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==Informed consent for non-therapeutic circumcision of minor boys==
A treatment decision should be guided by the best interests of the child, and must balance the potential benefit over the potential harm or risk.<ref> {{REFjournal
|last=Bioethics Committee, Canadian Paediatric Society
|first=
|author-link=
|etal=no
|title=Treatment decisions for infants and children
|trans-title=
|language=
|journal=CMAJ
|location=
|date=1986-09-01
|volume=135
|issue=
|pages=447-8
|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1491550/pdf/cmaj00125-0033.pdf
|archived=
|quote=
|pubmedID=3742387
|pubmedCID=1491550
|DOI=
|accessdate=2020-07-23
}}</ref>
A [[circumcision]] of a boy may be therapeutic or non-therapeutic. Therapeutic circumcision may be justified only in rare cases when the [[foreskin]] is deformed, diseased, or damaged by irreparable [[trauma]] and the apparent benefit to the patient exceeds the risks and harms.
However, the vast and overwhelming majority of circumcisions of children are performed to excise healthy, functional tissue from the body of a child who is too immature to grant consent.
The Bioethics Committee of the [[American Academy of Pediatrics]] (1995) considered the power granted to parents to grant surrogate consent for diagnosis and treatment of a child. The Committee says that a parent may give "informed permission" for investigation and treatment of disease. The difference between informed consent and informed permission is unclear. When a child is ill, it is the practice to allow a parent to grant informed permission for diagnostic tests and appropriate treatment.<ref name="aap1995">{{REFjournal
|last=Bioethics Committee, American Academy of Pediatrics.
|first=
|author-link=
|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
|pages=314-7
|url=http://www.cirp.org/library/ethics/AAP/
|archived=
|quote=
|pubmedID=7838658
|pubmedCID=
|DOI=
|accessdate=2020-07-23
}}</ref>
Infant boys are born with a healthy [[foreskin]]. No disease or deformity is present to be diagnosed or treated. [[Circumcision]] of an infant boy is neither a diagnostic procedure nor a treatment for disease. The limited parental surrogate powers to grant informed permission recognized by the Bioethics Committee do not extend to the granting of permission or consent for the non-therapeutic circumcision of a minor child.<ref name="aap1995" />
If the medical industry had actually followed this sound ethical guidance, then the [[circumcision]] of male infants would have ended abruptly. The medical industry has chosen to ignore this advice and allow parents to grant consent for non-therapeutic circumcision of male children, so that the physician income derived from circumcision may be maintained.
Svoboda et al. (2000) examined the ethics and legality of informed consent for non-therapeutic neonatal circumcision. With regard to ethics, they concluded:
<blockquote>
Amputating a highly sensitive and functional part of the body is extremely intrusive and should be undertaken only in situations of extreme urgency. Neonatal circumcision as it is routinely performed in this country clearly does not satisfy this criterion. It is therefore unethical and unlawful, and no parental permission should be effective.<ref name="svoboda2002">{{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=
|etal=no
|title=Informed Consent for Neonatal Circumcision: An Ethical and Legal Conundrum
|trans-title=
|language=English
|journal=J Contemp Health Law Policy
|location=
|date=2000-09
|volume=17
|issue=1
|pages=61-133
|url=https://scholarship.law.edu/cgi/viewcontent.cgi?article=1255&context=jchlp
|archived=
|quote=
|pubmedID=
|pubmedCID=
|DOI=
|accessdate=2020-07-22
}}</ref>
</blockquote>
Regarding legality, they concluded:
<blockquote>
Consent to neonatal circumcision has not been directly considered by the the courts; therefore our analysis, out of necessity, relies on established legal precedents of cases that share common elements with neonatal circumcision. With near uniformity, these precedents indicate that any consent given for neonatal circumcision would not be valid. Court decisions are in part influenced by the culture in which they occur. However, circumcision has been gradually falling out of favor in the last few decades. When the balance of public opinion shifts to opposing the practice, the legal system will become more accepting of lawsuits and lobbying for the protection of baby boys. Consequently, the legal system will no longer be able to ignore the conflict between the practice and the legal and ethical duties of medical professionals. In the meantime, the medical community should personally reexamine the ethics of the practice.<ref name="svoboda2002" />
</blockquote>
Adler (2013) considered the legality of non-therapeutic circumcision of boys. He concluded in part:
<blockquote>
This article has addressed whether circumcision is legal, and has shown that it is not. To summarize the law, boys, like girls and adults, have
absolute rights under the common law to personal security and bodily integrity, and to freedom or the autonomy to make important and irreversible decisions about their bodies that can be delayed, like circumcision, for themselves. …
… A physician's legal duty is to provide competent medical care to pediatric patients independent of their parents' desires. Thus, physicians cannot take orders from parents to operate on children for reasons having nothing to do with medicine. Parents' religious rights in turn are subordinate to their sons' absolute rights to [[genital integrity]] and autonomy, and parents cannot risk harming their children, let alone actually harm them for religious reasons. Furthermore, physicians and parents have a legal duty to ''protect'' boys from circumcision.<ref name="adler2013">{{REFjournal
|last=Adler
|first=Peter W.
