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The medical ethics committee of the [https://www.bma.org.uk/ British Medical Association] also reviewed the ethics behind circumcision. Since circumcision has associated medical and psychological risks with no unequivocally proven medical benefits, they advise physicians to keep up with clinical evidence and only perform this procedure if it's in the child best interest.<ref name="bma2006" /> However, they acknowledge the procedure as a cultural and religious practice, which may be an important ritual for the child's incorporation into the group.<ref name="bma2006"/> They recognize that parents have the authority to make choices for their child, and they emphasize it is important for parents to act in their child's best interest.<ref name="bma2006"/> They ultimately report that views vary in their community about the benefits and risks of the procedure, and there is no clear policy for this situation.<ref name="bma2006"/>
====Adult circumcision====
In a paper published June 2006, the [https://www.bma.org.uk/ British Medical Association] Committee on Medical Ethics does not consider circumcision of an adult male to be controversial, provided that the adult is of sound mind and grants his personal consent after receiving all material information regarding the known risks, disadvantages, and potential benefits to be derived from the surgical operation.<ref name="bma2006" />
====Child circumcision====
In the same British Medical Association paper, circumcision of a child to treat a clear and present medical indication after a trial of conservative treatment also is not considered to be ethically questionable, provided that a suitable surrogate has granted surrogate consent after receiving all material information regarding the known risks, disadvantages, and potential benefits to be derived from the surgical operation.<ref name="bma2006"/>
====Criticism and revision of BMA statement====
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
|init=R
|authorlink=
|date=2004-06
|title=The development of professional guidelines on the law and ethics of male circumcision
|url=http://jme.bmj.com/cgi/content/full/30/3/254
|journal=Journal of Medical Ethics
|volume=30
|issue=3
|pages=254-258
|DOI=10.1136/jme.2004.008615
|pubmedCID=1733857
|pubmedID=15173358
|accessdate=
|quote=
}}</ref> He identifies this as a difficulty in achieving consensus within the medical ethics committee. Arguments put forward in discussions, according to Mussell, included the social and cultural benefits of circumcision, the violation of the child's rights, and the violation of the child's autonomy.<ref name="mussell2004"/>
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
|init=M
|last2=Thomson
|init2=M
|title=A covenant with the status quo? Male circumcision and the new BMA guidance to doctors
|journal=Journal of Medical Ethics
|date=2005
|volume=31
|issue=8
|pages=463-469
|url=http://jme.bmj.com/content/31/8/463.full
|DOI=10.1136/jme.2004.009340
|pubmedID=16076971
|pubmedCID=1734197
}}</ref> The BMA issued a revised statement in 2006 and now reports the controversy regarding the lawfulness of non-therapeutic child circumcision and recommends that doctors obtain the consent of ''both'' parents before performing non-therapeutic circumcision of a male minor. The revised statement now mentions that male circumcision is generally assumed to be lawful provided that it is performed competently, is believed to be in the child's best interests, and there is valid consent from both parent or the child if it is capable of expressing a view.<ref name="bma2006" />
Regardless 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 these issuesa neonate, infant or child. They balanced this against the general practice [[pain]], [[trauma]], and loss of body tissue and function. They concluded the medical community 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 is to receive surrogate informed ]] and elsewhere of parental consent or permission from parents or legal guardians for non-therapeutic circumcision of childrenis entirely unethical.<ref name="bma2006myers2020">{{REFjournal |last=Myers |first= |init=A |author-link=Alex Myers |last2=Earp |first2= |init2=BD |author2-link=Brian D. Earp |etal=no |title=What is the best age to circumcise? A medical and ethical analysis |trans-title= |language= |journal= Bioethics |location= |date=2020 |volume=34 |issue=7 |pages=645-63 |url=https://www.researchgate.net/profile/Brian-Earp-2/publication/337720859_What_Is_the_Best_Age_to_Circumcise_A_Medical_and_Ethical_Analysis/links/5f815f61a6fdccfd7b555395/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=32068898 |pubmedCID= |DOI= |doi=10.1111/>bioe.12714 |format=PDF |accessdate=2020-05-27}}</ref name="povenmire"/>
The non-therapeutic circumcision industry in the United States produces more than $1 billion annually. 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 $1 billion annual business would collapse. The American medical trade associations, more than other nations, have been unwilling to recognize the child's right to bodily integrity, to security of the person, and the right to personal autonomy.== Observations ==
* {{REFjournal
|last=Freeman
|init=MD
|authorlink=
|date=1999
|title=A child's right to circumcision
|journal=BJU Int
|volume=83
|issue=Suppl. 1
|pages=74-78
|pubmedID=10349417
|DOI=10.1046/j.1464-410x.1999.0830s1074.x
}}
→The emerging consensus on surrogate consent for non-therapeutic newborn, infant, and child circumcision: Update URL.
