racp2010"/> With neonatal male circumcision, they acknowledge that the child may later on disagree with the parents' decision <ref name="racp2010"/> but using the same reasoning, an [[uncircumcised]] child may also disagree with his parents' decision not to have him circumcised in infancy,<ref name="racp2010"/> but he can have a circumcision at any age.
  
−
===Canada===
+
===[[Canada]]===
 
[[File:Flag of Canada (Pantone).svg|thumb|upright=0.3]]
 
[[File:Flag of Canada (Pantone).svg|thumb|upright=0.3]]
  
 
The [[Canadian Paediatric Society]] (CPS) issued a position statement on September 8, 2015, which highlighted the ethical issue surrounding the child's inability to give consent.<ref name="CPS2015">{{REFjournal
 
The [[Canadian Paediatric Society]] (CPS) issued a position statement on September 8, 2015, which highlighted the ethical issue surrounding the child's inability to give consent.<ref name="CPS2015">{{REFjournal
 
  |last=Sorakan
 
  |last=Sorakan
−
  |first=ST..
+
  |init=ST
 
  |last2=Finla
 
  |last2=Finla
−
  |first2=J.C.
+
  |init2=JC
 
  |last3=Jefferies
 
  |last3=Jefferies
−
  |first3=A.L.
+
  |init3=AL
 
  |title=Newborn male circumcision
 
  |title=Newborn male circumcision
 
  |journal=Paediatr Child Health
 
  |journal=Paediatr Child Health
Line 82: Line 555:
 
  |pubmedID=26435672
 
  |pubmedID=26435672
 
  |pubmedCID=4578472
 
  |pubmedCID=4578472
−
}}</ref> Since children require a substituted decision maker acting in their best interests, they recommend to hold off non-medically indicated procedures, such as circumcision, until children can make their own decisions. Yet the CPS also states that parents of male newborns must receive unbiased information about neonatal circumcision, so that they can weigh specific risks and benefits of circumcision in the context of their own familial, religious and cultural beliefs.<ref name="CPS2015"/>
+
}}</ref> Since children require a substituted decision maker acting in their best interests, they recommend deferring non-medically indicated procedures, such as [[circumcision]], until children can make their own decisions. Yet the CPS also self-servingly states that parents of male newborns must receive unbiased information about neonatal circumcision, so that they can weigh specific risks and benefits of circumcision in the context of their own familial, religious and cultural beliefs!<ref name="CPS2015"/>
  
−
===Denmark===
+
=== [[Denmark]] ===
 
[[File:Flag of Denmark.svg|thumb|upright=0.3]]
 
[[File:Flag of Denmark.svg|thumb|upright=0.3]]
  
Line 102: Line 575:
 
}}</ref>
 
}}</ref>
  
−
===Netherlands===
+
===[[Netherlands]]===
 
[[File:Flag of the Netherlands.svg|thumb|upright=0.3]]
 
[[File:Flag of the Netherlands.svg|thumb|upright=0.3]]
  
Line 108: Line 581:
  
 
=== Scandinavia ===
 
=== Scandinavia ===
−
In 2013 children's ombudsmen from Sweden, Norway, Finland, Denmark, and Iceland, along with the Chair of the Danish Children's Council and the children's spokesperson for Greenland, passed a resolution that emphasized the decision to be circumcised should belong to the individual, who should be able to give informed consent.<ref name="resolution2">{{REFweb
+
In 2013 children's ombudsmen from [[Sweden]], [[Norway]], [[Finland]], [[Denmark]], and Iceland, along with the Chair of the Danish Children's Council and the children's spokesperson for Greenland, passed a resolution that emphasized the decision to be [[circumcised]] should belong to the individual, who should be able to give [[informed consent]].<ref name="resolution2">{{REFweb
 
  |last=Nordic Association of Children's Ombudsmen
 
  |last=Nordic Association of Children's Ombudsmen
 
  |title=Let the boys decide for themselves
 
  |title=Let the boys decide for themselves
Line 116: Line 589:
 
}}[] Tuesday, 1 October 2013</ref>
 
}}[] Tuesday, 1 October 2013</ref>
  
−
The Nordic Association of Clinical Sexologists supports the position of the Nordic Association of Ombudsmen who reason that circumcision violates the individual's human rights by denying the male child his ability to make the decision for himself.<ref>[http://nacs.eu/data/press_release001.pdf Statement on Non-Therapeutic Circumcision of Boys.]. Nordic Association of Clinical Sexologists, Helsinki, 10 October 2013.</ref>
+
The Nordic Association of Clinical Sexologists supports the position of the Nordic Association of Ombudsmen who reason that circumcision violates the individual's [[human rights]] by denying the male child his ability to make the decision for himself.<ref>[http://nacs.eu/data/press_release001.pdf Statement on Non-Therapeutic Circumcision of Boys.]. Nordic Association of Clinical Sexologists, Helsinki, 10 October 2013.</ref>
  
 
The medical doctors at Sørland Hospital in Kristiansand, Southern Norway have all refused to perform circumcisions on boys, citing reasons of conscience.<ref>{{REFnews
 
The medical doctors at Sørland Hospital in Kristiansand, Southern Norway have all refused to perform circumcisions on boys, citing reasons of conscience.<ref>{{REFnews
Line 127: Line 600:
 
}}</ref>
 
}}</ref>
  
−
===United Kingdom===
+
===[[United Kingdom]]===
 
[[File:Flag of the United Kingdom.svg|thumb|upright=0.3]]
 
