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==Guidance from the Bioethics Committee of the American Academy of Pediatrics==
The Bioethics Committee of the [[American Academy of Pediatrics]] has provided important guidance on adapting general principles to pediatric practice.
The Committue published an important statement applicable to surrogate consent in February 1995. It contains many general principles for the guidance of pediatricians but avoided directly considering [[circumcision]], the big moneymaker.<ref name="bioethics1995">{{REFjournal
|last=Kohrman
|first=
|init=A
|author-link=
|last2=Clayton
|first2=
|init2=EW
|author2-link=
|last3=Frader
|first3=
|init3=JE
|author3-link=
|last4=Grodin
|first4=
|init4=MA
|author4-link=
|last5=Moseley
|first5=
|init5=KL
|author5-link=
|last6=Porter
|first6=
|init6=IH
|author6-link=
|last7=Wagner
|first7=
|init7=VM
|author7-link=
|etal=no
|title=Informed consent, parental permission, and assent in pediatric practice. Committee on Bioethics, American Academy of Pediatrics
|trans-title=
|language=
|journal=Pediatrics
|date=1995-02
|volume=95
|issue=2
|pages=314-7
|url=https://www.cirp.org/library/ethics/AAP/
|archived=
|quote=Such providers have legal and ethical duties to their child patients to render competent medical care based on what the patient needs, not what someone else expresses. Although impasses regarding the interests of minors and the expressed wishes of their parents or guardians are rare, the pediatrician's responsibilities to his or her patient exist independent of parental desires or proxy consent.
|pubmedID= 7838658
|pubmedCID=
|DOI=
|doi=
|accessdate=2025-04-30
}}</ref>
The Bioethics Committee of the AAP revisited informed consent in August 2016 with a statement<ref name="bioethics2016">{{REFjournal
|last=Katz
|first=
|init=Al
|author-link=
|last2=Macauley
|first2=
|init2=RC
|author2-link=
|last3=Mercurio
|first3=
|init3=MR
|author3-link=
|last4=Moon
|first4=
|init4=MR
|author4-link=
|last5=Okun
|first5=
|init5=AL
|author5-link=
|last6=Opel
|first6=
|init6=DJ
|author6-link=
|last7=Statter
|first7=
|init7=MB
|author7-link=
|etal=no
|title=Informed Consent in Decision-Making in Pediatric Practice
|trans-title=
|journal=Pediatrics
|date=2016-08
|volume=138
|issue=2
|page=e20161484
|url=https://publications.aap.org/pediatrics/article/138/2/e20161484/52512/Informed-Consent-in-Decision-Making-in-Pediatric
|archived=
|quote=The law has evolved to require a full disclosure to the patient of the facts necessary to form the basis of a reasonable, informed consent. Informed consent incorporates 3 duties: disclosure of information to patients and their surrogates, assessment of patient and surrogate understanding of the information and their capacity for medical decision-making, and obtaining informed consent before treatments and interventions.
|pubmedID=27456514
|pubmedCID=
|DOI=10.1542/peds.2016-1484
|accessdate=2025-04-30
}}</ref> and a companion technical report.<ref>{{REFjournal
|last=Katz
|first=
|init=AL
|author-link=
|last2=Webb
|first2=
|init2=SA
|author2-link=
|etal=no
|title=Informed Consent in Decision-Making in Pediatric Practice — Technical Report
|trans-title=
|journal=Pediatrics
|date=2026-08
|volume=138
|issue=2
|page=e20161485
|url=https://publications.aap.org/pediatrics/article/138/2/e20161485/52519/Informed-Consent-in-Decision-Making-in-Pediatric?autologincheck=redirected
|archived=
|quote=Autonomy (from the ancient Greek autos [self] and nomos [rule or law]) can be seen as derived from Kantian moral philosophy, with key elements of liberty, the capacity to live life according to your own reasons and motives, and agency, the rational capacity for intentional action. A formulation of Kant’s categorical imperative notes that we are obliged to act out of fundamental respect for other persons by virtue of their personal autonomy.