{{Construction Site}}Male [[circumcision]] is the surgical removal of the [[foreskin]] (prepuce) from the human [[penis]].<ref name=sawyer_2011>{{REFbook
|last=Sawyer
|init=S
}}</ref><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>
Some [[Medical trade association| medical trade associations take ]] formerly took the position that the parents should determine what is in the best interest of the newborn, infant , or child.<ref name="AAP1999">{{REFjournal
|last=Task force on circumcision
|title=Circumcision policy statement
|pubmedID=10049981
|pubmedCID=
}},</ref> Others say that circumcision is an infringement of however the child's autonomy and should be delayed until he is capable of making the decision himself.<ref name="KNMG2010">AAP has now abandoned all previous position statements on male [[http://circumstitions.com/Docs/KNMG-policy.pdf Non-Therapeutic Circumcision of Male Minorscircumcision]]. Utrecht: Royal Dutch Medical Association, 2010.</ref>
Others say that circumcision is an infringement of the child's autonomy and should be delayed until he is capable of making the decision himself.<ref name="KNMG2010">[http://circumstitions.com/Docs/KNMG-policy.pdf Non-Therapeutic Circumcision of Male Minors]. Utrecht: Royal Dutch Medical Association, 2010.</ref> A circumcision operation may be performed at any age, so an [[intact]] boy may elect to have a [[circumcision]] whenever he wishes. ==Medical societies trade association views==
===Australia and New Zealand===
[[File:Flag of Australia (converted).svg|thumb|upright=0.3]]
The [https://www.racp.edu.au/ Royal Australasian College of Physicians] (2010) released a statement indicating that neonatal male circumcision "generally considered an ethical procedure", provided that 1) the child's decision makers, typically the parents, are acting in best interest of child and have been given full knowledge and 2) the procedure is performed by a competent provider, with sufficient analgesia, and does not unnecessarily harm the child or have substantial risks.<ref name="racp2010">[https://www.racp.edu.au/docs/default-source/advocacy-library/circumcision-of-infant-males.pdf Circumcision of Male Infants.] [[Royal Australasian College of Physicians]]. September 2010.</ref> They argue that parents should be allowed to be the primary decision-makers because providers may not understand the full psychosocial benefits of circumcision.<ref name="racp2010" /> Additionally, this procedure does not present substantial harm compared to its potential benefits, so parents should be allowed full decision-making capacity as long as they are educated properly.<ref name="racp2010"/>
This statement also recognizes that waiting until the boy is of sufficient age to make his own decision would better respect his autonomy, but points out that this may interfere with a child's religious inclusion that [[circumcision ]] was meant to confer.<ref name="racp2010"/> With neonatal male circumcision, they acknowledge that the child may later on disagree with the parents' decision <ref name="racp2010"/> but using the same reasoning, an [[uncircumcised]] child may also disagree with his parents' decision not to have him circumcised in infancy.,<ref name="racp2010"/>but he can have a circumcision at any age.
