Ethics of non-therapeutic child circumcision: Difference between revisions
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<b><i>Human dignity</i></b> is the term given to the principle that humans and human life are entitled to respect. The United Nations has developed many [[human rights]] instruments that provide general guidance on protecting human dignity ."<ref>{{REFbook | |||
<i>Human dignity</i> is the term given to the principle that humans and human life are entitled to respect. The United Nations has developed many [[human rights]] instruments that provide general guidance on protecting human dignity ."<ref>{{REFbook | |||
|last=President's Council on Bioethics | |last=President's Council on Bioethics | ||
|first= | |first= | ||
| Line 6: | Line 5: | ||
|year=2008-03 | |year=2008-03 | ||
|title=Human Dignity and Bioethics | |title=Human Dignity and Bioethics | ||
|url= | |url=https://bioethicsarchive.georgetown.edu/pcbe/reports/human_dignity/ | ||
|scope= | |scope= | ||
|location=Washington, DC | |location=Washington, DC | ||
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|ISBN= | |ISBN= | ||
|accessdate=2025-06-28 | |accessdate=2025-06-28 | ||
}}</ref> | }}</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. | <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 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]]. | ||
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}}</ref> The foreskin has [[Foreskin#Physiological_functions| protective, immunological, sensory, and sexual functions]], which are irreversibly destroyed and cease to function after the [[amputation]] of the foreskin by circumcision, imposing a lifetime loss of functional tissue and loss of function upon the patient. The '''ethics of non-therapeutic child circumcision''' being imposed on unconsenting minors (babies and children) has been a source of ongoing controversy.<ref name="bma2006">Committee on Medical Ethics. [https://www.bma.org.uk/advice/employment/ethics/children-and-young-people/non-therapeutic-male-circumcision-of-children-ethics-toolkit The law and ethics of male circumcision: Guidance for doctors]. London: British Medical Association 2006.</ref> | }}</ref> The foreskin has [[Foreskin#Physiological_functions| protective, immunological, sensory, and sexual functions]], which are irreversibly destroyed and cease to function after the [[amputation]] of the foreskin by circumcision, imposing a lifetime loss of functional tissue and loss of function upon the patient. The '''ethics of non-therapeutic child circumcision''' being imposed on unconsenting minors (babies and children) has been a source of ongoing controversy.<ref name="bma2006">Committee on Medical Ethics. [https://www.bma.org.uk/advice/employment/ethics/children-and-young-people/non-therapeutic-male-circumcision-of-children-ethics-toolkit The law and ethics of male circumcision: Guidance for doctors]. London: British Medical Association 2006.</ref> | ||
The concern about the ongoing practice of child circumcision has | The concern about the ongoing practice of [[child circumcision]] has spurred the publication of numerous articles in journals of medical ethics. | ||
==Ethics journals == | ==Ethics journals == | ||
| Line 39: | Line 38: | ||
|volume=30 | |volume=30 | ||
|issue=3 | |issue=3 | ||
|pages=237- | |pages=237-63 | ||
|url=http://jme.bmj.com/content/30/3.toc#Symposiumoncircumcision Symposium on circumcision | |url=http://jme.bmj.com/content/30/3.toc#Symposiumoncircumcision Symposium on circumcision | ||
}}</ref> The symposium published the original version (2003) of the BMA policy statement and six articles by various individuals with a wide spectrum of views on the ethicality of circumcision of male minors. In the introduction, Holm (2004) states: | }}</ref> The symposium published the original version (2003) of the BMA policy statement and six articles by various individuals with a wide spectrum of views on the ethicality of circumcision of male minors. In the introduction, Holm (2004) states: | ||
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In August 2017, the American Medical Association ''Journal of Ethics'' featured two separate articles challenging the morality of performing non-therapeutic infant circumcision. | 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]] argues against non-therapeutic circumcision.<ref name="svoboda2017">{{REFjournal | [[J. Steven Svoboda| Svoboda]] (2017) argues against non-therapeutic circumcision.<ref name="svoboda2017">{{REFjournal | ||
|date=2017-08-01 | |date=2017-08-01 | ||
|title=Nontherapeutic Circumcision of Minors as an Ethically Problematic Form of Iatrogenic Injury | |title=Nontherapeutic Circumcision of Minors as an Ethically Problematic Form of Iatrogenic Injury | ||
| Line 87: | Line 86: | ||
|volume=19 | |volume=19 | ||
|issue=8 | |issue=8 | ||
|pages=815- | |pages=815-24 | ||
|DOI=10.1001/journalofethics.2017.19.8.msoc2-1708 | |DOI=10.1001/journalofethics.2017.19.8.msoc2-1708 | ||
|pubmedID=28846521 | |pubmedID=28846521 | ||
| Line 95: | Line 94: | ||
}}</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"/> | }}</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 | Reis and Reis's article (2017) explore the role physicians play in neonatal circumcision.<ref name="reis-reis2017">{{REFjournal | ||
|date=2017-08-01 | |date=2017-08-01 | ||
|title=Are Physicians Blameworthy for Iatrogenic Harm Resulting from Unnecessary Genital Surgeries? | |title=Are Physicians Blameworthy for Iatrogenic Harm Resulting from Unnecessary Genital Surgeries? | ||
| Line 111: | Line 110: | ||
|first2=E. | |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"/> | }}</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== | ==Principles of medical ethics== | ||
The | ===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 | |last=Beauchamp | ||
|first= | |first= | ||
| Line 129: | Line 130: | ||
|url= | |url= | ||
|work= | |work= | ||
|editor= | |editor=Beauchamp TL, Walters L | ||
|edition= | |edition= | ||
|volume= | |volume= | ||
| Line 142: | Line 143: | ||
|accessdate=2025-06-27 | |accessdate=2025-06-27 | ||
