Changes

}}</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 |init=GJ |author-link=Gregory Boyle |last2=Svoboda |init2=JS |author2-link=J. Steven Svoboda |last3=Price |init3=CP |author3-link=Christopher P. Price |last4=Turner |init4=JN |author4-link=J. Neville Turner |date=BoyleGJ SvobodaJS PriceCP TurnerJN 2000 |title=Circumcision of healthy boys: Criminal assault? |url=http://www.cirp.org/library/legal/boyle1/ |journal=Journal of Law and Medicine |volume=7 |issue= |pages=301–310}}</ref><ref name="RACPSumm">{{REFweb

The expired American Academy of Pediatrics (AAP) position statement on male circumcision (2012) has attracted significant critical commentduring its brief life, including from the AAP itself.

}}</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

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

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"/> <!--[[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=MorrisFox |init=BJ |authorlink=Brian J. MorrisM |last2=BailisThomson |init2=SA |last3=Wiswell |init3=TEM |title=Circumcision rates in A covenant with the United States: rising or fallingstatus quo? What effect might Male circumcision and the new affirmative pediatric policy statement have?BMA guidance to doctors |journal=Mayo Clinic ProceedingsJournal of Medical Ethics |date=2014-052005 |volume=8931 |issue=58 |pages=677463-686469 |url=http://jme.bmj.com/content/31/8/463.full |DOI=10.10161136/j.mayocp.2014jme.012004.001009340 |pubmedID=2470273516076971 |pubmedCID=1734197}}</ref>-->

}}</ref> Some believe that consent Consent for a non-therapeutic operation offends the principle of autonomy, when granted by a surrogate.

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

}}</ref> <ref name="conundrum"/><ref name="Adler">{{REFjournal |last=Adler |first=Peter W. |init=PW |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

}}</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" /> == 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="aap1995">{{REFjournal |last=Committee on Bioethics |etal=no |title=Informed consent, parental permission, and assent in pediatric practice |trans-title= |language= |journal=Pediatrics |location= |date=1995-02 |volume=95 |issue=2 |article= |page= |pages=314-7 |url=http://www.cirp.org/library/ethics/AAP/ |archived= |quote= |pubmedID=7838658 |pubmedCID= |DOI= |accessdate=2023-05-26}}</ref> 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=SorakanCommittee 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. There are no medical indications for a neonatal [[circumcision]]. 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. 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=STG |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 |accessdate=2023-07-11}}</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 name="myers2020">{{REFjournal |last=Myers |first= |init=A |author-link=Alex Myers |last2=FinlayEarp |first2= |init2=JCBD |last3author2-link=JefferiesBrian D. Earp |init3etal=ALno |title=Newborn male circumcisionWhat is the best age to circumcise? A medical and ethical analysis |trans-title= |language= |journal=Paediatr Child HealthBioethics |location= |date=20152020 |volume=2034 |issue=67 |pages=311645-31563 |url=httphttps://www.cpsresearchgate.canet/profile/Brian-Earp-2/publication/en337720859_What_Is_the_Best_Age_to_Circumcise_A_Medical_and_Ethical_Analysis/documentslinks/position5f815f61a6fdccfd7b555395/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=2643567232068898 |pubmedCID=4578472 |DOI= |doi=10.1111/bioe.12714 |format=PDF |accessdate=2020-05-27

Regardless of these issuesMoreover, 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.boys may also be unlawful,<ref name="bma2006Adler">{{REFjournal |last=Adler |first=Peter W. |init=PW |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 name="povenmire"/>if a court should accept Adler's arguments.

==Observations==

|quote=As they 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.

|accessdate=2023-05-27}}</ref></ref>