Argument: Circumcision does not have sufficient medical justifications

Issue Report: Infant male circumcision


Somerville, Margaret (November 2000). “Altering Baby Boys’ Bodies: The Ethics of Infant Male Circumcision”. 2000. – A common error made by those who want to justify infant male circumcision on the basis of medical benefits is that they believe that as long as some such benefits are present, circumcision can be justified as therapeutic, in the sense of preventive health care. This is not correct. A medical-benefits or “therapeutic” justification requires that overall the medical benefits should outweigh the risks and harms of the procedure required to obtain them, that this procedure is the only reasonable way to obtain these benefits, and that these benefits are necessary to the well-being of the child. None of these conditions is fulfilled for routine infant male circumcision. If we view a child’s foreskin as having a valid function, we are no more justified in amputating it than any other part of the child’s body unless the operation is medically required treatment and the least harmful way to provide that treatment.

[…]Physicians who undertake infant male circumcision could be legally liable for medical malpractice (civil liability in battery or negligence), which can result in an award of damages simply for carrying out the circumcision even if it was competently performed. They could also, as explained, be charged with criminal liability for assault. In both ethics and law, a physician has a primary obligation of personal care to the patient. This obligation requires the physician both to place the patient first and to first do no harm. Physicians who undertake surgery on patients must prove that it is justified. The usual justification is that the surgery is necessary therapy and that the patient—or if incompetent, the patient’s legal representative—gave informed consent to the surgery. In general, parents cannot authorize non-therapeutic interventions—that is, routine circumcision—on their children. A competent adult man could consent to non-therapeutic circumcision on himself, but this does not mean he may consent to it on his son. If the parents’ consent to the circumcision of their son was held to be legally inoperative, the physician would be liable. Moreover, if, in the light of new medical evidence, a reasonably careful and competent physician would not consider it medically necessary to undertake circumcision on a child, to do so could result in legal liability regardless of the parents’ consent. Such liability is even more likely if a reasonably careful and competent physician would consider it not just unnecessary but contrary to a reasonable standard of medical care to undertake circumcision on a particular child in given circumstances. A long-recognized example of such a situation is when the child suffers from haemophilia, a condition that could cause him to bleed to death from circumcision. But as our knowledge of the risks and harms of circumcision expands, the range of circumstances in which undertaking routine circumcision on any child is a breach of a reasonable standard of medical care also expands. To summarize, it seems to me clear that, certainly outside the religious context, recent medical research on routine infant male circumcision shows that this operation cannot be ethically or legally justified on the basis of its potential medical benefits.

There has been some confusion about the ethical and legal effect of this lack of a medical justification for routine infant male circumcision, particularly on the part of medical associations who seem to be concerned not to speak out against the practice. For instance, the American Academy of Pediatrics recognizes that the potential medical benefits of this procedure do not outweigh its risks to a degree that it can be recommended to parents as a routine procedure. But they then conclude that the decision about circumcision should be left to the parents in consultation with their physician. In my opinion, this conclusion is wrong both ethically and legally. Unless the potential and actual medical benefits of a surgical intervention on a child unable to consent for himself clearly outweigh its risks (and the academy has found that in the case of routine infant male circumcision they do not), then it cannot be ethically or legally justified just on the basis of the parents’ consent and, therefore, the physician must not undertake it unless he or she has some other justification for doing so. The question therefore is how should we balance respect for baby boys’ rights to physical integrity and parents’ responsibilities and rights with regard to their children and to their freedom of conscience and religion?

The British Medical Association – The medical benefits previously claimed, however, have not been convincingly proven, and it is now widely accepted, including by the BMA, that this surgical procedure has medical and psychological risks. It is essential that doctors perform male circumcision only where this is demonstrably in the best interests of the child. The responsibility to demonstrate that non-therapeutic circumcision is in a particular child