Changes

The [https://www.racp.edu.au/ Royal Australasian College of Physicians] (2010) released a statement indicating that neonatal male circumcision "generally considered an ethical procedure", provided that 1) the child's decision makers, typically the parents, are acting in best interest of child and have been given full knowledge and 2) the procedure is performed by a competent provider, with sufficient analgesia, and does not unnecessarily harm the child or have substantial risks.<ref name=":0racp2010">[https://www.racp.edu.au/docs/default-source/advocacy-library/circumcision-of-infant-males.pdf Circumcision of Male Infants.] [[Royal Australasian College of Physicians]]. September 2010.</ref> They argue that parents should be allowed to be the primary decision-makers because providers may not understand the full psychosocial benefits of circumcision.<ref name=":0racp2010" /> Additionally, this procedure does not present substantial harm compared to its potential benefits, so parents should be allowed full decision-making capacity as long as they are educated properly.<ref name=":0racp2010"/>

This statement also recognizes that waiting until the boy is of sufficient age to make his own decision would better respect his autonomy, but points out that this may interfere with a child's religious inclusion that circumcision was meant to confer.<ref name=":0racp2010"/> With neonatal male circumcision, they acknowledge that the child may later on disagree with the parents' decision <ref name=":0racp2010"/> but using the same reasoning, an uncircumcised child may also disagree with his parents' decision not to have him circumcised in infancy.<ref name=":0racp2010"/>

The [[Canadian Paediatric Society]] (CPS) issued a position statement on September 8, 2015, which highlighted the ethical issue surrounding the child's inability to give consent.<ref name="CPS20152CPS2015">{{REFjournal

}}</ref> Since children require a substituted decision maker acting in their best interests, they recommend to hold off non-medically indicated procedures, such as circumcision, until children can make their own decisions. Yet the CPS also states that parents of male newborns must receive unbiased information about neonatal circumcision, so that they can weigh specific risks and benefits of circumcision in the context of their own familial, religious and cultural beliefs.<ref name="CPS20152CPS2015"/>

The medical ethics committee of the [[British Medical Association]] also reviewed the ethics behind circumcision. Since circumcision has associated medical and psychological risks with no unequivocally proven medical benefits, they advise physicians to keep up with clinical evidence and only perform this procedure if it's in the child best interest.<ref name=":02bma2006">Committee on Medical Ethics. [www.bma.org.uk/-/media/Files/PDFs/Practical advice at work/Ethics/Circumcision.pdf The law & ethics of male circumcision: guidance for doctors]; June 2006 [Retrieved 3 November 2019.].</ref> However, they acknowledge the procedure as a cultural and religious practice, which may be an important ritual for the child's incorporation into the group.<ref name=":02bma2006"/> They recognize that parents have the authority to make choices for their child, and they emphasize it is important for parents to act in their child's best interest.<ref name=":02bma2006"/> They ultimately report that views vary in their community about the benefits and risks of the procedure, and there is no clear policy for this situation.<ref name=":02bma2006"/>

Commenting on the development of the 2003 British Medical Association guidance on circumcision, Mussell (2004) reports that debate in society is highly polarized, and he attributes it to the different faiths and cultures that make up BMA.<ref name=":1mussell2004">{{REFjournal

}}</ref> He identifies this as a difficulty in achieving consensus within the medical ethics committee. Arguments put forward in discussions, according to Mussell, included the social and cultural benefits of circumcision, the violation of the child's rights, and the violation of the child's autonomy.<ref name=":1mussell2004"/>

In a paper published June 2006, the [[British Medical Association]] Committee on Medical Ethics does not consider circumcision of an adult male to be controversial, provided that the adult is of sound mind and grants his personal consent after receiving all material information regarding the known risks, disadvantages, and potential benefits to be derived from the surgical operation.<ref name="BMA2006bma2006">{{REFweb

|accessdate=20132019-11-25}}</ref> Circumcision of adults as a public health measure for the purpose of reducing the spread of [[Circumcision and HIV|HIV]] also involves ethical concerns such as informed consent and concerns about reducing attention paid to other measures. According to the [[Centers for Disease Control and Prevention|CDC]] website, research has documented a significant reduction of HIV/AIDS transmission when a male is circumcised.<ref>{REFweb |title=HIV and Male Circumcision {{!}} Gateway to Health Communication {{!}} CDC |url=https://www.cdc.gov/healthcommunication/toolstemplates/entertainmented/tips/hivcircumcision.html |website=www.cdc.gov |language=en-us |date=2017-02-2303

