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<b>Ethics</b> is defined as "the principles of conduct governing an individual or a group". <b>MedicaL Medical ethics</b> or <b>bioethics</b> provide guidance on protecting the human dignity of patients in medical treatment.
==Principles of medical ethics==
|accessdate=2025-06-27
}}</ref>
==Surrogate consent==
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.
Since children, and especially infants, are legally incompetent to grant [[informed consent]] for medical or surgical treatment, that consent must be granted by a surrogate — someone designated to act on behalf of the child-patient, if treatment is to occur.<ref name="conundrum">{{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=James G. Dwyer
|title=Informed Consent for Neonatal Circumcision: An Ethical and Legal Conundrum
|url=https://scholarship.law.wm.edu/cgi/viewcontent.cgi?article=1166&context=facpubs
|pages=60-133
|journal=J Contemp Health Law & Policy
|volume=17
|date=2000
}}</ref>
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="conundrum" /><ref name="bioethics">{{REFjournal
|last=Committee on Bioethics
|title=Informed consent, parental permission, and assent in pediatric practice
|journal=Pediatrics
|date=1995
|volume=95
|issue=2
|pages=314-317
|url=http://pediatrics.aappublications.org/content/95/2/314.full.pdf
|pubmedID=7838658
}} Reaffirmed May 2011.</ref> A surrogate may only act in the best interests of the patient.<ref name="conundrum"/> A surrogate may not put a child at risk for religious reasons.<ref name="conundrum"/> A surrogate may grant consent for a medical procedure that has ''no'' [[medical indication]] ''only'' if it is the child's best interests.<ref name="conundrum"/>
The attending physician must provide the surrogate with all material information concerning the proposed benefits, risks, advantages, and drawbacks of the proposed treatment or procedure.<ref name="conundrum"/><ref name="bioethics"/>
The Committee on Bioethics of the AAP (1995) states that parents may only grant surrogate informed permission for diagnosis and treatment with the assent of the child whenever appropriate.<ref name="bioethics"/>
There was an unresolved question whether surrogates may grant effective consent for non-therapeutic child circumcision.<ref name="povenmire">{{REFjournal
|last=Povenmire
|init=R
|authorlink=
|date=
|note=1998–1999
|title=Do Parents Have the Legal Authority to Consent to the Surgical Amputation of Normal, Healthy Tissue From Their Infant Children?: The Practice of Circumcision in the United States
|journal=Journal of Gender, Social Policy and the Law
|volume=7
|issue=1
|pages=87-123
|pubmedID=16526136
|url=http://www.cirp.org/library/legal/povenmire/
|accessdate=2013-11-25
}}</ref>
<ref name="conundrum"/> Richards (1996) argues that parents may only consent to medical care, so are not empowered to grant consent for non-therapeutic circumcision of a child because it is not medical care.<ref name="richards">{{REFjournal
|last=Richards
|init=D
|authorlink=
|date=1996-05
|title=Male Circumcision: Medical or Ritual?
|journal=Journal of Law and Medicine
|volume=3
|issue=4
|pages=371-376
|url=http://www.cirp.org/library/legal/richards/
|accessdate=2008-04-11
}}</ref> The [[Canadian Paediatric Society]] (2015) recommends that circumcisions done in the absence of a [[medical indication]] or for personal reasons "should be deferred until the individual concerned is able to make their own choices."<ref name="CPS2015" />
Regardless of these issues, the unethical general practice of the medical community in the United States is to receive surrogate informed consent or permission from parents or legal guardians for non-therapeutic circumcision of children.<ref name="povenmire"/><ref name="conundrum" />
== The emerging consensus on surrogate consent for non-therapeutic newborn, infant, and child circumcision ==
The power of parents and other surrogates to grant consent is dependent upon the existence of a physical or medical condition in a minor child that requires diagnostic and/or treatment.<ref name="richards"/> <ref name="aap1995">{{REFjournal
|last=Committee on Bioethics
|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
|article=
|page=
|pages=314-7
|url=http://www.cirp.org/library/ethics/AAP/
|archived=
|quote=
|pubmedID=7838658
|pubmedCID=
|DOI=
|accessdate=2023-05-26
}}</ref> The right to grant surrogate consent cannot exist in the absence of such a condition. The AAP Committee on Bioethics (2016) now states: "A parent’s authority is not absolute but constrained by respect for the child."<ref name="aviva2016">{{REFjournal
|last=Committee on Bioethics
|etal-no
|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?autologincheck=redirected
|archived=
|quote=
|pubmedID=27456514
|pubmedCID=
|DOI=
|doi=10.1542/peds.2016-1484
|accessdate=2023-05-27
}}</ref> This may mean that the AAP now recognizes the child as a person with legal rights of his/her own.
