Changes

Male [[circumcision]] is the surgical removal of the [[foreskin]] (prepuce) from the human penis.<ref name=sawyer_2011>{{REFbook

|last=Sawyer

|title=Pediatric Physical Examination & Health Assessment

|pages=555-556

}}</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

|last=Boyle

|author-link=Gregory Boyle

|last2=Svoboda

|author2-link=J. Steven Svoboda

|last3=Price

|author3-link=Christopher P. Price

|last4=Turner

|author4-link=J. Neville Turner

|title=Circumcision of healthy boys: Criminal assault?

|url=http://www.cirp.org/library/legal/boyle1/

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

|last2=Finla

|last3=Jefferies

|title=Newborn male circumcision

|journal=Paediatr Child Health

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

|last=Mussell

|authorlink=

|date=2004-06

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

|last=Fox

|last2=Thomson

|title=A covenant with the status quo? Male circumcision and the new BMA guidance to doctors

|journal=Journal of Medical Ethics

|last=Van Howe

|first=Robert S.

|last2=Svoboda

|first2=J. Steven

|date=2013-07-01

|title=Out of step: fatal flaws in the latest AAP policy report on neonatal circumcision

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

|last2=Aigrain

|last3=Barauskas

|last4=Bjarnason

|last5=Boddy

|last6=Czauderna

|last7=de Gier

|last8=de Jong

|last9=Fasching

|date=2013-04-01

|title=Cultural Bias in the AAP's 2012 Technical Report and Policy Statement on Male Circumcision

"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

|title=Irreversible bodily interventions in children

|journal=Journal of Medical Ethics

"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

|title=Circumcision: a surgeon’s perspective

|journal=Journal of Medical Ethics

"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

|title=Male circumcision: a scientific perspective

|journal=Journal of Medical Ethics

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

|title=Value judgment, harm, and religious liberty

|journal=Journal of Medical Ethics

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

|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

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

|title=The development of professional guidelines on the law and ethics of male circumcision

|journal=Journal of Medical Ethics

}}</ref> The numerous articles represent a diverse variety of views.<ref>{{REFjournal

|last=Foddy

|title=The concise argument: Medical, religious and social reasons for and against an ancient rite

|journal=Journal of Medical Ethics

}}</ref><ref>{{REFjournal

|last=Earp

|title=The ethics of infant male circumcision

|journal=Journal of Medical Ethics

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

|title=Informed consent for neonatal circumcision: an ethical and legal conundrum

|journal=J Urol

<!--[[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

|last=Morris

|authorlink=Brian J. Morris

|last2=Bailis

|last3=Wiswell

|title=Circumcision rates in the United States: rising or falling? What effect might the new affirmative pediatric policy statement have?

|journal=Mayo Clinic Proceedings

|last=Rennie

|first=Stuart

|authorlink=

|first2=Adamson S.

|first3=Daniel

|date=2007-06

|title=Male circumcision and HIV prevention: ethical, medical and public health tradeoffs in low-income countries

|last=Harmon

|first=Katherine

|title=Can male circumcision stem the AIDS epidemic in Africa?

|url=http://www.nature.com/news/can-male-circumcision-stem-the-aids-epidemic-in-africa-1.9520

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

|first=J. Steven

|first2=Robert S.

|first3=James G.

|author3-link=James G. Dwyer

|title=Informed Consent for Neonatal Circumcision: An Ethical and Legal Conundrum

There is an unresolved question whether surrogates may grant effective consent for non-therapeutic child circumcision.<ref name="povenmire">{{REFjournal

|last=Povenmire

|authorlink=

|date=

|accessdate=2013-11-25

}}</ref><ref name="conundrum"/><ref name="Adler">{{REFjournal

|first=Peter W.

|author-link=Peter W. Adler

|url=http://rjolpi.richmond.edu/archive/Adler_Formatted.pdf

}}</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

|authorlink=

|date=1996-05

}}</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

|last2=Finlay

|last3=Jefferies

|title=Newborn male circumcision

|journal=Paediatr Child Health

{{SEEALSO}}

* [[Human rights]]

{{LINKS}}

* {{REFjournal

|last=Freeman

|authorlink=

|date=1999

* {{REFjournal

|last=Goodman

|journal=BJU Int

|date=1999