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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. 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 the treatment of disease, and do <i>NOT</i> apply to non-therapeutic procedures.
Relocate section.
<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==
If a boy is to be [[circumcised]], then someone must grant effective consent. The boy may not do it for himself because of his minority status. [[Circumcision]] of boys is a medically-unnecessary, non-therapeutic, harmful excision of functional tissue that causes loss of various functions.
|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 the treatment of disease, and do <i>NOT</i> apply to non-therapeutic procedures.
}}</ref>
</blockquote>