===Canada===
|pubmedID=26435672
|pubmedCID=4578472
}}</ref> Since children require a substituted decision maker acting in their best interests, they recommend to hold off deferring non-medically indicated procedures, such as [[circumcision]], until children can make their own decisions. Yet the CPS also self-servingly states that parents of male newborns must receive unbiased information about neonatal circumcision, so that they can weigh specific risks and benefits of circumcision in the context of their own familial, religious and cultural beliefs.!<ref name="CPS2015"/>
===[[Denmark]] ===
[[File:Flag of Denmark.svg|thumb|upright=0.3]]
=== Scandinavia ===
In 2013 children's ombudsmen from Sweden, Norway, Finland, [[Denmark]], and Iceland, along with the Chair of the Danish Children's Council and the children's spokesperson for Greenland, passed a resolution that emphasized the decision to be circumcised should belong to the individual, who should be able to give [[informed consent]].<ref name="resolution2">{{REFweb
|last=Nordic Association of Children's Ombudsmen
|title=Let the boys decide for themselves
}}[] Tuesday, 1 October 2013</ref>
The Nordic Association of Clinical Sexologists supports the position of the Nordic Association of Ombudsmen who reason that circumcision violates the individual's [[human rights ]] by denying the male child his ability to make the decision for himself.<ref>[http://nacs.eu/data/press_release001.pdf Statement on Non-Therapeutic Circumcision of Boys.]. Nordic Association of Clinical Sexologists, Helsinki, 10 October 2013.</ref>
The medical doctors at Sørland Hospital in Kristiansand, Southern Norway have all refused to perform circumcisions on boys, citing reasons of conscience.<ref>{{REFnews
===United Kingdom===
[[File:Flag of the United Kingdom.svg|thumb|upright=0.3]]
====2019 revision of BMA guidance====
The [[British Medical Association]], being cognizant of the [[Re B and G (children) (No 2) EWFC 3]] (2015) and [[Re L and B (CHILDREN)]] (2016) family court decisions, issued a new guidance to its member physicians in 2019. The new guidance urges its member physicians to take an extremely cautious approach to parental requests for the performance of non-therapeutic [[circumcision]] on minor boys and to ascertain that the requested non-therapeutic circumcision is in the boy's best interests.<ref name="bma2019">{{REFdocument
|title=Non-therapeutic male circumcision (NTMC) of children – practical guidance for doctors
|url=https://www.bma.org.uk/media/1847/bma-non-therapeutic-male-circumcision-of-children-guidance-2019.pdf
|contribution=
|last=Anonymous
|first=
|publisher=British Medical Association
|date=2019
|accessdate=2021-06-29
}}</ref>
[[Antony Lempert| Lempert]] et al. (2022) criticized the 2019 BMA guidance for "serious weaknesses". They listed:
# the absence of an explicit stance on the underlying ethical status of NPC, coupled with an implicit permissive stance,<br>
# an incoherent and impracticable analysis of the child’s best interests,<br>
# unbalanced guidance regarding cultural issues,<br>
# unbalanced guidance regarding scientific issues,<br>
# unjustified differential treatment of children of the same sex,<br>
# unjustified differential treatment of children of different sexes,<br>
# problems with child safeguarding, and
# problems with regulation and training,<br>
# an unjustified presumption of lawfulness of NPC of minors, and<br>
# failure adequately to address recent case law.<ref name="lempert2022">{{REFjournal
|last=Lempert
|first=Antony
|init=A
|author-link=Antony Lempert
|last2=Chegwidden
|first2=James
|init2=J
|author2-link=James Chegwidden
|last3=Steinfeld
|first3=Rebecca
|init3=R
|author3-link=Rebecca Steinfeld
|last4=Earp
|first4=Brian D.
|init4=BD
|author4-link=Brian D. Earp
|etal=no
|title=Non-therapeutic penile circumcision of minors: Current controversies in UK law and medical ethics.
|journal=Clinical Ethics
|location=
|date=2022-05
|season=
|volume
|issue=
|article=
|page=
|pages=
|url=https://www.researchgate.net/publication/360642209_Non-therapeutic_Penile_Circumcision_of_Minors_Current_Controversies_in_UK_Law_and_Medical_Ethics
|archived=
|quote=
|pubmedID=
|pubmedCID=
|DOI=
|accessdate=2022-05-20
}}</ref>
==== American Academy of Pediatrics ====
The [[American Academy of Pediatrics ]] currently has ''no'' official stance on neonatal circumcision. The previous statement expired in 2017 and has not been reaffirmed.<ref>{{REFjournal
|last=Task Force On Circumcision
|date=2012-09-01
=====Criticism=====
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.
In a dissenting paper, Frisch et al. (2013) point out "Circumcision fails to meet the criteria to serve as a preventive measure for UTI [...] As a preventive measure for penile cancer, circumcision also fails to meet the criteria for preventive medicine [...] circumcision for [[HIV ]] protection in Western countries fails to meet the criteria for preventive medicine [...] Circumcision fails to meet the commonly accepted criteria for the justification of preventive medical procedures in children."
