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}}</ref> It is not clear that Cole, who had recently had heart surgery, was stable and healthy. It also is not clear that [[informed consent]] was received by the parents, Tim and Gabrielle Groth, who apparently granted surrogate consent for a non-therapeutic surgical amputation in violation of [[Medical_ethics#Medical_ethics_and_circumcision| standards of medical ethics]].<ref>{{REFweb |url=https://intactamerica.org/ethical-debate-behind-circumcision/ |title=Are We Sacrificing Newborns for Tradition? The Ethical Debate Behind Circumcision |last=Alissa |first= |init=K |author-link=Kristel Alissa |publisher=Intact America |date=2025-03-25 |accessdate=2025-04-29}}</ref>

It is not clear why the Groths selected [[circumcision]] for Cole, since [[circumcision of the newborn]] does not treat or prevent disease and puts the infant boy at risk of [[bleeding]], [[infection]], and [[Documented severe complications of circumcision| surgical riskmisadventure]]. The most usual reason is to enable the hospital and attending physician to collect a fee.<ref name="garrett2023-12-21">{{REFweb |url=https://intactamerica.org/economics-of-circumcision/ |title=The Economics of Circumcision: A Full Breakdown of This Penis Business |last=Garrett |first=Connor |init= |author-link=Connor Judson Garrett |publisher=Intact America |date=2023-12-21 |accessdate=2024-05-15}}</ref>