|pubmedID=27456510
|pubmedCID=
|DOI=10.1542/peds.2016-1485
|accessdate=2025-05-02
}}</ref>
The Committee on Bioethics seeks to modify surrogate consent in pediatric medicine to granting of "informed permission" with assent by the child when appropriate. Thesestatements address consent for treatment of disease in pediatric patients, however they have relatively little to say about non-therapeutic procedures such as [[circumcision of the newborn]]. The 1995 statement did say:
<blockquote>
Such providers have legal and ethical duties to their child patients to render competent medical care based on what the patient needs, not what someone else expresses. Although impasses regarding the interests of minors and the expressed wishes of their parents or guardians are rare, the pediatrician's responsibilities to his or her patient exist independent of parental desires or proxy consent.<ref name="bioethics1995" />
</blockquote>
This statement would cover doctors who refuse to perform harmful non-therapeutic circumcision on boys, however it is not clear that it ever has been applied to refusal to perform injurious [[circumcision]].
The 2016 statement identifies the harm principle and states:
<blockquote>
The harm principle may be seen as a more realistic standard to apply in pediatric surrogate medical decision-making. The intent of the harm principle is not to identify a single course of action that is in the minor’s best interest or is the physician’s preferred approach, but to identify a harm threshold below which parental decisions will not be tolerated and outside intervention is indicated to protect the child.<ref name="bioethics2016" />
</blockquote>
The harmful, injurious wounding of child [[circumcision]] brings harm, not only to the child, but also to a society filled with wounded males, however circumcision brings in huge amounts of money, so the Bioethics Committee is effectively muzzled with regard to [[circumcision]].<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=2025-05-02
|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 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>
The desire to protect physician income derived from non-therapeutic [[circumcision]] induces an element of [[bias]] into the statements of the Bioethics Committee.
One should note that these guidances from the Bioethics Committee of the American Academy of Pediatrics apply to the granting of "informed permission" by surrogates for the treatment of disease, and do <i>NOT</i> apply to non-therapeutic procedures.
→Conclusion: typo,
A <b>surrogate</b> is one who takes the place of another.<ref>{{REFweb
|url=https://www.merriam-webster.com/dictionary/surrogate
'''{{FULLPAGENAME}}''' is consent for medical and/or surgical treatment that is granted by a substitute for the patient. Surrogate consent is used when the patient is mentally or legally incapable of granting consent.
'''{{FULLPAGENAME}}''' is regulated by law. In the [[United States]], surrogate Surrogate consent is regulated by state law, which varies from state to state.<ref>{{REFweb
|url=https://www.americanbar.org/groups/law_aging/publications/bifocal/vol_36/issue_1_october2014/default_surrogate_consent_statutes/
|title=Decisions by Surrogates: An Overview of Surrogate Consent Laws in the United States
</blockquote>
The [https://scholar.google.com/scholar_case?case=3012582275354260465&hl=en&as_sdt=8000003&scfhb=1 Prince v Massachusetts], 21 U.S. 158, 159-60 (1944) decision said:
<blockquote>
<i>Parents may be free to become martyrs themselves. But it does not follow they are free, in identical circumstances, to make martyrs of their children before they have reached the age of full and legal discretion when they can make that choice for themselves.</i>
</blockquote>
==Consent for circumcision of minors==
}}</ref>
</blockquote>
Professor Peter W. Adler, J.D., (2013) argues strongly that child [[circumcision]] is unlawful:
<blockquote>
Legal scholars, foreign medical associations, intactivist organizations, and increasing numbers of menis claim the opposite, namely that circumcision is painful, risky, harmful, irreversible surgery that benefits few men, if any. These opponents of circumcision argue that, in any event, boys have a right to be left genitally intact, like girls under federal law, and to make the circumcision decision for themselves as adults.
These opponents of circumcision can point to a June 2012 decision by a court in Cologne, Germany, which held that non-therapeutic circumcision for religious reasons is criminal assault. The German court reasoned that circumcision causes grievous bodily harm, and that boys have a fundamental right to genital integrity that supersedes their parents' religious rights.<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
|format=PDF
|accessdate=2025-05-04}}
</ref>
==Guidance from the Bioethics Committee of the American Academy of Pediatrics==
The Bioethics Committee of the [[American Academy of Pediatrics]] has provided important guidance on adapting general principles to pediatric practice.