Frisch et al. conclude that "The AAP report lacks a serious discussion of the central ethical dilemma with, on one side, parents’ right to act in the best interest of the child on the basis of cultural, religious, and health-related beliefs and wishes and, on the other side, infant boys’ basic right to physical integrity in the absence of compelling reasons for surgery. Physical integrity is one of the most fundamental and inalienable rights a child has. Physicians and their professional organizations have a professional duty to protect this right, irrespective of the gender of the child."
|pubmedID=23509170
|issn=0031-4005
}}</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
|last=Task Force On Circumcision
|date=2013-04-01
== Journal of Medical Ethics ==
<!--
===JME symposium on circumcision, June 2004===
The ''Journal of Medical Ethics'' published a "symposium on circumcision" in its June 2004 issue.<ref name="symposium2004">{{REFjournal
|pubmedCID=1733850
}}</ref>
-->
===Journal of Medical Ethics circumcision issue, July 2013===
The ''Journal of Medical Ethics'' devoted the entire July 2013 issue to the controversial issue of non-therapeutic circumcision of male children.<ref>{{REFjournal
==Other views==
Povenmire (1988) argues argued that parents should not have the power to consent to neonatal non-therapeutic circumcision.<ref name="povenmire"/>
Richards (1996) argues argued that parents only have power to consent to therapeutic procedures.<ref name="richards"/>
[[Margaret A. Somerville|Somerville]] (2000) argues that the nature of the medical benefits cited as a justification for infant circumcision are such that the potential medical problems can be avoided or, if they occur, treated in far less invasive ways than circumcision. She states that the removal of healthy genital tissue from a minor should not be subject to parental discretion, or that physicians who perform the procedure are not acting in accordance with their ethical duties to the patient, regardless of parental consent.<ref name="Somerville2000">{{REFbook
|last=Somerville
|first=MargaretA. |init=M
|author-link=Margaret A. Somerville
|title=The ethical canary: science, society, and the human spirit
}}</ref>
[[Margaret A. Somerville|Somerville]] argues that because of a lack of credible information about male circumcision in some societies, the ability for the caregiver to grant [[informed consent ]] on behalf of their child is compromised. This may be especially true of caregivers from a religious or cultural tradition that is particularly biased towards or against circumcising infants.<ref name="Somerville2000"/>
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
}}</ref>
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
|last=College of Physicians & Surgeons of British Columbia
|title=Circumcision (Infant Male)
}}</ref>
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>-->
The Belgian Federal 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
|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.
}}</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 Federal Institute for health insurance 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>{{REFweb |url=https://www.standaard.be/cnt/dmf20170920_03084394 |title=De Block blijft besnijdenis terugbetalen |last=Vergauwen |first=Eveline |website=De Standaard |language=nl-BE |access-date=2019-06-14}}</ref>--><!--==HIV in southern and eastern Africa=={{Main|Circumcision and HIV}} Rennie et al. (2007) remark that the results of three randomised controlled trials in sub-Saharan Africa, showing reduced risk of HIV among circumcised men, "alter the terms of the debate over the ethics of male circumcision."<ref name="rennie2007">{{REFjournal |last=Rennie |first=Stuart |init=S |authorlink= |last2=Muula |first2=Adamson S. |init2=AS |last3=Westreich |first3=Daniel |init3=D |date=2007-06 |title=Male circumcision and HIV prevention: ethical, medical and public health tradeoffs in low-income countries |journal=Journal of Medical Ethics |volume=33 |issue=6 |pages=357-361 |pubmedID=17526688 |url=http://jme.bmj.com/cgi/content/full/33/6/357 |accessdate= |pubmedCID=2598273 |quote= |DOI=10.1136/jme.2006.019901}}</ref> However, the methodology of the African RCTs has been severely criticised, thereby invalidating claims that circumcision reduces the sexual transmission of HIV.<ref>{{REFbook |last=Boyle |first=G.J. |author-link=Gregory Boyle |year=2013 |chapter=Critique of African RCTs into Male Circumcision and HIV Sexual Transmission. |editors=[[George C. Denniston]], [[Frederick M. Hodges]], [[Marilyn Fayre Milos]] |title=Genital Cutting: Protecting Children from Medical, Cultural, and Religious Infringements |location=Dordrecht, The Netherlands |publisher=Springer Science+Business Media |DOI=10.1007/978-94-007-6407-1_15 |isbn=978-94-007-6406-4}}</ref> Supporters of circumcision argue that using circumcision and other available means to halt the spread of HIV is in the common good (but overlook the fact that HIV is transmitted in the seminal fluid). Rennie et al. argue that "it would be unethical to not seriously consider one of the most promising—although also one of the most controversial—new approaches to HIV-prevention in the 25-year history of the epidemic."