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==Surrogate consent==
Patient autonomy is an important 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.
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="bioethics">{{REFjournal
|last=Committee on Bioethics
|title=Informed consent, parental permission, and assent in pediatric practice
|journal=Pediatrics
|date=1995
|volume=95
|issue=2
|pages=314-317
|url=http://pediatrics.aappublications.org/content/95/2/314.full.pdf
|pubmedID=7838658
}} 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"/>
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 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
|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" />
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" />
→Surrogate consent
|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.
== The emerging consensus on surrogate consent for non-therapeutic newborn, infant, and child circumcision ==