[[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"/>
+
====2019 revision of BMA guidance====
  
−
====Adult circumcision====
+
The [[British Medical Association]], being cognizant of the [[Re B and G (children) (No 2) EWFC 3]] (2015) and [[Re L and B (CHILDREN)]] (2016) family court decisions, issued a new guidance to its member physicians in 2019. The new guidance urges its member physicians to take an extremely cautious approach to parental requests for the performance of non-therapeutic [[circumcision]] on minor boys and to ascertain that the requested non-therapeutic circumcision is in the boy's best interests.<ref name="bma2019">{{REFdocument
−
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" />
+
|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=Anonymous
 +
|first=
 +
|publisher=British Medical Association
 +
|format=PDF
 +
|date=2019
 +
|accessdate=2021-06-29
 +
}}</ref>
  
−
====Child circumcision====
+
[[Antony Lempert| Lempert]] et al. (2022) criticized the 2019 BMA guidance for "serious weaknesses". They listed:
−
 
+
# the absence of an explicit stance on the underlying ethical status of NPC, coupled with an implicit permissive stance,<br>
−
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"/>
+
# an incoherent and impracticable analysis of the child’s best interests,<br>
−
 
+
# unbalanced guidance regarding cultural issues,<br>
−
====Criticism and revision of BMA statement====
+
# unbalanced guidance regarding scientific issues,<br>
−
 
+
# unjustified differential treatment of children of the same sex,<br>  
−
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
+
# unjustified differential treatment of children of different sexes,<br>
−
  |last=Mussell
+
# problems with child safeguarding, and
−
  |first=R.
+
# problems with regulation and training,<br>
−
  |authorlink=
+
# an unjustified presumption of lawfulness of NPC of minors, and<br>
−
  |date=2004-06
+
# failure adequately to address recent case law.<ref name="lempert2022">{{REFjournal
−
  |title=The development of professional guidelines on the law and ethics of male circumcision
+
  |last=Lempert
−
  |url=http://jme.bmj.com/cgi/content/full/30/3/254
+
  |first=Antony
−
  |journal=Journal of Medical Ethics
+
|init=A
−
  |volume=30
+
|author-link=Antony Lempert
−
  |issue=3
+
|last2=Chegwidden
−
  |pages=254-258
+
|first2=James
−
  |DOI=10.1136/jme.2004.008615
+
|init2=J
−
  |pubmedCID=1733857
+
|author2-link=James Chegwidden
−
  |pubmedID=15173358
+
|last3=Steinfeld
−
  |accessdate=
+
|first3=Rebecca
 +
|init3=R
 +
|author3-link=Rebecca Steinfeld
 +
|last4=Earp
 +
|first4=Brian D.
 +
  |init4=BD
 +
  |author4-link=Brian D. Earp
 +
|etal=no
 +
  |title=Non-therapeutic penile circumcision of minors: Current controversies in UK law and medical ethics.
 +
|journal=Clinical Ethics
 +
|location=
 +
  |date=2022-05
 +
  |season=
 +
  |volume
 +
  |issue=
 +
  |article=
 +
  |page=
 +
  |pages=
 +
  |url=https://www.researchgate.net/publication/360642209_Non-therapeutic_Penile_Circumcision_of_Minors_Current_Controversies_in_UK_Law_and_Medical_Ethics
 +
  |archived=
 
  |quote=
 
  |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"/>
+
  |pubmedID=
−
 
+
  |pubmedCID=
−
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
+
  |DOI=
−
  |last=Fox
+
  |accessdate=2022-05-20
−
  |first=M.
+
}}</ref>
−
  |last2=Thomson
 
−
  |first2=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" />
 
  
−
===United States===
+
===[[United States]]===
 
[[File:Flag of the United States.svg|thumb|upright=0.3]]
 
[[File:Flag of the United States.svg|thumb|upright=0.3]]
  
 
==== American Academy of Pediatrics ====
 
==== American Academy of Pediatrics ====
−
The American Academy of Pediatrics currently has no official stance on neonatal circumcision. The previous statement has expired and not been reaffirmed.<ref>{{REFjournal
+
The [[American Academy of Pediatrics]] currently has ''no'' official stance on neonatal circumcision. The previous statement expired in 2017 and has not been reaffirmed.<ref>{{REFjournal
 
  |last=Task Force On Circumcision
 
  |last=Task Force On Circumcision
 
  |date=2012-09-01
 
  |date=2012-09-01
Line 200: Line 688:
  
 
=====Criticism=====
 
=====Criticism=====
−
The expired American Academy of Pediatrics (AAP) position statement on male circumcision (2012) has attracted significant critical comment, including from the AAP itself.
+
The expired American Academy of Pediatrics (AAP) position statement on male circumcision (2012) attracted significant critical comment during its brief life, including from the AAP itself.
  
−
In a dissenting paper, Frisch ''et al''. (2013) point out "Circumcision fails to meet the criteria to serve as a preventive measure for UTI [...] As a preventive measure for penile cancer, circumcision also fails to meet the criteria for preventive medicine [...] circumcision for HIV protection in Western countries fails to meet the criteria for preventive medicine [...] Circumcision fails to meet the commonly accepted criteria for the justification of preventive medical procedures in children."
+
In a dissenting paper, Frisch et al. (2013) point out "Circumcision fails to meet the criteria to serve as a preventive measure for UTI [...] As a preventive measure for penile cancer, circumcision also fails to meet the criteria for preventive medicine [...] circumcision for [[HIV]] protection in Western countries fails to meet the criteria for preventive medicine [...] Circumcision fails to meet the commonly accepted criteria for the justification of preventive medical procedures in children."
  
