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Introduction

Male circumcision involves the irreversible removal of a substantial amount of functional tissue from the human body. The propriety of medically unnecessary non-therapeutic circumcision of male infant is controversial. The two major viewpoints are the traditional parent-centered viewpoint and the newer child-centered viewpoint.

Traditonal Viewpoint

The traditional viewpoint hold that the circumcision of male children is ethical provided that a parent grants consent for the operation after being informed of the possible benefits and known risks. This view is typified by the 1999 Circumcision Policy Statement (1999) of the American Academy of Pediatrics.

The practice of medicine has long respected an adult's right to self-determination in health care decision-making. This principle has been operationalized through the doctrine of informed consent. The process of informed consent obligates the physician to explain any procedure or treatment and to enumerate the risks, benefits, and alternatives for the patient to make an informed choice. For infants and young children who lack the capacity to decide for themselves, a surrogate, generally a parent, must make such choices.

Parents and physicians each have an ethical duty to the child to attempt to secure the child's best interest and well-being. However, it is often uncertain as to what is in the best interest of any individual patient. In cases such as the decision to perform a circumcision in the neonatal period when there are potential benefits and risks and the procedure is not essential to the child's current well-being, it should be the parents who determine what is in the best interest of the child. In the pluralistic society of the United States in which parents are afforded wide authority for determining what constitutes appropriate child-rearing and child welfare, it is legitimate for the parents to take into account cultural, religious, and ethnic traditions, in addition to medical factors, when making this choice.

Physicians counseling families concerning this decision should assist the parents by explaining the potential benefits and risks and by ensuring that they understand that circumcision is an elective procedure. Parents should not be coerced by medical professionals to make this choice.

Newer Viewpoint

That traditional view is challenged, however, by the American Academy of Pediatrics Committee on Bioethics, which places responsibility on the physician. It holds that health care 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."

and that:

"the pediatrician's responsibilities to his or her patient exist independent of parental desires or proxy consent."

and by the newer American Medical Assocation Principles of Medical Ethics which require:

VIII. A physician shall, while caring for a patient, regard responsibility to the patient as paramount.

A newer guidance on the circumcision of male children has been enunciated by the Committee on Medical Ethics of the British Medical Association. That view require medical doctors to proceed on a case by case basis to determine the best interests of the child before deciding to perform a circumcision. A similar position has been taken by the College of Physicians and Surgeons of British Columbia.

Hellston expresses the view that the protection of the child's rights should govern the practice.

Conclusion

There is no clear consensus regarding the ethicality of the non-therapeutic circucision of male children.

References

• American Academy of Pediatrics Committee on Bioethics. Informed consent, parental permission, and assent in pediatric practice. Pediatrics 1995;95(2):314-7. URL: http://www.cirp.org/library/ethics/AAP/

• Task Force on Circumcision. Circumcision Policy Statement. Pediatrics URL: http://aappolicy.aappublications.org/cgi/content/full/pediatrics%3b103/3/686

• Council on Ethical and Judical Affairs. Principles of Medical Ethics. Chicago: American Medical Association, 2001. URL: http://www.ama-assn.org/ama/pub/category/2512.html

• Committee on Medical Ethics. The law & ethics of male circumcision - guidance for doctors. London: British Medical Association, 2003. URL: http://www.bma.org.uk/ap.nsf/Content/malecircumcision2003