|note= | |note= | ||
}}</ref> | }}</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. | 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: | There are also a number of secondary principles of medical ethics that include: | ||
* Provision of futile, ineffective, or unnecessary treatment | * <b>Provision of futile, ineffective, or unnecessary treatment.</b> | ||
* Misuse of medical resources | * <b>Misuse of medical resources.</b> | ||
* Surrogate consent | * <b>Surrogate consent.</b> (See below.) | ||
* Informed consent | * <b>Informed consent.</b> Informed consent is required by law. See [[Informed consent]]. | ||
* Patient exploitation | * <b>Patient exploitation.</b> (See below.) | ||
* Duties to child-patients | * <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 | ||
* Preservation of the child’s right to an open future<ref>{{REFweb | |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/ | |url=https://www.doctorsopposingcircumcision.org/for-professionals/medical-ethics/ | ||
|title=Medical Ethics and the Non-therapeutic Circumcision of Male Children | |title=Medical Ethics and the Non-therapeutic Circumcision of Male Children | ||
| Line 259: | Line 282: | ||
}}</ref> | }}</ref> | ||
== | ==Autonomy== | ||
Patient autonomy is the first principle of medical ethics.<ref>{{REFbook | Patient autonomy is the first principle of medical ethics.<ref>{{REFbook | ||
|last=Beauchamp | |last=Beauchamp | ||
| Line 320: | Line 343: | ||
}}</ref> | }}</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=" | 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=" | 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=" | 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 | There was an unresolved question whether surrogates may grant effective consent for non-therapeutic child circumcision.<ref name="povenmire">{{REFjournal | ||
| Line 403: | Line 416: | ||
}}</ref> | }}</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" /> | Regardless of these issues, the unethical general practice of the medical community in the [[United States]] is to receive surrogate informed consent or permission from parents or legal guardians for non-therapeutic circumcision of children.<ref name="povenmire"/><ref name="conundrum" /> | ||
=== The emerging consensus on surrogate consent for non-therapeutic newborn, infant, and child circumcision === | === The emerging consensus on surrogate consent for non-therapeutic newborn, infant, and child circumcision === | ||
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=" | 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 | |last=Committee on Bioethics | ||
|etal-no | |etal-no | ||
| Line 473: | Line 465: | ||
}}</ref> | }}</ref> | ||
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 | 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 name-"myers2020">{{REFjournal | ||
|last=Myers | |last=Myers | ||
|first= | |first= | ||
| Line 508: | Line 500: | ||
|init=PW | |init=PW | ||
|author-link=Peter W. Adler | |author-link=Peter W. Adler | ||
|url= | |url=https://scholarship.richmond.edu/cgi/viewcontent.cgi?article=1265&context=jolpi | ||
|title=Is Circumcision Legal? | |title=Is Circumcision Legal? | ||
|volume=16 | |volume=16 | ||
| Line 948: | Line 940: | ||
}}</ref> | }}</ref> | ||
The Belgian | 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=Comité Consultif de Bioéthique de Belgique | |last=Comité Consultif de Bioéthique de Belgique | ||
|website=SPF Santé Publique | |website=SPF Santé Publique | ||
| Line 961: | 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 {{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."<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> 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"/> | ||
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.<ref name="bollinger2012">{{REFweb | The non-therapeutic [[circumcision industry]] in the [[United States]] costs more than $3.6 billion annually.<ref name="bollinger2012">{{REFweb | ||
| Line 975: | Line 969: | ||
|date=2012 | |date=2012 | ||
|accessdate=2021-11-12 | |accessdate=2021-11-12 | ||
|format= | |format=PDF | ||
|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 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. | |quote=As the saying goes, follow the money.}} | ||
}}</ref> [[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 | |||
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. | |||
}}</ref> | |||
[[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. | |||
The performance of harmful, medically not indicated [[circumcision]] upon a child simply to collect a surgical fee must be regarded as <b>patient exploitation</b>.<ref>Principle 13, [https://www.cfpc.ca/CFPC/media/Resources/Education/CMA-Code-of-Ethics.pdf CMA Code of Ethics]. Ottawa: Canadian Medical Association; updated 2004.</ref> | |||
==Is circumcision without valid consent battery?== | ==Is circumcision without valid consent battery?== | ||
Boyle et al. (2004) | Boyle et al. (2004) argued that non-therapeutic circumcision of boys is "assault",<ref>{{BoyleGJ SvobodaJS PriceCP TurnerJN 2000}}</ref> but is it actually battery? | ||
<b>Simple battery</b> is defined as: | <b>Simple battery</b> is defined as: | ||
<blockquote> | <blockquote> | ||
| Line 1,009: | Line 1,010: | ||
|date=2025-02 | |date=2025-02 | ||
|accessdate=2025-06-29 | |accessdate=2025-06-29 | ||
}}</ref> | }}</ref> | ||
</blockquote> | </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]] | * [[Brian D. Earp]] | ||
* [[Brussels Collaboration on Bodily Integrity]] | * [[Brussels Collaboration on Bodily Integrity]] | ||
* [[Human rights]] | * [[Human rights]] | ||
* [[Informed consent]] | |||
* [[Jurisprudence]] | * [[Jurisprudence]] | ||
* [[Surrogate consent]] | |||
{{LINKS}} | {{LINKS}} | ||
* {{REFjournal | * {{REFjournal | ||
| Line 1,027: | Line 1,030: | ||
|date=1999 | |date=1999 | ||
|volume=83 Suppl. 1 | |volume=83 Suppl. 1 | ||
|pages=22- | |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 | |accessdate=2023-05-27 | ||
}}</ref> | }}</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}} | ||