<ref name="rennie"/> However, there clearly remains a risk of transmitting or acquiring HIV while engaging in unprotected sex and other high risk behaviors (circumcised or not). The [[World Health Organization]] (2007) states that provision of circumcision should be consistent with "medical ethics and human rights principles." They state that "[i]nformed consent, confidentiality and absence of coercion should be assured. ... Parents who are responsible for providing consent, including for the circumcision of male infants, should be given sufficient information regarding the benefits and risks of the procedure in order to determine what is in the best interests of the child."<ref>WHO/UNAIDS Technical Consultation. [http://www.who.int/entity/hiv/mediacentre/MCrecommendations_en.pdf Male Circumcision and HIV Prevention: Research Implications for Policy and Programming]. Montreux, 6–8 March 2007</ref> However, since babies and children are not sexually active, sexually-transmitted HIV infection is not a relevant concern. Critics of non-therapeutic circumcision argue that advocating circumcision to prevent HIV infection may detract from other efforts to prevent the spread of the virus such as using condoms. If the adult chooses to remain celibate or if a couple remain monogamous, or if HIV is eliminated by the time the child is an adult, the sexual reduction surgery would not have been needed. Moreover, they argue that circumcising a child purportedly to partially protect him from HIV infection in adulthood may be seen as granting permission to engage in dangerous sexual practices. Obviously baby boys do not need such protection and can choose for themselves as consenting adults if they want a circumcision.<ref name="Somerville"/> This stance, however, does not take into account the fact that adult men may already have contracted HIV before getting circumcised.<ref>{{REFjournal |last=Harmon |first=Katherine |init=K |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 |journal=Nature News |language=en |DOI=10.1038/nature.2011.9520 |date=2011}}</ref> The UK National Health Service ([[NHS]]) has stated that the African studies have "important implications for the control of sexually transmitted infections in Africa", but that in the United Kingdom practising safe sex including condom use is the best way to prevent sexually-transmitted disease when having sex.<ref>{{REFweb |url=https://www.nhs.uk/news/lifestyle-and-exercise/circumcision-and-stis/ |title=Circumcision and STIs |date=2009-03-26}}</ref>-->
==Surrogate consent==
|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> Some believe that consent 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
|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 is was an unresolved question whether surrogates may grant effective consent for non-therapeutic child circumcision.<ref name="povenmire">{{REFjournal
|last=Povenmire
|init=R
|url=http://www.cirp.org/library/legal/povenmire/
|accessdate=2013-11-25
}}</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
|last=Richards
|init=D
|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" /> == 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=SorakanCommittee on Bioethics |initetal=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=ST |last2quote=Finlay |init2pubmedID=JC7838658 |last3pubmedCID=Jefferies |init3DOI=AL |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=Committee on Bioethics |etal-no |title=Newborn male 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=G |author-link=George Hill |title=Can anyone authorize the nontherapeutic permanent alteration of a child's body? |journal=Paediatr Child HealthThe American Journal of Bioethics |date=20152003 |volume=203 |issue=62 |pages=31116-3158 |url=httphttps://www.cpsresearchgate.canet/enprofile/documentsGeorge-Hill-3/publication/position371599857_Can_Anyone_Authorize_the_Nontherapeutic_Permanent_Alteration_of_a_Child's_Body/circumcisionlinks/648b8819c41fb852dd0949be/Can-Anyone-Authorize-the-Nontherapeutic-Permanent-Alteration-of-a-Childs-Body.pdf |quote= |pubmedID=2643567214635628 |pubmedCID=4578472 |DOI=10.1162/152651603766436342 |format=PDF |accessdate=2023-07-11}}</ref>-->
Moreover, non-therapeutic circumcision of boys may also be unlawful,<ref name="Adler">{{REFjournal |last=ObservationsAdler |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> if a court should accept Adler's arguments.
The non-therapeutic circumcision industry in the United States produces more than $2 billion annually.<ref name="bollinger2012">{{REFweb
|url=https://www.academia.edu/6442587/High_Cost_of_Circumcision_3.6_Billion_Annually
|title=High Cost of Circumcision: $3.6 Billion Annually
|last=Bollinger
|first=Dan
|author-link=Dan Bollinger
|publisher=Academia
|website=https://www.academia.edu
|date=2012
|accessdate=2021-11-12
|format=
|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.
}}</ref> [[Third-party payment]] is a major support to the performance of this 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 $2 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 right to [[physical integrity]], to security of the person, and the right to personal autonomy.
{{SEEALSO}}
* [[Brian D. Earp]]
* [[Human rights]]
{{LINKS}}
* {{REFjournal
|last=Goodman
|DOI=10.1046/j.1464-410x.1999.0830s1022.x
|pubmedID=10349411
|accessdate=2023-05-27}}</ref></ref>
{{REF}}
[[Category:Medical ethics]]
[[Category:Human rights]]