It is argued by opponents of circumcision that the male himself should be allowed to make the decision about whether he does or does not want to be circumcised. That is, that one should allow him to make the decision when he is grown up (the so-called ‘right to self-determination’ argument). However, there are problems with this argument, not the least of which is the fact that the greatest benefits accrue the earlier in life the procedure is performed. If left till later ages the individual has already been exposed to the risk of urinary tract infections, the physical problems, and carries a residual risk, albeit reduced compared with no circumcision, of penile cancer and possibly HIV infection.
Moreover, it would take a very ‘street-wise’, outgoing, adolescent male to make this decision and undertake the process of ensuring that it was done. Perception of risk among young men is highly distorted, many not being able to perceive themselves as being at risk of, say, HIV infection [440].
Awareness of the vagaries of adolescent decision-making would cause many parents to quite reasonably choose infancy for their son’s circumcision [463]. Moreover, most males in the late teens and 20s, not to mention many men of any age, are reticent to confront such issues, even if they hold private convictions and preferences about wanting to be rid of the foreskin from their penis.
Furthermore, despite having problems with this part of their anatomy, many will suffer in silence rather than seek medical advice or treatment. Thus to argue that circumcision be delayed until the male can make his own decision is specious. By the teen or later years the procedure is no longer as fast, simple, cheap or as pain-free, and a general, as opposed to a local, anaesthetic is more likely to be employed. A general anesthetic carries some, albeit low, risks, and is not absolutely necessary, being preferred, however, by surgeons for longer procedures such as the most involved (sleeve- resection) technique.
Really though parental responsibility must over-ride arguments based on 'the rights of the child'. Think what would happen if we allowed children to reach the age of legal consent in relation to, for example, immunization, whether they should or should not be educated, or even daily routines such as tooth-brushing, the type of food consumed, amount they exercise, responsible behavior, respect for others, etc.
A period of great benefit would have been lost, to the potential detriment of the person concerned. In fact of all the many decisions a parent or legal guardian must make for their growing child over the years until they are legally considered adults, there are many that will likely have a more profound effect on them than the presence or absence of a foreskin [12].
Parents have the legal right to authorize surgical procedures in the best interests of their children [22, 169, 592].
For them to make this decision medical practitioners are obliged to disclose to them fully and objectively ALL information relating to circumcision. This includes benefits and risks, prognosis and alternative methods. Unfortunately, in a survey in California, 40% of parents believed they had not been provided with enough information [4]. Parents of those children who were left uncircumcised said that no medical provider discussed circumcision with them, as opposed to 15% of parents of children who were circumcised. Twice as many parents (27% of uncircumcised vs 14% of circumcised boys) were unhappy with their initial decision, i.e., twice as many in retrospect would have wanted their child to have been circumcised had they known more.
Dr Terry Russell states “The likely legal position is that any person who is advised against, or denied circumcision on spurious grounds, who then goes on to suffer from one of the conditions which might reasonably have been prevented or minimised by circumcision, has a right to damages against the person who advised against or denied circumcision on spurious grounds” [483].
He, like others, points out that reliance by anti-circumcision activists on the 1990 United Nations Convention on the Rights of the Child, article 24 (3) is a ploy.
This article was to prevent female genital mutilation, which has been incorrectly termed ‘female circumcision’, a gross misnomer, in an attempt to link it to male circumcision. The former involves infibulation and amputation of the clitoris and thus resembles penile amputation (which in fact is often required to treat men with penile cancer, seen almost always in men not circumcised in infancy!). Even in Islam, a nick in the clitoral hood, so permitting a small flow of blood, is sufficient to conform with the Koran. Anecdotally, true female circumcision (= removal of the clitoral hood) is said to increase sexual sensitivity and frequency of orgasm. This claim awaits research support, however.
Particular difficulties have been encountered by religious minorities in the UK, where the Human Rights Act 1998 has been construed, quite contentiously, as prohibiting circumcision of minors [198].
The British Medical Association (BMA) has produced a guide on the law and ethics of male circumcision in which it recognizes the legality of male circumcision provided it is performed competently, is in the child’s best interests, and there is valid consent [81]. It notes that the Human Rights Act 2000 has not been invoked in any legal case involving circumcision. This Act of course relates to other matters that are relevant.
The BMA Guide notes that “circumcision of boys has been considered to be either medically or socially beneficial or, at least, neutral”, and that “the responsibility to demonstrate that non-therapeutic circumcision is in a particular child’s best interests falls to his parents” [81]. In a checklist in a BMA publication [78] the BMA identifies the following as relevant to an assessment of best interests: the patient’s own ascertainable wishes, feelings and values; the patient’s ability to understand what is proposed and weigh up the alternatives; the patient’s potential to participate in the decision, if provided with additional support or explanations; the patient’s physical and emotional needs; the risk of harm or suffering; the views of the parents and family; the implications for the family of performing or not performing the procedure; religious or cultural background; the prioritising of options which maximize the patient’s future opportunities and choices [81].
The BMA Guide points out that, like any medical procedure, action can be taken against the doctor if a circumcision was carried out negligently, but that “action cannot be taken against a doctor simply because a man is unhappy about having been circumcised at all” (e.g., in infancy) [81]. “A valid consent from a person authorized to give it on the patient’s behalf (such as the parents) is legally sufficient in such cases”. It concludes by saying “The General Medical Council does not prohibit doctors from performing non-therapeutic circumcision, although would take action if a doctor was performing such operations incompetently”. The Council explicitly advises that doctors must “have the necessary skills and experience to perform the operation and use appropriate measures, including anaesthesia, to minimise pain and discomfort” [201][81].
Thus circumcision is legal. This includes so-called ‘non-therapeutic’ circumcision.
