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= | ||
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}}</ref> Medical doctors have a general duty to respect the [[human rights]] of their patients. | }}</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 == | ||
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|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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|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 | ||
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==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= | ||
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|url= | |url= | ||
|work= | |work= | ||
|editor= | |editor=Beauchamp TL, Walters L | ||
|edition= | |edition= | ||
|volume= | |volume= | ||
| Line 143: | 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.) | ||
* <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>{{REFjournal | * <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= | |last=American Academy of Pediatrics Committee on Bioethics | ||
|first= | |first= | ||
|init= | |init= | ||
|author-link= | |author-link= | ||
|etal=no | |||
|etal= | |||
|title=Informed Consent, Parental Permission, and Assent in Pediatric Practice | |title=Informed Consent, Parental Permission, and Assent in Pediatric Practice | ||
|journal=Pediatrics | |journal=Pediatrics | ||
| | ||date=1995-11 | ||
|volume=96 | |||
|volume= | |issue=5 Pt 1 | ||
|issue= | |pages=981-2 | ||
|pages= | |||
|url=https://www.cirp.org/library/ethics/AAP/ | |url=https://www.cirp.org/library/ethics/AAP/ | ||
|archived= | |archived= | ||
|quote= | |quote= | ||
|pubmedID= | |pubmedID=7478854 | ||
|pubmedCID= | |pubmedCID= | ||
|DOI= | |DOI= | ||
| Line 210: | Line 175: | ||
|accessdate=2025-06-30 | |accessdate=2025-06-30 | ||
}}</ref> | }}</ref> | ||
* Preservation of the child’s right to an open future<ref>{{REFweb | * <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 | ||
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}}</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 | ||
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}}</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 | ||
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}}</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 531: | 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 1,043: | Line 977: | ||
[[Third-party payment]] is a major support to the performance of this injurious medically-unnecessary surgery. If parents could not grant consent for non-therapeutic circumcision, then no one could grant consent for the non-therapeutic circumcision of a child, so the $3.6 billion annual business would collapse. The American [[Medical trade association| medical trade associations]], more than those of other nations, have been unwilling to recognize the child's [[human rights]] to [[physical integrity]], to security of the person, and the right to personal autonomy. | [[Third-party payment]] is a major support to the performance of this injurious medically-unnecessary surgery. If parents could not grant consent for non-therapeutic circumcision, then no one could grant consent for the non-therapeutic circumcision of a child, so the $3.6 billion annual business would collapse. The American [[Medical trade association| medical trade associations]], more than those of other nations, have been unwilling to recognize the child's [[human rights]] to [[physical integrity]], to security of the person, and the right to personal autonomy. | ||
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> | 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> | ||
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* [[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 1,095: | 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}} | ||