−
Frisch ''et al''. conclude that "The AAP report lacks a serious discussion of the central ethical dilemma with, on one side, parents’ right to act in the best interest of the child on the basis of cultural, religious, and health-related beliefs and wishes and, on the other side, infant boys’ basic right to physical integrity in the absence of compelling reasons for surgery. Physical integrity is one of the most fundamental and inalienable rights a child has. Physicians and their professional organizations have a professional duty to protect this right, irrespective of the gender of the child."
+
Frisch et al. conclude that "The AAP report lacks a serious discussion of the central ethical dilemma with, on one side, parents’ right to act in the best interest of the child on the basis of cultural, religious, and health-related beliefs and wishes and, on the other side, infant boys’ basic right to physical integrity in the absence of compelling reasons for surgery. Physical integrity is one of the most fundamental and inalienable rights a child has. Physicians and their professional organizations have a professional duty to protect this right, irrespective of the gender of the child."
  
−
Van Howe & Svoboda (2013) criticize the AAP statement because it failed to include important points, in accurately analyzed and interpret current medical literature, and made unsupported conclusions.<ref>{{REFjournal
+
[[Robert S. Van Howe|Van Howe]] & [[J. Steven Svoboda|Svoboda]] (2013) criticize the AAP statement because it failed to include important points, in accurately analyzed and interpret current medical literature, and made unsupported conclusions.<ref>{{REFjournal
 
  |last=Van Howe
 
  |last=Van Howe
 
  |first=Robert S.
 
  |first=Robert S.
 +
|init=RS
 +
|author-link=Robert S. Van Howe
 
  |last2=Svoboda
 
  |last2=Svoboda
 
  |first2=J. Steven
 
  |first2=J. Steven
 +
|init2=JS
 +
|author2-link=J. Steven Svoboda
 
  |date=2013-07-01
 
  |date=2013-07-01
 
  |title=Out of step: fatal flaws in the latest AAP policy report on neonatal circumcision
 
  |title=Out of step: fatal flaws in the latest AAP policy report on neonatal circumcision
Line 224: Line 716:
 
}}</ref>
 
}}</ref>
  
−
Frisch ''et al''. (2013) pointed out the difference of the AAP's statements in comparison to other Western countries, such as Canada, Australia, and various European countries.<ref name="frisch2013">{{REFjournal
+
Frisch et al. (2013) pointed out the difference of the AAP's statements in comparison to other Western countries, such as Canada, Australia, and various European countries.<ref name="frisch2013">{{REFjournal
 
  |last=Frisch
 
  |last=Frisch
−
  |first=M.
+
  |init=M
 
  |last2=Aigrain
 
  |last2=Aigrain
−
  |first2=Y.
+
  |init2=Y
 
  |last3=Barauskas
 
  |last3=Barauskas
−
  |first3=V.
+
  |init3=V
 
  |last4=Bjarnason
 
  |last4=Bjarnason
−
  |first4=R.
+
  |init4=R
 
  |last5=Boddy
 
  |last5=Boddy
−
  |first5=S.-A.
+
  |init5=SA
 
  |last6=Czauderna
 
  |last6=Czauderna
−
  |first6=P.
+
  |init6=P
 
  |last7=de Gier
 
  |last7=de Gier
−
  |first7=R.P.E.
+
  |init7=RPE
 
  |last8=de Jong
 
  |last8=de Jong
−
  |first8=T.P.V.M.
+
  |init8=TPVM
 
  |last9=Fasching
 
  |last9=Fasching
−
  |first9=G.
+
  |init9=G
 
  |date=2013-04-01
 
  |date=2013-04-01
 
  |title=Cultural Bias in the AAP's 2012 Technical Report and Policy Statement on Male Circumcision
 
  |title=Cultural Bias in the AAP's 2012 Technical Report and Policy Statement on Male Circumcision
Line 254: Line 746:
 
  |pubmedID=23509170
 
  |pubmedID=23509170
 
  |issn=0031-4005
 
  |issn=0031-4005
−
}}</ref> They attribute this to cultural bias since non-therapeutic male circumcision is prevalent in the United States. They also criticized the strength of the health benefits the statement had claimed, such as protection from HIV and other STIs.<ref name="frisch2013"/> The American Academy of Pediatrics responded that because about half of American males are circumcised and half are not, there may be a more tolerant view concerning circumcision in the US, but that if there is any cultural “bias” among the AAP task force who wrote the Circumcision Policy statement, it is much less important than the bias Frisch ''et al''. may hold because of clear prejudices against the practice that can be found in Europe. The AAP elaborately explained why they reached conclusions regarding the health benefits of circumcision that are different from the ones reached by some of their European counterparts.<ref>{{REFjournal
+
}}</ref> They attribute this to cultural bias since non-therapeutic male circumcision is prevalent in the United States. They also criticized the strength of the health benefits the statement had claimed, such as protection from [[HIV]] and other STIs.<ref name="frisch2013"/> The American Academy of Pediatrics responded that because about half of American males are [[circumcised]] and half are not, there may be a more tolerant view concerning circumcision in the US, but that if there is any cultural “bias” among the AAP task force who wrote the Circumcision Policy statement, it is much less important than the bias Frisch et al. may hold because of clear prejudices against the practice that can be found in Europe. The AAP elaborately explained why they reached conclusions regarding the health benefits of circumcision that are different from the ones reached by some of their European counterparts.<ref>{{REFjournal
 
