Changes

French physician [[Claude François Lallemand]] (1790 – 1854) recommended [[circumcision]] as a treatment for ''spermatorrhea '' (excessive, involuntary ejaculation), which was then believed to be a disease. Lallemand influenced later English physicians such as [[William Acton]].<ref name="darby2005">{{REFjournal

[[Edward H. Dixon]] (1845) from New York, [[United States| USA]], advocated circumcision to prevent [[masturbation]].<ref name="Dixon1845">{{Dixon1845}}</ref>

[[R. W. Cockshut|Cockshut]] (1935) published a letter in the ''British Medical Journal'' that urged circumcision of all male infants because the "glans of the circumcised rapidly assumes a leathery texture less sensitive than [[skin]]." The advantage, according to [[R. W. Cockshut|Cockshut]], is that masturbation would be reduced.<ref name="cockshut1935">{{REFjournal

Rickwood et al. (2000) reported that the incidence of boys [[circumcised ]] reached 35 percent by the early 1930s.<ref name="rickwood2000">{{REFjournal

A national election was held in the United Kingdom at the end of World War II. The Labour Party gained a majority of the seats in Parliament and its leader, Clement Atlee, became prime minister. The party leaned to the left and supported social welfare. Aneurin Bevan was Minister of Health. [https://www.nhs.uk/ The National Health Service] (NHS) was created in 1948 to provide free medical treatment for all. Services were provided based on clinical need, not ability to pay. The NHS did not provide non-therapeutic [[circumcision]], so the incidence of circumcision dropped to a very low level.<ref name="gollaher1994">{{REFjournal |last=Gollaher |first=David L. |init=DL |author-link=David Gollaher |title=From ritual to science: the medical transformation of circumcision in America |journal=Journal of Social History |date=GollaherDL 1994-09 |volume=28 |issue=1 |pages=5-36 |url=http://www.cirp.org/library/history/gollaher/ |accessdate=2021-10-26}}</ref>

Sir [[James Calvert Spence]], a prominent senior British paediatrician, urged his younger colleague, [[Douglas Gairdner]], to produce a paper on infant circumcision. The now famous classic paper, ''The fate of the foreskin: a study of circumcision'', was published in the ''British Medical Journal'' on Christmas Eve, 1949. The paper reported 16 deaths per year from non-therapeutic infant circumcision and concluded in part: "'''The prepuce of the young infant should therefore be left in its natural state.'''"<ref name="gairdner1949">{{GairdnerDM 1949}}</ref>

The NHS provides male circumcision only when there was a clinical need.<ref>{{REFweb

}}</ref> The NHS performs circumcisions on boys only for therapeutic need.<refname="nhschild">{{REFweb

The ''British Medical Journal'', the house organ of the [https://www.bma.org.uk British Medical Association], in an unsigned editorial in 1979, slammed the practice of child circumcision, calling it unnecessary, and citing the danger of contracting staphylococcal [[infection ]] in the newborn nursery.<ref>{{REFjournal

|first=Robert S.

|author-link=Robert S. Van Howe

|trans-title= |language= |journal= Clin Pediatr (Phila)

Fewer boys were being [[circumcised ]] so there were more [[intact]] boys. The general practitioners (GPs) in the UK seemed to be unable to distinguish between true [[phimosis]] and developmentally non-retractile healthy [[foreskin ]] and were referring numerous boys for unnecessary [[circumcision]].

Rickwood et al. (1980) had provided guidance on diagnosis of [[phimosis]]. According to Rickwood et al. true [[phimosis ]] occurs when the [[foreskin]] has been attacked by [[balanitis xerotica obliterans ]] (BXO) (also known as lichen sclerosis). If BXO is not present then true phimosis does not exist.<ref name="rickwood1980">{{REFjournal

Several papers critical of phimosis diagnosis practice in the UK were published in the late 1980s and early 1990s. Rickwood & Walker (1989) reported that in the Mersey region (northwest England) "many boys are [[circumcised ]] for development non-retractability of the prepuce rather than for true [[phimosis ]] and that in consequence some two-thirds of the operations are unnecessary."<ref name="rickwood1989">{{REFjournal

}}</ref> Griffiths & Frank (1992) also expressed concern regarding the apparent inability of general practitioners to distinguish between a true phimosis and a developmentally non-retractile [[foreskin]]. They pointed out, "Not surprisingly, the diagnostic inaccuracy was greatest when the referring doctor did not examine the patient."<ref name="griffiths1992">{{REFjournal

