Sunday, February 6, 2011

Why Infant Circumcision is considered Unethical

This is a summary of Gender Across Borders Paper by Joseph Petersen ( , and also that of Dr Robert Darby, with my additions in bold italics:

1. One of the primary ideas that has evolved in Western law and medical ethics is the strong support of personal autonomy. That individuals have the right to make important decisions about their own lives for themselve, (Which is now becoming understood as a basic human right) .
2. The patient needs to be fully informed, and consent of the patient for treatment is obtained in all but a few, very specific circumstances such as immediate medical need. (The patient here being the infant cannot be fully informed and cannot consent, therefore proxy consent becomes an important issue)
3. The American Academy of Pediatrics (AAP) Committee on Bioethics, for example, said in their 1995 report, Informed Consent, Parental Permission, and Assent in Pediatric Practice, that, “Parents and physicians should not exclude children and adolescents from decision-making without persuasive reasons.” The Academy goes on to say:
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. (What a pity American Doctors who perform infant circumcisions do not observe the medical ethics proscribed to them by the AAP)
4. That is the objective needs of the child patient must be the primary focus, not the subjective preferences of his or her parents. (Infant circumcision is carried out on the subjective preferences of the parents and a clear violation of medical ethics)
5. In the context of this doctor/child/parent relationship, the doctor’s responsibility to assess the objective needs of his child patient and then present options to the child’s parents.
6. British Medical Association discussed this in, The Law and Ethics of Male Circumcision – Guidance for Doctors, where they noted:
Unnecessarily invasive procedures should not be used where alternative, less invasive techniques, are equally efficient and available. It is important that doctors keep up to date and ensure that any decisions to undertake an invasive procedure are based on the best available evidence. Therefore, to circumcise for therapeutic reasons where medical research has shown other techniques to be at least as effective and less invasive would be unethical and inappropriate. (Infant circumcision violates this ethical premise in 100% of cases)
7. Dr. Margaret Somerville, a prominent medical ethicist at McGill University, noted in discussing circumcision that, “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.” Does circumcision in the neonatal period:
  1. Provide benefits that exceed the risks and harms of the procedure? (the only prophelactic benefit that can be attained by an infant is a very small reduction in the risk of attaining a UTI though this is contested, therefore given UTI's are rare in male infants, the standard treatment is a course of anti-biotics, and the complications of circumcision far exceed the risk and severity of an easily treated UTI, Circumcision causes harm, pain, and loss of functional anatomical tissue, and has rsiks of complications associated with it, circumcision clearly does not meet this criteria)
  2. Provide benefits that can not reasonably be realized in some other way? (Breastfeeding, proper intact care, and anti-biotics, are universally recognised as best treatment and preventative care for UTI's in infants)
  3. Provide benefits that are necessary to the welfare of the child? (Rare UTI;s are easily treated by conservative medicine, and therefore circumcision is not necessary to the welfare of the child)

8. The potential benefits that American parents cite when justifying infant circumcision pertain to maladies that can be prevented with less invasive, more effective, methods or can be easily treated should they occur.
9.The lack of clear objective medical need makes routine infant circumcision simply unethical.
10. The foreskin is healthy functional anatomy providing protective & errogenous functions & only the owner of this organ should be permitted to make the decision about its non-therapeutic removal.
11. Circumcision comes with risks and complications & to subject a child to this without therapeutic need is a violation of the hippocratic oath.
12. Many adult men resent their infant circumcisions spending many years restoring their foreskins and some are involved in the anti-infant-circumcision movement.
13. Giving primacy to a socio-cultural group to perform infant circumcision on an individual is a violation of that individuals human rights.

A Summary of Dr Robert Darby arguments :
Medical ethics and human rights
Circumcision advocates refer to the objections to circumcision on medical ethics and human rights grounds as "nebulous", but I suggest that these issues are central to the whole question. No matter how great the benefits of circumcision may be, the fact remains that the foreskin belongs to its owner as surely as his fingers, toes, ears, liver and any other organ. The only health-related situation where it can be ethically removed without consent is in a life-threatening emergency, or in order to address a deformity, injury or disease that has not responded to conservative treatments after reasonable efforts.
To be ethically acceptable a medical intervention must pass the five tests proposed by bioethicists Beauchamp and Childress:
  1. Beneficence - Does the proposed procedure provide a net therapeutic benefit to the patient, considering the risk, pain, and loss of normal function?
  2. Non-maleficence - Does the procedure avoid permanently diminishing the patient in any way that could be avoided?
  3. Proportionality - Will the final result provide a significant net benefit to the patient in proportion to the risk undertaken and the losses sustained?
  4. Justice - Will the patient be treated as fairly as we would all wish to be treated?
  5. Autonomy - Lacking life-threatening urgency, will the procedure honour the patient's right to his or her own likely choice? Could it wait for the patient's assent?
Non-therapeutic circumcision of minors fails all these tests. It is not beneficent because it provides no therapeutic benefit (nor even a relevant prophylactic benefit, since a child is at zero risk of STIs). It is malefic because it diminishes the genitals. It is disproportional because the net gain (if any) is out of proportion to the loss, harm and risk of complications. It is unjust because adult preferences show clearly that if he had a choice in the matter the boy would refuse the operation. And it fails to respect the boy's autonomy and preserve his future options as an adult individual. It has been strongly argued that such unwarranted interventions are unethical, violate the individual's right to physical integrity, and are of borderline legality.

THis is from the Turkish Journal of Psychiatry concluding circumcision is unethical:

1 comment:

  1. Great article. Circumcision is profoundly unethical.