|init=PW
|author-link=Peter W. Adler
|title=Is circumcision legal?
|journal=Richmond Journal of Law and the Public Interest
|date=2013
|volume=16
|issue=3
|pages=439-86
|url=https://scholarship.richmond.edu/cgi/viewcontent.cgi?article=1265&context=jolpi
|accessdate=2020-07-25
}}</ref>
</blockquote>
A court of appeals in Cologne, Germany [[Cologne circumcision court judgment]] ruled in 2012 that non-therapeutic male circumcision is an assault on the child, an injury to the child, and a violation of the child's rights under the [https://www.btg-bestellservice.de/pdf/80201000.pdf Basic Law of Germany]. No American court has so ruled. Until such time as an American court issues such a ruling, non-therapeutic circumcision of children in America, driven by the [[Financial Incentive| financial incentive]] is expected to continue.
At the present time, ethics and law notwithstanding, non-therapeutic circumcisions of boys are performed with parental consent. Parents will be offered medically-unnecessary, non-therapeutic circumcision and encouraged to grant consent, the sole beneficiary being the bank accounts of the hospital and the doctor. The information supplied below is intended to inform and assist parents of boys.
The Bioethics Committee (2016) of the [[American Academy of Pediatrics]] updated its guidance on informed consent in pediatric practice, however it still does not recognize the child as a human being with rights under domestic and international law.<ref>{{REFjournal
|last=Katz
|first=Aviva L.
|init=
|author-link=
|last2=Macauley
|first2=Robert C.
|init2=
|author2-link=
|last3=Mercurio
|first3=Mark C.
|init3=
|author3-link=
|etal=yes
|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
|archived=
|quote=
|pubmedID=27456510
|pubmedCID=
|DOI=10.1542/peds.2016-1484
|accessdate=2022-01-24
}}</ref>
Wasserman et al. (2019) recognized children as persons entitled to respect.
<blockquote>
Respect is something we owe to others to demonstrate that we recognize them as persons rather than objects. Patients (including children) are persons even if they do not reason well, particularly if have a kind of agency that is capable of expressing preferences. Once way to respect persons is to acknowledge that their preferences matter, something that may require soliciting those preferences, even in cases in which it would be ethically wrong to give them what they prefer. This is because it is disrespectful, and perhaps even dehumanizing to treat preference-expressing patients as mere bystanders or obstacles to their own care.<ref name="wasserman2019">{{REFjournal
|last=Wasserman
|first=Jason Adam
|init=JA
|author-link=
|last2=Navin
|first2=Mark Christopher
|init2=MC
|author2-link=
|last3=Vercier
|first3=Christian John
|init3=CJ
|author3-link=
|etal=yes
|title=Pediatric assent and treating children over objection
|journal=Pediatrics
|location=
|date=2019-11
|volume=114
|issue=5
|article=
|page=
|pages=e20190382
|url=https://publications.aap.org/pediatrics/article/144/5/e20190382/38213/Pediatric-Assent-and-Treating-Children-Over
|quote=
|pubmedID=1666301
|pubmedCID=
|DOI=10.1542/peds.2019-0382
|accessdate=2022-01-25
}}</ref>
</blockquote>
Although this may be an advance, Wasserman et al., speaking for the [[AAP]], still do not recognize the [[human rights]] of children.
Rearrange sections.
</blockquote>
==Information for parents regarding non-therapeutic circumcision of infant boys.==
[[Intaction]] (2022) has provided an introductory video.