The Committue published an important statement applicable to surrogate consent in February 1995. It contains many general principles for the guidance of pediatricians but avoided directly considering [[circumcision]], the big moneymaker.<ref name="bioethics1995">{{REFjournal
|last=Kohrman
|first=
|init=A
|author-link=
|last2=Clayton
|first2=
|init2=EW
|author2-link=
|last3=Frader
|first3=
|init3=JE
|author3-link=
|last4=Grodin
|first4=
|init4=MA
|author4-link=
|last5=Moseley
|first5=
|init5=KL
|author5-link=
|last6=Porter
|first6=
|init6=IH
|author6-link=
|last7=Wagner
|first7=
|init7=VM
|author7-link=
|etal=no
|title=Informed consent, parental permission, and assent in pediatric practice. Committee on Bioethics, American Academy of Pediatrics
|trans-title=
|language=
|journal=Pediatrics
|date=1995-02
|volume=95
|issue=2
|pages=314-7
|url=https://www.cirp.org/library/ethics/AAP/
|archived=
|quote=Such providers have legal and ethical duties to their child patients to render competent medical care based on what the patient needs, not what someone else expresses. Although impasses regarding the interests of minors and the expressed wishes of their parents or guardians are rare, the pediatrician's responsibilities to his or her patient exist independent of parental desires or proxy consent.
|pubmedID= 7838658
|pubmedCID=
|DOI=
|doi=
|accessdate=2025-04-30
}}</ref>
The Bioethics Committee of the AAP revisited informed consent in August 2016 with a statement<ref name="bioethics2016">{{REFjournal
|last=Katz
|first=
|init=Al
|author-link=
|last2=Macauley
|first2=
|init2=RC
|author2-link=
|last3=Mercurio
|first3=
|init3=MR
|author3-link=
|last4=Moon
|first4=
|init4=MR
|author4-link=
|last5=Okun
|first5=
|init5=AL
|author5-link=
|last6=Opel
|first6=
|init6=DJ
|author6-link=
|last7=Statter
|first7=
|init7=MB
|author7-link=
|etal=no
|title=Informed Consent in Decision-Making in Pediatric Practice
|trans-title=
|journal=Pediatrics
|date=2016-08
|volume=138
|issue=2
|page=e20161484
|url=https://publications.aap.org/pediatrics/article/138/2/e20161484/52512/Informed-Consent-in-Decision-Making-in-Pediatric
|archived=
|quote=The law has evolved to require a full disclosure to the patient of the facts necessary to form the basis of a reasonable, informed consent. Informed consent incorporates 3 duties: disclosure of information to patients and their surrogates, assessment of patient and surrogate understanding of the information and their capacity for medical decision-making, and obtaining informed consent before treatments and interventions.
|pubmedID=27456514
|pubmedCID=
|DOI=10.1542/peds.2016-1484
|accessdate=2025-04-30
}}</ref> and a companion technical report.<ref>{{REFjournal
|last=Katz
|first=
|init=AL
|author-link=
|last2=Webb
|first2=
|init2=SA
|author2-link=
|etal=no
|title=Informed Consent in Decision-Making in Pediatric Practice — Technical Report
|trans-title=
|journal=Pediatrics
|date=2026-08
|volume=138
|issue=2
|page=e20161485
|url=https://publications.aap.org/pediatrics/article/138/2/e20161485/52519/Informed-Consent-in-Decision-Making-in-Pediatric?autologincheck=redirected
|archived=
|quote=Autonomy (from the ancient Greek autos [self] and nomos [rule or law]) can be seen as derived from Kantian moral philosophy, with key elements of liberty, the capacity to live life according to your own reasons and motives, and agency, the rational capacity for intentional action. A formulation of Kant’s categorical imperative notes that we are obliged to act out of fundamental respect for other persons by virtue of their personal autonomy.
|pubmedID=27456510
|pubmedCID=
|DOI=10.1542/peds.2016-1485
|accessdate=2025-05-02
}}</ref>
The Committee on Bioethics seeks to modify surrogate consent in pediatric medicine to granting of "informed permission" with assent by the child when appropriate. These statements address consent for treatment of disease in pediatric patients, however they have relatively little to say about non-therapeutic procedures such as [[circumcision of the newborn]]. The 1995 statement did say:
<blockquote>
Such providers have legal and ethical duties to their child patients to render competent medical care based on what the patient needs, not what someone else expresses. Although impasses regarding the interests of minors and the expressed wishes of their parents or guardians are rare, the pediatrician's responsibilities to his or her patient exist independent of parental desires or proxy consent.<ref name="bioethics1995" />
</blockquote>
This statement would cover doctors who refuse to perform harmful non-therapeutic circumcision on boys, however it is not clear that it ever has been applied to refusal to perform injurious [[circumcision]].