  |last=Task Force On Circumcision
 
  |last=Task Force On Circumcision
 
  |date=2013-04-01
 
  |date=2013-04-01
Line 260: Line 752:
 
  |url=https://pediatrics.aappublications.org/content/131/4/801
 
  |url=https://pediatrics.aappublications.org/content/131/4/801
 
  |journal=Pediatrics
 
  |journal=Pediatrics
−
|language=en
 
 
  |volume=131
 
  |volume=131
 
  |issue=4
 
  |issue=4
Line 268: Line 759:
 
  |pubmedID=23509171
 
  |pubmedID=23509171
 
}}</ref>
 
}}</ref>
−
 
−
====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 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
 
−
|journal=AMA Journal of Ethics
 
−
|language=en
 
−
|volume=19
 
−
|issue=8
 
−
|pages=815-824
 
−
|DOI=10.1001/journalofethics.2017.19.8.msoc2-1708
 
−
|pubmedID=28846521
 
−
|issn=2376-6980
 
−
|last1=Svoboda
 
−
|first1=J.S.
 
−
}}</ref> 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.<ref name="svoboda2017"/> He states that benefits do not outweigh the risks, and also claims that foreskin removal should be considered a sexual harm.<ref name="svoboda2017"/> 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.<ref name="svoboda2017"/>
 
−
 
−
Reis and Reis's article explore the role physicians play in neonatal circumcision.<ref name="reis-reis2017">{{REFjournal
 
−
|date=2017-08-01
 
−
|title=Are Physicians Blameworthy for Iatrogenic Harm Resulting from Unnecessary Genital Surgeries?
 
−
|journal=AMA Journal of Ethics
 
−
|language=en
 
−
|volume=19
 
−
|issue=8
 
−
|pages=825-833
 
−
|DOI=10.1001/journalofethics.2017.19.8.msoc3-1708
 
−
|pubmedID=28846522
 
−
|issn=2376-6980
 
−
|last=Reis-Dennis
 
−
|first=S.
 
−
|last2=Reis
 
−
|first2=E.
 
−
}}</ref> 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.<ref name="reis-reis2017"/> However, they still advise against physicians recommending unnecessary, irreversible surgeries, which is a category circumcision falls in frequently.<ref name="reis-reis2017"/>
 
−
 
−
== Journal of Medical Ethics ==
 
−
===JME symposium on circumcision, June 2004===
 
−
The ''Journal of Medical Ethics'' published a "symposium on circumcision" in its June 2004 issue.<ref name="symposium2004">{{REFjournal
 
−
|title=Symposium on Circumcision
 
−
|journal=Journal of Medical Ethics
 
−
|date=2004
 
−
|volume=30
 
−
|issue=3
 
−
|pages=237-263
 
−
|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:
 
  
 
<blockquote>
 
<blockquote>
 
"It is therefore very interesting that the piece of evidence we really need to have in order to be able to assess the status of circumcision is singularly lacking. We simply do not have valid comparative data concerning the effects of early circumcision on adult sexual function and satisfaction. Until such data become available, the circumcision debate cannot be brought to a satisfactory conclusion, and there will always be a lingering suspicion that the sometimes rather strident opposition to circumcision is partly driven by cultural prejudices, dressed up as ethical arguments."<ref name="holm">{{REFjournal
 
"It is therefore very interesting that the piece of evidence we really need to have in order to be able to assess the status of circumcision is singularly lacking. We simply do not have valid comparative data concerning the effects of early circumcision on adult sexual function and satisfaction. Until such data become available, the circumcision debate cannot be brought to a satisfactory conclusion, and there will always be a lingering suspicion that the sometimes rather strident opposition to circumcision is partly driven by cultural prejudices, dressed up as ethical arguments."<ref name="holm">{{REFjournal
 
  |last=Holm
 
  |last=Holm
−
  |first=S.
+
  |init=S
 
  |title=Irreversible bodily interventions in children
 
  |title=Irreversible bodily interventions in children
 
  |journal=Journal of Medical Ethics
 
  |journal=Journal of Medical Ethics
Line 336: Line 780:
 
"The most fundamental principle of surgery is that no operation should be done if there is no disease, as it cannot be justified if the risk of the procedure is not balanced by the risk of a disease. Even when patients have significant disease, potentially dangerous operations can hardly be justified if their risks are much greater than the disease itself. The problem for routine circumcision is that since there is no disease, no complication whatsoever can be tolerated, since the risks of the procedure are not being balanced against the risks of any present disease."<ref name="hutson">{{REFjournal
 
"The most fundamental principle of surgery is that no operation should be done if there is no disease, as it cannot be justified if the risk of the procedure is not balanced by the risk of a disease. Even when patients have significant disease, potentially dangerous operations can hardly be justified if their risks are much greater than the disease itself. The problem for routine circumcision is that since there is no disease, no complication whatsoever can be tolerated, since the risks of the procedure are not being balanced against the risks of any present disease."<ref name="hutson">{{REFjournal
 
  |last=Hutson
 
  |last=Hutson
−
  |first=J.M.
+
  |init=JM
 
  |title=Circumcision: a surgeon’s perspective
 
  |title=Circumcision: a surgeon’s perspective
 
  |journal=Journal of Medical Ethics
 
  |journal=Journal of Medical Ethics
Line 355: Line 799:
 