In the same British Medical Association paper, circumcision of a child to treat a clear and present medical indication after a trial of conservative treatment also is not considered to be ethically questionable, provided that a suitable [[wikt:surrogate|surrogate]] has granted surrogate consent after receiving all material information regarding the known risks, disadvantages, and potential benefits to be derived from the surgical operation.<ref name="BMA2006bma2006"/>

The BMA statement of 2003 took the position that non-therapeutic circumcision of children is lawful in the United Kingdom.<ref name="BMA2003"/> British law professors Fox & Thomson (2005), citing the [[House of Lords]] case of [[R v Brown]], challenged this statement. They argued that consent cannot make an unlawful act lawful.<ref name="fox-thomson">{{REFjournal

}}</ref> The BMA issued a revised statement in 2006 and now reports the controversy regarding the lawfulness of non-therapeutic child circumcision and recommends that doctors obtain the consent of ''both'' parents before performing non-therapeutic circumcision of a male minor. The revised statement now mentions that male circumcision is generally assumed to be lawful provided that it is performed competently, is believed to be in the child's best interests, and there is valid consent from both parent or the child if it is capable of expressing a view.<ref name="BMA2006bma2006" />

The American Academy of Pediatrics currently has no official stance on neonatal circumcision. The previous statement has expired and not been reaffirmed.<ref>{{REFjournal

Frisch ''et al''. conclude that "The AAP report2 report lacks a serious discussion of the central ethical dilemma with, on 1 one side, parents’ right to act in the best interest of the child on the basis of cultural, religious, and health-related beliefs and wishes and, on the other side, infant boys’ basic right to physical integrity in the absence of compelling reasons for surgery. Physical integrity is 1 one of the most fundamental and inalienable rights a child has. Physicians and their professional organizations have a professional duty to protect this right, irrespective of the gender of the child."

Van Howe & Svoboda (2013) criticize their the AAP statement because it failed to include important points, in accurately analyzed and interpret current medical literature, and made unsupported conclusions.<ref>{{REFjournal

Frisch ''et al''. (2013) pointed out the difference of the AAP's statements in comparison to other Western countries, such as Canada, Australia, and various European countries.<ref name=":03frisch2012">{{REFjournal

}}</ref> They attribute this to cultural bias since non-therapeutic male circumcision is prevalent in the United States. They also criticized the strength of the health benefits the statement had claimed, such as protection from HIV and other STIs.<ref name=":03frisch2013"/> The American Academy of Pediatrics responded that because about half of American males are circumcised and half are not, there may be a more tolerant view concerning circumcision in the US, but that if there is any cultural “bias” among the AAP taskforce task force who wrote the Circumcision Policy statement, it is much less important than the bias Frisch ''et al''. may hold because of clear prejudices against the practice that can be found in Europe. The AAP elaborately explained why they reached conclusions regarding the health benefits of circumcision that are different from the ones reached by some of their European counterparts.<ref>{{REFjournal

Svoboda argues against non-therapeutic circumcision.<ref name=":05svoboda2017">{{REFjournal

}}</ref> He states that this decision should be considered in the context of benefit vs risk of harm, rather than simply risk-benefit due to the non-therapeutic nature of the procedure.<ref name=":05svoboda2017"/> He states that benefits do not outweigh the risks, and also claims that foreskin removal should be considered a sexual harm.<ref name=":05svoboda2017"/> He also goes on to conclude that non-therapeutic circumcision largely violates the physician's duty to respect a patient's autonomy since many procedures take place before a patient is able to freely give consent himself.<ref name=":05svoboda2017"/>

Reis and Reis's article explore the role physicians play in neonatal circumcision.<ref name=":14reis-reis2017">{{REFjournal

}}</ref> They state that if physicians outline all the currently known risks and benefits of the procedure to the parents and believes the procedure is indeed medically indicated, they cannot be held accountable for any harm from the procedure.<ref name=":14reis-reis2017"/> However, they still advise against physicians recommending unnecessary, irreversible surgeries, which is a category circumcision falls in frequently.<ref name=":14reis-reis2017"/>

The ''[[Journal of Medical Ethics]]'' published a "symposium on circumcision" in its June 2004 issue.<ref name="symposiumsymposium2004">{{REFjournal