<youtube>v=DcfyCpRUlFY</youtube>
==Informed consent for non-therapeutic circumcision of minor boys==
A treatment decision should be guided by the best interests of the child, and must balance the potential benefit over the potential harm or risk.<ref> {{REFjournal
|last=Bioethics Committee, Canadian Paediatric Society
|first=
|author-link=
|etal=no
|title=Treatment decisions for infants and children
|trans-title=
|language=
|journal=CMAJ
|location=
|date=1986-09-01
|volume=135
|issue=
|pages=447-8
|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1491550/pdf/cmaj00125-0033.pdf
|archived=
|quote=
|pubmedID=3742387
|pubmedCID=1491550
|DOI=
|accessdate=2020-07-23
}}</ref>
A [[circumcision]] of a boy may be therapeutic or non-therapeutic. Therapeutic circumcision may be justified only in rare cases when the [[foreskin]] is deformed, diseased, or damaged by irreparable [[trauma]] and the apparent benefit to the patient exceeds the risks and harms.
However, the vast and overwhelming majority of circumcisions of children are performed to excise healthy, functional tissue from the body of a child who is too immature to grant consent.
The Bioethics Committee of the [[American Academy of Pediatrics]] (1995) considered the power granted to parents to grant surrogate consent for diagnosis and treatment of a child. The Committee says that a parent may give "informed permission" for investigation and treatment of disease. The difference between informed consent and informed permission is unclear. When a child is ill, it is the practice to allow a parent to grant informed permission for diagnostic tests and appropriate treatment.<ref name="aap1995">{{REFjournal
|last=Bioethics Committee, American Academy of Pediatrics.
|first=
|author-link=
|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
|pages=314-7
|url=http://www.cirp.org/library/ethics/AAP/
|archived=
|quote=
|pubmedID=7838658
|pubmedCID=
|DOI=
|accessdate=2020-07-23
}}</ref>
Infant boys are born with a healthy [[foreskin]]. No disease or deformity is present to be diagnosed or treated. [[Circumcision]] of an infant boy is neither a diagnostic procedure nor a treatment for disease. The limited parental surrogate powers to grant informed permission recognized by the Bioethics Committee do not extend to the granting of permission or consent for the non-therapeutic circumcision of a minor child.<ref name="aap1995" />
If the medical industry had actually followed this sound ethical guidance, then the [[circumcision]] of male infants would have ended abruptly. The medical industry has chosen to ignore this advice and allow parents to grant consent for non-therapeutic circumcision of male children, so that the physician income derived from circumcision may be maintained.
Svoboda et al. (2000) examined the ethics and legality of informed consent for non-therapeutic neonatal circumcision. With regard to ethics, they concluded:
<blockquote>
Amputating a highly sensitive and functional part of the body is extremely intrusive and should be undertaken only in situations of extreme urgency. Neonatal circumcision as it is routinely performed in this country clearly does not satisfy this criterion. It is therefore unethical and unlawful, and no parental permission should be effective.<ref name="svoboda2002">{{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=
|etal=no
|title=Informed Consent for Neonatal Circumcision: An Ethical and Legal Conundrum
|trans-title=
|language=English
|journal=J Contemp Health Law Policy
|location=
|date=2000-09
|volume=17
|issue=1
|pages=61-133
|url=https://scholarship.law.edu/cgi/viewcontent.cgi?article=1255&context=jchlp
|archived=
|quote=
|pubmedID=
|pubmedCID=
|DOI=
|accessdate=2020-07-22
}}</ref>
</blockquote>
Regarding legality, they concluded:
<blockquote>
Consent to neonatal circumcision has not been directly considered by the the courts; therefore our analysis, out of necessity, relies on established legal precedents of cases that share common elements with neonatal circumcision. With near uniformity, these precedents indicate that any consent given for neonatal circumcision would not be valid. Court decisions are in part influenced by the culture in which they occur. However, circumcision has been gradually falling out of favor in the last few decades. When the balance of public opinion shifts to opposing the practice, the legal system will become more accepting of lawsuits and lobbying for the protection of baby boys. Consequently, the legal system will no longer be able to ignore the conflict between the practice and the legal and ethical duties of medical professionals. In the meantime, the medical community should personally reexamine the ethics of the practice.<ref name="svoboda2002" />
</blockquote>
Adler (2013) considered the legality of non-therapeutic circumcision of boys. He concluded in part:
<blockquote>
This article has addressed whether circumcision is legal, and has shown that it is not. To summarize the law, boys, like girls and adults, have
absolute rights under the common law to personal security and bodily integrity, and to freedom or the autonomy to make important and irreversible decisions about their bodies that can be delayed, like circumcision, for themselves. …
… A physician's legal duty is to provide competent medical care to pediatric patients independent of their parents' desires. Thus, physicians cannot take orders from parents to operate on children for reasons having nothing to do with medicine. Parents' religious rights in turn are subordinate to their sons' absolute rights to [[genital integrity]] and autonomy, and parents cannot risk harming their children, let alone actually harm them for religious reasons. Furthermore, physicians and parents have a legal duty to ''protect'' boys from circumcision.<ref name="adler2013">{{REFjournal
|last=Adler
|first=Peter W.