"If we believe in evidence based medicine, then there can be no debate about male circumcision; it has become a desirable option for the whole world. Paradoxically, this simple procedure is a life saver; it can also bring about major improvements to both male and female reproductive health. Rather than condemning it, we in the developed world have a duty to develop better procedures that are neither physically cruel nor potentially dangerous, so that male circumcision can take its rightful place as the kindest cut of all."<ref name="short">{{REFjournal
 
"If we believe in evidence based medicine, then there can be no debate about male circumcision; it has become a desirable option for the whole world. Paradoxically, this simple procedure is a life saver; it can also bring about major improvements to both male and female reproductive health. Rather than condemning it, we in the developed world have a duty to develop better procedures that are neither physically cruel nor potentially dangerous, so that male circumcision can take its rightful place as the kindest cut of all."<ref name="short">{{REFjournal
 
  |last=Short
 
  |last=Short
−
  |first=R.V.
+
  |init=RV
 
  |title=Male circumcision: a scientific perspective
 
  |title=Male circumcision: a scientific perspective
 
  |journal=Journal of Medical Ethics
 
  |journal=Journal of Medical Ethics
Line 370: Line 814:
 
Viens (2004) contends that "we do not know in any robust or determinate sense that infant male circumcision is harmful in itself, nor can we say the same with respect to its purported harmful consequences." He suggests that one must distinguish between practices that are grievously harmful and those that enhance a child's cultural or religious identity. He suggests that medical professionals, and bioethicists especially, "must take as their starting point the fact that reasonable people will disagree about what is valuable and what is harmful."<ref name="viens">{{REFjournal
 
Viens (2004) contends that "we do not know in any robust or determinate sense that infant male circumcision is harmful in itself, nor can we say the same with respect to its purported harmful consequences." He suggests that one must distinguish between practices that are grievously harmful and those that enhance a child's cultural or religious identity. He suggests that medical professionals, and bioethicists especially, "must take as their starting point the fact that reasonable people will disagree about what is valuable and what is harmful."<ref name="viens">{{REFjournal
 
  |last=Viens
 
  |last=Viens
−
  |first=A.M.
+
  |init=AM
 
  |title=Value judgment, harm, and religious liberty
 
  |title=Value judgment, harm, and religious liberty
 
  |journal=Journal of Medical Ethics
 
  |journal=Journal of Medical Ethics
Line 385: Line 829:
 
Hellsten (2004), however, describes arguments in support of circumcision as "rationalisations",  and states that infant circumcision can be "clearly condemned as a violation of children’s rights whether or not they cause direct pain." He argues that, to question the ethical acceptability of the practice, "we need to focus on child rights protection." Hellsten concludes, "Rather, with further education and knowledge the cultural smokescreen around the real reasons for the maintenance of the practice can be overcome in all societies no matter what their cultural background.<ref name="hellsten">{{REFjournal
 
Hellsten (2004), however, describes arguments in support of circumcision as "rationalisations",  and states that infant circumcision can be "clearly condemned as a violation of children’s rights whether or not they cause direct pain." He argues that, to question the ethical acceptability of the practice, "we need to focus on child rights protection." Hellsten concludes, "Rather, with further education and knowledge the cultural smokescreen around the real reasons for the maintenance of the practice can be overcome in all societies no matter what their cultural background.<ref name="hellsten">{{REFjournal
 
  |last=Hellsten
 
  |last=Hellsten
−
  |first=S.K.
+
  |init=SK
 
  |title=Rationalising circumcision: from tradition to fashion, from public health to individual freedom—critical notes on cultural persistence of the practice of genital mutilation
 
  |title=Rationalising circumcision: from tradition to fashion, from public health to individual freedom—critical notes on cultural persistence of the practice of genital mutilation
 
  |journal=Journal of Medical Ethics
 
  |journal=Journal of Medical Ethics
Line 405: Line 849:
 
The BMA produced a document that set forth legal and ethical concerns but left the final decision on whether or not to perform a non-therapeutic circumcision to the attending physician.<ref name="mussell2">{{REFjournal
 
The BMA produced a document that set forth legal and ethical concerns but left the final decision on whether or not to perform a non-therapeutic circumcision to the attending physician.<ref name="mussell2">{{REFjournal
 
  |last=Mussell
 
  |last=Mussell
−
  |first=R.
+
  |init=R
 
  |title=The development of professional guidelines on the law and ethics of male circumcision
 
  |title=The development of professional guidelines on the law and ethics of male circumcision
 
  |journal=Journal of Medical Ethics
 
  |journal=Journal of Medical Ethics
Line 431: Line 875:
 
  |pubmedCID=1733850
 
  |pubmedCID=1733850
 
}}</ref>
 
}}</ref>
−
 
+
-->
−
===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.<ref>{{REFjournal
 
−
|title=The issue of male circumcision
 
−
|journal=Journal of Medical Ethics
 
−
|date=2013
 
−
|volume=39
 
−
|issue=7
 
−
|url=http://jme.bmj.com/content/39/7.toc
 
−
}}</ref> The numerous articles represent a diverse variety of views.<ref>{{REFjournal
 
−
|last=Foddy
 
−
|first=B.
 