Boys are born with a healthy [[foreskin]] that is free of disease. There are no medical indications for a neonatal [[circumcision]]. The [[medical trade association| medical trade associations]] and other promoters have put forward various alleged benefits from neonatal circumcision for decades to develop business for their physican-members.
The validity of surrogate consent for non-therapeutic circumcision of boys has been questioned for decades.<ref name="povenmire"/> <ref name="richards" /> <ref name="hill2003">{{REFjournal
|last=Hill
|first=
|init=G
|author-link=George Hill
|title=Can anyone authorize the nontherapeutic permanent alteration of a child's body?
|journal=The American Journal of Bioethics
|date=2003
|volume=3
|issue=2
|pages=16-8
|url=https://www.researchgate.net/profile/George-Hill-3/publication/371599857_Can_Anyone_Authorize_the_Nontherapeutic_Permanent_Alteration_of_a_Child's_Body/links/648b8819c41fb852dd0949be/Can-Anyone-Authorize-the-Nontherapeutic-Permanent-Alteration-of-a-Childs-Body.pdf
|quote=
|pubmedID=14635628
|pubmedCID=
|DOI=10.1162/152651603766436342
|format=PDF
|accessdate=2023-07-11
}}</ref>
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. The present practice in the [[United States]] and elsewhere of parental consent for non-therapeutic circumcision is entirely unethical.<ref name="myers2020">{{REFjournal
|last=Myers
|first=
|init=A
|author-link=Alex Myers
|last2=Earp
|first2=
|init2=BD
|author2-link=Brian D. Earp
|etal=no
|title=What is the best age to circumcise? A medical and ethical analysis
|trans-title=
|language=
|journal= Bioethics
|location=
|date=2020
|volume=34
|issue=7
|pages=645-63
|url=https://www.researchgate.net/profile/Brian-Earp-2/publication/337720859_What_Is_the_Best_Age_to_Circumcise_A_Medical_and_Ethical_Analysis/links/5f815f61a6fdccfd7b555395/What-Is-the-Best-Age-to-Circumcise-A-Medical-and-Ethical-Analysis.pdf
|archived=
|quote=Based on a careful consideration of the relevant evidence, arguments and counterarguments, we conclude that medically unnecessary penile circumcision-like other medically unnecessary genital procedures, such as 'cosmetic' labiaplasty-should not be performed on individuals who are too young (or otherwise unable) to provide meaningful consent to the procedure.
|pubmedID=32068898
|pubmedCID=
|DOI=
|doi=10.1111/bioe.12714
|format=PDF
|accessdate=2020-05-27
}}</ref>
Moreover, non-therapeutic circumcision of boys may also be unlawful,<ref name="Adler">{{REFjournal
|last=Adler
|first=Peter W.
|init=PW
|author-link=Peter W. Adler
|url=http://rjolpi.richmond.edu/archive/Adler_Formatted.pdf
|title=Is Circumcision Legal?
|volume=16
|issue=3
|journal=Richmond J. L. & Pub. Int.
|page=439
|date=2013
}}</ref> if a court should accept Adler's arguments.
==Medical trade association views==