|init=PW
|author-link=Peter W. Adler
|title=Is circumcision legal?
|journal=Richmond Journal of Law and the Public Interest
|date=2013
|volume=16
|issue=3
|pages=439-86
|url=https://scholarship.richmond.edu/cgi/viewcontent.cgi?article=1265&context=jolpi
|accessdate=2020-07-25
}}</ref>
</blockquote>
A court of appeals in Cologne, Germany [[Cologne circumcision court judgment]] ruled in 2012 that non-therapeutic male circumcision is an assault on the child, an injury to the child, and a violation of the child's rights under the [https://www.btg-bestellservice.de/pdf/80201000.pdf Basic Law of Germany]. No American court has so ruled. Until such time as an American court issues such a ruling, non-therapeutic circumcision of children in America, driven by the [[Financial Incentive| financial incentive]] is expected to continue.
At the present time, ethics and law notwithstanding, non-therapeutic circumcisions of boys are performed with parental consent. Parents will be offered medically-unnecessary, non-therapeutic circumcision and encouraged to grant consent, the sole beneficiary being the bank accounts of the hospital and the doctor. The information supplied below is intended to inform and assist parents of boys.
The Bioethics Committee (2016) of the [[American Academy of Pediatrics]] updated its guidance on informed consent in pediatric practice, however it still does not recognize the child as a human being with rights under domestic and international law.<ref>{{REFjournal
|last=Katz
|first=Aviva L.
|init=
|author-link=
|last2=Macauley
|first2=Robert C.
|init2=
|author2-link=
|last3=Mercurio
|first3=Mark C.
|init3=
|author3-link=
|etal=yes
|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
|archived=
|quote=
|pubmedID=27456510
|pubmedCID=
|DOI=10.1542/peds.2016-1484
|accessdate=2022-01-24
}}</ref>
Wasserman et al. (2019) recognized children as persons entitled to respect.
<blockquote>
Respect is something we owe to others to demonstrate that we recognize them as persons rather than objects. Patients (including children) are persons even if they do not reason well, particularly if have a kind of agency that is capable of expressing preferences. Once way to respect persons is to acknowledge that their preferences matter, something that may require soliciting those preferences, even in cases in which it would be ethically wrong to give them what they prefer. This is because it is disrespectful, and perhaps even dehumanizing to treat preference-expressing patients as mere bystanders or obstacles to their own care.<ref name="wasserman2019">{{REFjournal
|last=Wasserman
|first=Jason Adam
|init=JA
|author-link=
|last2=Navin
|first2=Mark Christopher
|init2=MC
|author2-link=
|last3=Vercier
|first3=Christian John
|init3=CJ
|author3-link=
|etal=yes
|title=Pediatric assent and treating children over objection
|journal=Pediatrics
|location=
|date=2019-11
|volume=114
|issue=5
|article=
|page=
|pages=e20190382
|url=https://publications.aap.org/pediatrics/article/144/5/e20190382/38213/Pediatric-Assent-and-Treating-Children-Over
|quote=
|pubmedID=1666301
|pubmedCID=
|DOI=10.1542/peds.2019-0382
|accessdate=2022-01-25
}}</ref>
</blockquote>
Although this may be an advance, Wasserman et al., speaking for the [[AAP]], still do not recognize the [[human rights]] of children.
{{SEEALSO}}