−
|title=The concise argument: Medical, religious and social reasons for and against an ancient rite
 
−
|journal=Journal of Medical Ethics
 
−
|date=2013
 
−
|volume=39
 
−
|issue=7
 
−
|page=415
 
−
|url=http://jme.bmj.com/content/39/7/415.full
 
−
|DOI=10.1136/medethics-2013-101605
 
−
|pubmedID=23781076
 
−
}}</ref><ref>{{REFjournal
 
−
|last=Earp
 
−
|first=B.D.
 
−
|title=The ethics of infant male circumcision
 
−
|journal=Journal of Medical Ethics
 
−
|date=2013
 
−
|volume=39
 
−
|issue=7
 
−
|pages=418-420
 
−
|url=https://www.academia.edu/3430963/The_ethics_of_infant_male_circumcision
 
−
|DOI=10.1136/medethics-2013-101517
 
−
|pubmedID=23781078
 
−
}}</ref>
 
  
 
==Other views==
 
==Other views==
−
Povenmire (1988) argues that parents should not have the power to consent to neonatal non-therapeutic circumcision.<ref name="povenmire"/>
+
Povenmire (1988) argued that parents should not have the power to consent to neonatal non-therapeutic circumcision.<ref name="povenmire"/>
  
−
Richards (1996) argues that parents only have power to consent to therapeutic procedures.<ref name="richards"/>
+
Richards (1996) argued 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
 
[[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
 
  |last=Somerville
 
  |last=Somerville
−
  |first=Margaret
+
  |first=Margaret A.
 +
|init=M
 
  |author-link=Margaret A. Somerville
 
  |author-link=Margaret A. Somerville
 
  |title=The ethical canary: science, society, and the human spirit
 
  |title=The ethical canary: science, society, and the human spirit
Line 487: Line 899:
 
}}</ref>
 
}}</ref>
  
−
[[Margaret A. Somerville|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.<ref name="Somerville2000"/>
+
[[Margaret A. Somerville|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.<ref name="Somerville2000"/>
  
 
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."<ref name="Canning">{{REFjournal
 
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."<ref name="Canning">{{REFjournal
 
  |last=Canning
 
  |last=Canning
−
  |first=D.A.
+
  |init=DA
 
  |title=Informed consent for neonatal circumcision: an ethical and legal conundrum
 
  |title=Informed consent for neonatal circumcision: an ethical and legal conundrum
 
  |journal=J Urol
 
  |journal=J Urol
Line 503: Line 915:
 
}}</ref>
 
}}</ref>
  
−
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.<ref name="bma2006"/> The College of Physicians and Surgeons of British Columbia took a similar position.<ref name="cpsbc">{{REFweb
+
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.<ref name="bma2006"/> The College of Physicians and Surgeons of British Columbia took a similar position.<ref name="cpsbc">{{REFweb
 
  |last=College of Physicians & Surgeons of British Columbia
 
  |last=College of Physicians & Surgeons of British Columbia
 
  |title=Circumcision (Infant Male)
 
  |title=Circumcision (Infant Male)
Line 511: Line 923:
 
}}</ref>
 
}}</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"/>
+
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">{{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>
  
−
<!--[[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
+
The Belgian 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
−
|last=Morris
 
−
|first=B.J.
 
−
|authorlink=Brian J. Morris
 
−
|last2=Bailis
 
−
|first2=S.A.
 
−
|last3=Wiswell
 
−
|first3=T.E.
 
−
|title=Circumcision rates in the United States: rising or falling? What effect might the new affirmative pediatric policy statement have?
 
−
|journal=Mayo Clinic Proceedings
 
−
|date=2014-05
 
−
|volume=89
 
−
|issue=5
 
−
|pages=677-686
 
−
|DOI=10.1016/j.mayocp.2014.01.001
 
−
|pubmedID=24702735
 
−
}}</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
 
 
  |last=Comité Consultif de Bioéthique de Belgique
 
  |last=Comité Consultif de Bioéthique de Belgique
 
  |website=SPF Santé Publique
 
  |website=SPF Santé Publique
Line 544: Line 953:
 
  |date=2017
 
  |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.
 
  |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 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."<ref name="bulletin2017"/> 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.<!--<ref>{{REFweb
+
}}</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." The committee found that the child's right to physical integrity is greater than a parent's religious right to circumcise.<ref name="bulletin2017"/>  
−
|url=https://www.standaard.be/cnt/dmf20170920_03084394
 
−
|title=De Block blijft besnijdenis terugbetalen
 
−
|last=Vergauwen
 
−
|first=Eveline
 
−
|website=De Standaard
 
−
|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
+
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.
−
|last=Rennie
 
−
|first=Stuart
 
−
|authorlink=
 
−
|first2=Adamson S.
 
−
|last2=Muula
 
−
|first3=Daniel
 
−
|last3=Westreich
 
−
|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=G.J.
 
