Involuntary circumcision: the legal issues

treated however parents (within minimal limitations) see Introduction fit [15]. Simply complying with parental wishes is increasingly less acceptable; the child’s best interests Circumcision is the amputation of the prepuce from the rest of the penis, resulting in permanent alteration of now must also be considered [16,17]. Like surrogate decision-makers for incompetent adults, parents should the anatomy, histology and function of the penis [1,2]. Recently, legal scholars have challenged the legality of be able to demonstrate that their judgement is the same as that which the child would rationally choose for neonatal circumcision [3–7] and argued that it constitutes child abuse [8,9]. While this conjecture may seem himself, if able to do so. Such a demonstration should be necessary before medical professionals may accede to outlandish to American physicians, who tend to a population in which 70–90% of the males are circumcised the preferences of parents regarding medical intervention for their children [12]. neonatally, such claims have a strong foundation in legal precedent and medico-ethical standards that aim In an eCort to protect the rights of children, the American Academy of Pediatrics Committee on Bioethics to protect the bodily integrity of persons. developed a policy about informed consent in cases involving children. Informed parental permission can subBodily integrity and informed consent stitute for consent from the child only for medical interventions in situations of clear and immediate mediAmong a free society’s most treasured principles are personal autonomy, respect for the individual and presercal necessity, such as an immediate threat to the child from disease, trauma or deformity. For non-essential vation of the body’s physical integrity [10]. Patients are entitled to make decisions about their medical care treatments, which can be deferred without substantial risk, the physician and family should wait until the through a process of ‘informed consent’. Medical providers must refrain from unwarranted interventions child’s consent can be obtained [18]. Such a principle should apply even more strongly in the case of circumand allow patients the individual self-determination to control their own lives [11,12]. cision, which carries significant potential for causing serious harm. The committee emphasized the duty of the Incompetent persons cannot, of course, exercise a right of self-determination; someone must make decisions physician to protect the patient (the child) from parental desires that might be detrimental to the child. for them. Ordinarily this surrogate decision-making is not regarded as anyone’s right. Rather, some individual is accorded the privilege of acting as advocate for the United States case law incompetent patient’s interests [13]. However, for children, the law in common-law jurisdictions has historiAmerican case law clearly protects the bodily integrity of incompetent individuals. For example, doctors may cally ignored this norm and has tolerated parents exercising power as if entitled to make medical decisions not sterilize or administer contraceptives to a mentally retarded woman, regardless of parental wishes, without for their minor children, without having to demonstrate that their choices were in the children’s best interests. showing that it is the least restrictive means available for protecting the woman’s interests [19]. Similarly, This stance is particularly prevalent in the USA, although echoes of it are seen in other common-law jurisdictions, courts have limited the authority of parents to secure medical intervention for children. In Wisconsin v Yoder, especially amongst lay people, who find ideas of children’s rights uncomfortable. However, in recent years the US Supreme Court held that parental authority may be limited ‘if it appears that parental decisions will there has been a trend among legislatures, courts, legal scholars and child-welfare advocates toward insistence jeopardize the health or safety of the child’ [20]. Lower courts have refused to allow parents to secure nonon respecting children, legally and morally, as distinct persons whose fundamental needs or ‘welfare interests’ medically indicated procedures on children. For example, in Little v Little, the guardian ad litem of a 14-year-old warrant legal protection [14], rather than viewing children as appendages or property of their parents to be mentally incompetent, but otherwise perfectly healthy,