}}</ref> Williams et al. (1993) complained that most of the 30,000 circumcisions that were being done in the UK were on boys under 15. They reported that of 69 boys referred by GPs, 29 had a healthy retractile [[foreskin]], 30 had a healthy non-retractile foreskin, and only 9 had a phimosis requiring circumcision.<ref name="williams1993"> {{REFjournal

In defence of the much criticised British GPs, it should be stated that the data they were provided by [[Douglas Gairdner]] regarding development of foreskin retractility retractability was very inaccurate,<ref>{{REFjournal

The 2000 British ''National Survey of Sexual Attitudes and Lifestyles'' (Natsal 2000) found that 15.8 percent of British males aged 16 to 44 reported being [[circumcised]]. The incidence of circumcision was highest in the men aged 40-44 at 19.6 percent [born 1956-60] and lowest in the group aged 16-19 [born 1981-84] at 11.7 percent. Men of ethnic minorities (except black Caribbeans) were significantly more likely to circumcised than those described as "white". Jews were 98.7 percent circumcised and Sikhs, Hindus, and Buddhists were only 9.8 percent circumcised.<ref>{{REFjournal

Quaba & MacKindlay (2004) reported a 33.7% decline in the incidence of [[circumcision ]] in Scotland from 1990 to 2000. This occurred because medical doctors were better trained in the recognition of [[Foreskin#Foreskin_in_infancy_and_childhood| healthy non-retractile foreskin in boys]].<ref name="quaba2004">{{REFjournal

"The basic right to bodily integrity which everyone possesses under the English common law means that any unlawful interference in this right amounts to an assault or battery, at the very least, and might in appropriate circumstances entail the statutory offence of grievous bodily harm. The question raised in cases of circumcision, [[excision ]] or [[infibulation ]] is whether the operation can be justified as constituting lawful as opposed to unlawful interference with this right."

"It thus appears that, at common law, while the circumcision of male infants here is lawful, provided that parental consent has been given, no amount of parental agreement or support can legitimise the circumcision, [[excision ]] or [[infibulation ]] of a young girl in this country, unless the operation is for therapeutic purposes."<ref name="poulter1986">{{REFbook

The [https://www.lawcom.gov.uk/ Law Commission of England and Wales] had proposed to recommend that circumcision of male children be made lawful. The late [[Christopher P. Price]], solicitor, , (1996 submitted a brief to the Law Commission in opposition to the proposal,<ref name="price1996">{{REFdocument

|first=Christopher P. |init=CP

|first=ChristopherP. |init=CP

The case of [[Re L and B (CHILDREN)| L and B (2016)]] was a case in which parents disagreed about the circumcision of two boys. The Muslim father wanted the boys circumcised, however the court ruled that no order should be issued so the boys could decide for themselves when they are of age. In this highly significant case, Mrs. Justice Roberts took the decision away from either parents and gave it to the boys, thereby recognising the boys' right to self-determination. Her conclusion is entirely consistent with the rights of the child under [[Human rights| human rights law]]. Her order also is entirely in accord with [https://assembly.coe.int/nw/xml/XRef/Xref-XML2HTML-en.asp?fileid=20174 Resolution 1952] of the [https://www.coe.int/en/web/portal Council of Europe].<ref name="resolution1952">{{REFdocument

The UK signed the ''[https://www.ohchr.org/EN/ProfessionalInterest/Pages/CCPR.aspx [International Covenant on Civil and Political Rights]]'' (ICCPR) on 16 September 1968 and formally ratified the [[ICCPR ]] treaty on 11 December 1968.<ref name="ratstatus">{{REFweb

}}</ref> Article 2 of the [[ICCPR ]] requires the UK to apply and enforce the provisions of the [[ICCPR ]] within its territory. See [[Human_rightsInternational_Covenant_on_Civil_and_Political_Rights#Application_of_the_ICCPR_to_non-therapeutic_circumcision_of_children| ICCPR: Application of the ICCPR to non-therapeutic circumcision of children]] for detailed information on the rights applicable to non-therapeutic circumcision of children.

The United Kingdom became a founder-member of the [https://www.coe.int/en/web/portal Council of Europe] on 5 May 1949 and therefore subject to the [https://rm.coe.int/1680a2353d ''European Convention on Human Rights''] (1950). Under that ''Convention'' the United Kingdom may be sued in the [https://www.echr.coe.int/Pages/home.aspx?p=home&c European Court of Human Rights] (Strasbourg) for alleged [[human rights ]] violations.