−
|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).
+
== Patient exploitation ==
  
−
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
+
The non-therapeutic [[circumcision industry]] in the [[United States]] costs more than $3.6 billion annually.<ref name="bollinger2012">{{REFweb
−
  |last=Harmon
+
|url=https://www.academia.edu/6442587/High_Cost_of_Circumcision_3.6_Billion_Annually
−
  |first=Katherine
+
|title=High Cost of Circumcision: $3.6 Billion Annually
−
  |title=Can male circumcision stem the AIDS epidemic in Africa?
+
  |last=Bollinger
−
  |url=http://www.nature.com/news/can-male-circumcision-stem-the-aids-epidemic-in-africa-1.9520
+
  |first=Dan
−
  |journal=Nature News
+
  |author-link=Dan Bollinger
−
  |language=en
+
|publisher=Academia
−
  |DOI=10.1038/nature.2011.9520
+
  |website=https://www.academia.edu
−
  |date=2011
+
  |date=2012
−
}}</ref>
+
  |accessdate=2021-11-12
 +
  |format=PDF
 +
  |quote=As the saying goes, follow the money.}}  
  
−
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
+
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.
−
|url=https://www.nhs.uk/news/lifestyle-and-exercise/circumcision-and-stis/
+
}}</ref>  
−
|title=Circumcision and STIs
 
−
|date=2009-03-26
 
−
}}</ref>-->
 
  
−
==Surrogate consent==
+
[[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.
−
Patient autonomy is an important principle of medical ethics.<ref>{{REFbook
 
−
|last=Beauchamp
 
−
|first=Tom L.
 
−
|last2=Childress
 
−
|first2=James F.
 
−
|title=Principles of Biomedical Ethics
 
−
|publisher=New York: Oxford University Press
 
−
|date=2001
 
−
}}</ref> Some believe that consent for a non-therapeutic operation offends the principle of autonomy, when granted by a surrogate.
 
  
−
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.<ref name="conundrum">{{REFjournal
+
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>
−
|first=J. Steven
 
−
|last=Svoboda
 
−
|first2=Robert S.
 
−
|last2=Van Howe
 
−
|first3=James G.
 
−
|last3=Dwyer
 
−
|author3-link=James G. Dwyer
 
−
|title=Informed Consent for Neonatal Circumcision: An Ethical and Legal Conundrum
 
−
|url=https://scholarship.law.wm.edu/cgi/viewcontent.cgi?article=1166&context=facpubs
 
−
|pages=60-133
 
−
|journal=J Contemp Health Law & Policy
 
−
|volume=17
 
−
|date=2000
 
−
}}</ref>
 
  
−
A surrogate's powers to grant consent are more circumscribed than the powers granted to a competent individual acting on his own behalf.<ref name="conundrum" /><ref name="bioethics">{{REFjournal
+
==Is circumcision without valid consent battery?==
−
|last=Committee on Bioethics
+
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?
−
|title=Informed consent, parental permission, and assent in pediatric practice
+
<b>Simple battery</b> is defined as:
−
|journal=Pediatrics
+
<blockquote>
−
|date=1995
+
At common law, an intentional unpermitted act causing harmful or offensive contact with the "person" of another.<ref>{{REFweb
−
|volume=95
+
|url=https://legal-dictionary.thefreedictionary.com/battery
−
|issue=2
+
|title=Battery
−
|pages=314-317
+
  |last=Anonymous
−
|url=http://pediatrics.aappublications.org/content/95/2/314.full.pdf
+
  |first=
−
|pubmedID=7838658
+
  |init=
−
}} Reaffirmed May 2011.</ref> A surrogate may only act in the best interests of the patient.<ref name="conundrum"/> A surrogate may not put a child at risk for religious reasons.<ref name="conundrum"/> A surrogate may grant consent for a medical procedure that has ''no'' medical indication ''only'' if it is the child's best interests.<ref name="conundrum"/>
+
|author-link=
−
 
+
|publisher=The Free Legal Dictionary
−
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 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 is an unresolved question whether surrogates may grant effective consent for non-therapeutic child circumcision.<ref name="povenmire">{{REFjournal
 
−
  |last=Povenmire
 
−
  |first=R.
 
−
  |authorlink=
 
 
  |date=
 
  |date=
−
|note=1998–1999
+
  |accessdate=2025-06-20
−
|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
+
}}</ref>
−
|journal=Journal of Gender, Social Policy and the Law
+
</blockquote>
−
|volume=7
 
−
|issue=1
 
−
|pages=87-123
 
−
|pubmedID=16526136
 
−
|url=http://www.cirp.org/library/legal/povenmire/
 
−
  |accessdate=2013-11-25
 
−
}}</ref><ref name="conundrum"/><ref name="Adler">{{REFjournal
 
−
|first=Peter W.
 
−
|last=Adler
 
−
|author-link=Peter W. Adler
 
−
|url=http://rjolpi.richmond.edu/archive/Adler_Formatted.pdf
 
−
|title=Is Circumcision Legal?
 
−
|volume=16
 
−
|issue=3
 
−
|journal=Richmond J. L. & Pub. Int.
 
−
|page=439
 
−
|date=2013
 
−
}}</ref> 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.<ref name="richards">{{REFjournal
 
−
|last=Richards
 
−
|first=D.
 
−
|authorlink=
 
−
|date=1996-05
 
−
|title=Male Circumcision: Medical or Ritual?
 
−
|journal=Journal of Law and Medicine
 
−
|volume=3
 
−
|issue=4
 
−
|pages=371-376
 
−
|url=http://www.cirp.org/library/legal/richards/
 
−
|accessdate=2008-04-11
 
−
}}</ref> <!--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."<ref name="CPS2015">{{REFjournal
 
−
|last=Sorakan
 
−
|first=S.T.
 
−
|last2=Finlay
 
−
|first2=J.C.
 
−
|last3=Jefferies
 
−
|first3=A.L.
 
