Male circumcision is the surgical removal of the foreskin (prepuce) from the human penis.
There is substantial disagreement amongst bioethicists and theologians over the practice of circumcision, with many believing that the routine circumcision of neonates for health purposes is a cost-ineffective and ethically-problematic intervention in developed countries, while circumcision on a consenting adult is generally viewed as a morally permissible action. Positions taken on the issue are heavily influenced by prevalence in the given area, religion, and culture. Some medical associations take the position that circumcision is an infringement of the child's autonomy and should be deferred until they are capable of making the decision themselves. Others state that parents should be allowed to determine what is in their best interest.Non-Therapeutic Circumcision of Male Minors . Utrecht: Royal Dutch Medical Association, 2010.
Background There is a long-running and vigorous debate over ethical concerns regarding circumcision, particularly neonatal circumcision for reasons other than intended direct medical benefit. There are three parties involved in the decision to circumcise a minor: the minor as the patient, the parents (or other guardians) and the physician. The physician is bound under the ethical principles of beneficence (promoting well-being) and non-maleficence ("first, do no harm"), and so is charged with the responsibility to promote the best interests of the patient while minimizing unnecessary harms. Those involved must weigh the factors of what is in the best interest of the minor against the potential harms of the procedure. Generally, circumcision on a minor is not ethically controversial or legally questionable when there is a clear and pressing medical indication for which it is the accepted best practice to resolve. Where circumcision is the chosen intervention, the physician has an ethical responsibility to ensure the procedure is performed competently and safely to minimize potential harms.
With a newborn involved, the decision is made more complex due to the principles of respect for autonomy and consent, as a newborn cannot understand or engage in a logical discussion of his own values and best interests. A mentally more mature child can understand the issues involved to some degree, and the physician and parents may elicit input from the child and weigh it appropriately in the decision-making process, although the law may not treat such input as legally informative. Ethicists and legal theorists also state that it is questionable for parents to make a decision for the child that precludes the child from making a different decision for himself later. Such a question can be raised for the decision by the parents either to circumcise or not to circumcise the child.
Parents are assumed to have the child's best interests in mind. Ethically, it is imperative that the medical practitioner inform the parents about the benefits and risks of the procedure and obtain informed consent before performing it. Practically, however, many parents come to a decision about circumcising the child before they are born, and a discussion of the benefits and risks of the procedure with a physician has not been shown to have a significant effect on the decision. Some parents request to have their newborn or older child circumcised for non-therapeutic reasons, such as the parents' desires to adhere to family tradition, cultural norms or religious beliefs. In considering such a request, the physician may consider (in addition to any potential medical benefits and harms) such non-medical factors in determining the child's best interests and may ethically perform the procedure. Equally, without a clear medical benefit relative to the potential harms, a physician may take the ethical position that non-medical factors do not contribute enough as benefits to outweigh the potential harms and refuse to perform the procedure.
The procedure's relationship to other prophylactic procedures, along with the concepts of group rights, consent, and religious freedom, have been discussed in academic literature.
Medical bodies Australia and New Zealand The Royal Australasian College of Physicians (2010) released a statement indicating that neonatal male circumcision is "generally considered an ethical procedure", provided that 1) the child's decision makers, typically the parents, are acting in the best interests of the child and are making an informed decision; and 2) the procedure is performed by a competent provider, with sufficient analgesia, and does not unnecessarily harm the child or have substantial risks. They argue that parents should be allowed to be the primary decision-makers because providers may not understand the full psychosocial benefits of circumcision. 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. The statement also establishes that "the option of leaving circumcision until later, when the boy is old enough to make a decision for himself does need to be raised with parents and considered", and that "the ethical merit of this option is that it seeks to respect the child's physical integrity, and capacity for autonomy by leaving the options open for him to make his own autonomous choice in the future."Circumcision of Male Infants. Royal Australasian College of Physicians. September 2010.
In 2022, the organization published an updated stance on infant circumcision. In their executive summary, they wrote "The frequency of diseases modifiable by circumcision, the level of protection offered by circumcision and the complication rates of circumcision do not warrant routine infant circumcision in Australia or Aotearoa New Zealand."
Canada 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. 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.
On January 11, 2024, the Canadian Paediatric Society reaffirmed their 2015 position, stating "While there may be a benefit for some boys in high-risk populations and circumstances where the procedure could be considered for disease reduction or treatment, the Canadian Paediatric Society does not recommend the routine circumcision of every newborn male."
Denmark The Danish Medical Association (Lægeforeningen) has released a statement (2016) regarding the circumcision of boys under the age of eighteen years. The organization says that the decision to circumcise should be "an informed personal choice" that men should make for themselves in adulthood. According to Dr. Lise Møller, the chairwoman of the Doctors' Association's Ethics Board, allowing the individual to make this decision himself when he is of age respects his right of self-determination.
The Danish College of General Practitioners has defined non-medical circumcision as mutilation.
Netherlands The Royal Dutch Medical Association (Koninklijke Nederlandsche Maatschappij tot bevordering der Geneeskunst) (KNMG) and several Dutch specialist medical societies published a statement of position regarding circumcision of male children on 27 May 2010. The KNMG argues against circumcising male minors due to lack of evidence the procedure is useful or necessary, its associated risks, and violation of the child's autonomy. They recommend deferring circumcision until the child is old enough to decide for himself. The KNMG questions why the ethics regarding male genital alterations should be viewed any differently from female genital alterations, when there are mild forms of female genital alterations like pricking the clitoral hood without removing any tissue or removing the clitoral hood altogether. They have expressed opposition to both male circumcision and all forms of female circumcision; they do not advocate a prohibition of male circumcision, even though they argue that there are good reasons for it to be banned, and prefer that circumcisions be done by doctors instead of illegal, underground circumcisers.
The Dutch Council on Public Health and Care does not agree with the Royal Dutch Medical Association and states that they wrongly do not distinguish between male and female circumcision and that they do not take into account the freedom of religion and the right of parents to raise their children according to their own beliefs or convictions.
Nordic countries
In 2013, children's ombudsmen from Sweden, Norway, Finland, Denmark, and Iceland, along with the Chair of the Danish Children's Council and the children's spokesperson for Greenland, passed a resolution that emphasized the decision to be circumcised should belong to the individual, who should be able to give informed consent.[] Tuesday, 1 October 2013
The Nordic Association of Clinical Sexologists supports the position of the Nordic Association of Ombudsmen who reason that circumcision violates the individual's human rights by denying the male child his ability to make the decision for himself.Statement on Non-Therapeutic Circumcision of Boys. . Nordic Association of Clinical Sexologists, Helsinki, 10 October 2013.
The medical doctors at Sørlandet Hospital Kristiansand in Kristiansand, southern Norway, have all refused to perform circumcisions on boys, citing reasons of conscience.
United Kingdom The medical ethics committee of the British Medical Association also reviewed the ethics behind circumcision. Since circumcision has associated risks with, in their view, no unequivocally proven medical benefits, they advise physicians to keep up with clinical evidence and only perform this procedure if it is in the child's best interest. They say the procedure is a cultural and religious practice, which may be an important ritual for the child's incorporation into the group. 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. They report that views vary in their community about the benefits and risks of the procedure, and there is no clear policy for this situation.
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. 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.
Adult circumcision 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.
Circumcision of adults as a public health measure for the purpose of reducing the spread of HIV also involves ethical concerns such as informed consent and concerns about reducing attention paid to other measures. According to the CDC website, research has documented a significant reduction of HIV/AIDS transmission when a male is circumcised.