The 2016 statement identifies the harm principle and states:
<blockquote>
The harm principle may be seen as a more realistic standard to apply in pediatric surrogate medical decision-making. The intent of the harm principle is not to identify a single course of action that is in the minor’s best interest or is the physician’s preferred approach, but to identify a harm threshold below which parental decisions will not be tolerated and outside intervention is indicated to protect the child.<ref name="bioethics2016" />
</blockquote>
The harmful, injurious wounding of child [[circumcision]] brings harm, not only to the child, but also to a society filled with wounded males, however circumcision brings in huge amounts of money, so the Bioethics Committee is effectively muzzled with regard to [[circumcision]].<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=2025-05-02
|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 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>
The desire to protect physician income derived from non-therapeutic [[circumcision]] induces an element of [[bias]] into the statements of the Bioethics Committee.
One should note that these guidances from the Bioethics Committee of the American Academy of Pediatrics apply to the granting of "informed permission" by surrogates for "diagnosis and treatment of children", and do <i>NOT</i> apply to non-therapeutic procedures such as medically non-indicated, non-therapeutic [[circumcision]], which is neither diagnosis nor treatment.
==Video==
===Circumcision — Your Legal Rights===
<youtube>v=8GT03orcHWM</youtube>
==Conclusion==
Patient autonomy is an important principle of medical ethics.<ref>{{REFbook
|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> Consent for a non-therapeutic operation offends the principle of autonomy, when granted by a surrogate.
A surrogate's powers to grant consent are more circumscribed than the powers granted to a competent individual acting on his own behalf.<ref name="svoboda2000" /> A surrogate's power to grant consent for treatment is dependent upon the existence of a medical condition in need of diagnosis and/or treatment. In the absence of such a condition, the surrogate lacks the power to consent.
A surrogate must:
* Act in the best interests of the patient.
* Protect the rights of the patient under Constitutional law, statute law, common law, and international human rights law.
* Receive [[informed consent]] prior to granting consent.
A circumcision for religious reasons is not medical treatment, so a surrogate may not consent to a religious circumcision. Furthermore, consent for a religious circumcision would violate the boy's religious right to chose his religion when he is of age.
A non-therapeutic [[circumcision]] exposes the patient to the surgical risks of [[infection]], [[bleeding]], and [[Documented severe complications of circumcision| surgical mishap]] without any health treatment or benefit, so it is not in the best interests of the patient. Furthermore, a surrogate may only consent to therapeutic procedures.
As explained above and we reiterate, 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.<ref name="myers2020" />
The present practice in the [[United States]] and elsewhere of parental surrogate consent for non-therapeutic circumcision is entirely unethical<ref name="myers2020" /> and may also be unlawful.<ref name="povenmire1998" /> <ref name="adler2013" />
The only person who can ethically and legally grant consent for a non-therapeutic [[circumcision]] is the owner of the [[penis]] when he has reached the legal age for consent.
{{SEEALSO}}
* [[Human rights]]
* [[Informed consent]]
{{LINKS}}
* {{REFweb
|url=https://intactamerica.org/circumcision-cosmetic-surgery-on-newborns/
|title=The World’s Oldest Cosmetic Surgery Is Still Performed on Newborns—Without Consent
|last=Alissa
|first=
|init=K
|author-link=Kristel Alissa
|publisher=Intact America
|date=2025-04-24
|accessdate=2025-05-16
}}
{{REF}}
[[Category:Circumcision]]
[[Category:Human_rights]]
[[Category:Law]]
[[Category:Medical ethics]]
[[Category:Medical term]]
[[Category:Australia]]
[[Category:USA]]