−
|title=Newborn male circumcision
 
−
|journal=Paediatr Child Health
 
−
|date=2015
 
−
|volume=20
 
−
|issue=6
 
−
|pages=311-315
 
−
|url=http://www.cps.ca/en/documents/position/circumcision
 
−
|pubmedID=26435672
 
−
|pubmedCID=4578472
 
−
}}</ref>-->
 
−
 
 
−
Regardless of these issues, the 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="bma2006"/><ref name="povenmire"/>
 
−
 
 
−
==Observations==
 
−
 
 
−
The non-therapeutic circumcision industry in the United States produces more than $1 billion annually.  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 $1 billion annual business would collapse. The American 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.
 
  
 +
<b>Aggravated battery</b> is defined as:
 +
<blockquote>
 +
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.<ref>{{REFweb
 +
|url=https://www.law.cornell.edu/wex/aggravated_battery
 +
|title=aggravated battery
 +
|last=
 +
|first=
 +
|init=
 +
|author-link=
 +
|publisher=Legal Information Institute
 +
|date=2025-02
 +
|accessdate=2025-06-29
 +
}}</ref>
 +
</blockquote>
 +
A scapel actually is a specialized knife, designed to cut human flesh, so a court may regard a scapel as a weapon.
 
{{SEEALSO}}
 
{{SEEALSO}}
−
 
+
* [[Brian D. Earp]]
 +
* [[Brussels Collaboration on Bodily Integrity]]
 
* [[Human rights]]
 
* [[Human rights]]
−
 
+
* [[Informed consent]]
 +
* [[Jurisprudence]]
 +
* [[Surrogate consent]]
 
{{LINKS}}
 
{{LINKS}}
−
 
−
* {{REFjournal
 
−
|last=Freeman
 
−
|first=M.D.
 
−
|authorlink=
 
−
|date=1999
 
−
|title=A child's right to circumcision
 
−
|journal=BJU Int
 
−
|volume=83
 
−
|issue=Suppl. 1
 
−
|pages=74-78
 
−
|pubmedID=10349417
 
−
|DOI=10.1046/j.1464-410x.1999.0830s1074.x
 
−
}}
 
 
* {{REFjournal
 
* {{REFjournal
 
  |last=Goodman
 
  |last=Goodman
−
  |first=J.
+
  |init=J
−
  |title=[https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1464-410x.1999.0830s1022.x Jewish circumcision: an alternative perspective]
+
  |author-link=Jenny Goodman
 +
|url=https://www.cirp.org/library/cultural/goodman1999/
 +
|title=Jewish circumcision: an alternative perspective
 
  |journal=BJU Int
 
  |journal=BJU Int
 
  |date=1999
 
  |date=1999
 
  |volume=83 Suppl. 1
 
  |volume=83 Suppl. 1
−
  |pages=22-27
+
  |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
 +
|accessdate=2023-05-27
 +
}}</ref>
 +
* {{REFweb
 +
|url=https://www.reddit.com/r/bioethics/comments/1in2lv6/the_bioethics_of_infant_circumcision/
 +
|title=The Bioethics of Infant Circumcision
 +
|last=Anonymous
 +
|publisher=REDDIT
 +
|date=2025-02
 +
|accessdate=2025-11-06
 
}}
 
}}
 +
{{REF}}
  
  
−
{{REF}}
 
  
 +
[[Category:Criminal circumcision]]
 +
[[Category:Education]]
 
[[Category:Human rights]]
 
[[Category:Human rights]]
 +
[[Category:Medical ethics]]
 +
[[Category:Parental information]]

Latest revision as of 00:40, 7 November 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]

Autonomy

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] [10] 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] [10]

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.[10]

There was an unresolved question whether surrogates may grant effective consent for non-therapeutic child circumcision.[21]

[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.[22] 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."[23]

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.[21][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.[22] [10] 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."[24] 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.[21] [22] [25]

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.[26]

Moreover, non-therapeutic circumcision of boys may also be unlawful,[27] 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.[21]

Richards (1996) argued that parents only have power to consent to therapeutic procedures.[22]

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.[28]

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.[28]

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."[29]

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.[30]

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".[31]

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.[32][33] 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.[33]

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.[34]

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.[35]

Is circumcision without valid consent battery?

Boyle et al. (2004) argued that non-therapeutic circumcision of boys is "assault",[36] 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.[37]

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.[38]

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. ↑ a b c d e 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 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.
  22. ↑ 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.
  23. ↑ 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.
  24. ↑ REFjournal Committee on Bioethics. Informed Consent in Decision-Making in Pediatric Practice. Pediatrics. August 2016; 138(2): e20161484.. PMID. DOI. Retrieved 27 May 2023.
  25. ↑ 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.
  26. ↑ 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.
  27. ↑ REFjournal Adler PW. Is Circumcision Legal?. Richmond J. L. & Pub. Int.. 2013; 16(3): 439.
  28. ↑ 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.
  29. ↑ REFjournal Canning DA. Informed consent for neonatal circumcision: an ethical and legal conundrum. J Urol. 2002; 168(4 Pt 1): 1650-1651. PMID. DOI.
  30. ↑ REFweb College of Physicians & Surgeons of British Columbia (2007). Circumcision (Infant Male). Retrieved 6 December 2013.
  31. ↑ 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.
  32. ↑ 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.
  33. ↑ 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.
  34. ↑ 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. }}
  35. ↑ Principle 13, CMA Code of Ethics. Ottawa: Canadian Medical Association; updated 2004.
  36. ↑ 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.
  37. ↑ REFweb Anonymous. Battery, The Free Legal Dictionary. Retrieved 20 June 2025.
  38. ↑ REFweb (February 2025). aggravated battery, Legal Information Institute. Retrieved 29 June 2025.
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