The case clearly established the right of children in the UK to protection under the ECHR. Nevertheless, no known cases have applied international [[human rights ]] law specifically to the practice of non-therapeutic child circumcision in the UK.

The [[human rights ]] provisions of the Convention have now been brought into domestic law by the [https://www.legislation.gov.uk/ukpga/1998/42/contents Human Rights Act 1998], so violations of [[human rights ]] law could be litigated in the domestic courts of the UK.

Although the UK has been a member of the [[Council of EuropeDebate Genital Cutting Of Boys| Council of Europe]], a [[human rights ]] organisation since 1949, a state-party to the [[ICCPR ]] since 1976, and the CRC since 1991, the General Medical Council has not revised its policies and procedures to recognise the [[human rights ]] of child patients to the physical security of their person. The GMC holds four disciplinary sessions a year. Over the last decade it has disciplined 39 doctors for ritual (non-therapeutic) [[circumcision]] issues. The Medical Protection Society warned circumcision carries "considerable risks and complications”. Religious and cultural [[circumcision]] on boys is permitted, including by non-doctors, and largely occurs among Jewish, Muslim and some African Christian communities, where they are often considered a religious obligation.<ref>{{REFnews |title=Exposed: the horror statistics behind ritual circumcision of baby boys in the UK |url=https://www.mirror.co.uk/news/uk-news/exposed-horrors-ritual-circumcision-baby-28990951 |last=Penmman |first=Andrew |init= |author-link= |publisher=Mirror |website= |date=2023-01-19 |accessdate=2023-01-20 |format= |quote=}}</ref>

The [https://www.bma.org.uk/ [British Medical Association]] (BMA) is a [[medical trade association]]. It represents and protects the interests of its doctor-members. Unlike American medical trade associations, the BMA do not claim to be an authority on medical science. Its advice to members address ethical and legal issues to assist members in staying out of legal difficulties. The BMA have provided several statements regarding child circumcision to inform its members since 1996:

{{UNI|Keele University |KU}} law professors Fox & Thomson 2005 reviewed the 2003 BMA statement and cited legal deficiencies in that statement.<ref>{{REFjournal

The 2019 BMA guidance regarding non-therapeutic circumcision of boys is divided into twelve “cards”. Card Four discusses law. [[Human rights ]] law is recognised but the BMA fail to understand the significance of [[human rights ]] law. The BMA do not clearly state that [[human rights ]] law grants rights to children which helps to define the best interests of the child and should be respected and protected. The BMA seems to lean toward protecting the alleged right of its members to profit from carrying out non-therapeutic circumcision on boys, in the face of increasingly severe legal concerns. 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 (8) 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> In addition, they noted an egregiously inadequate description of the male [[foreskin]] and its functions.<ref name="lempert2022"/>

* The [[Fifth International Symposium]] convened at the {{UNI|University of Oxford|Oxon}}, Oxford, England, United Kingdom on 5-7 August 1998.

* The [[Tenth International Symposium]] on Circumcision, Genital Integrity and Human Rights convened at the {{UNI|University of Keele|KU}}, Keele, Newcastle, Staffordshire, England, United Kingdom on September 4-6, 2008.

* The [[Fourteenth International Symposium]] on Genital Autonomy and Children's Rights convened at the {{UNI|University of Keele|KU}}, Keele, Staffordshire, England, United Kingdom on September 14-16, 2016.

[[15 Square]] is a registered charity that provides information and aid to parents and both [[intact]] and [[circumcised ]] males. The name refers to the approximate area of the adult male [[foreskin]] in square inches. 15 Square is based in Stone, Staffordshire. 

The BMA (2019) reports reported that the NHS therapeutically circumcises about 10,000 boys under 18-years-of-age per year.<ref name="bma2019">{{REFdocument

|url=https://www.bma.org.uk/advice-and-supportmedia/ethics1847/children-and-youngbma-people/non-therapeutic-male-circumcision-toolkitof-children-guidance-2019.pdf

The incidence of non-therapeutic [[circumcision ]] of boys in the United Kingdom has been substantially reduced from its former peaks in the 1930s and early 1940s. Non-therapeutic circumcision of boys remains lawful provided that both parents grant consent. The practice seems to be concentrated among ethnic minorities. Ethical and [[human rights]] concerns about the surgery persist.