Recommendation by a law body to ban infant male circumcision has serious worldwide implications for pediatric practice and human rights

Abstract

BackgroundRecent attempts in the USA and Europe to ban the circumcision of male children have been unsuccessful. Of current concern is a report by the Tasmanian Law Reform Institute (TLRI) recommending that non-therapeutic circumcision be prohibited, with parents and doctors risking criminal sanctions except where the parents have strong religious and ethnic ties to circumcision. The acceptance of this recommendation would create a precedent for legislation elsewhere in the world, thereby posing a threat to pediatric practice, parental responsibilities and freedoms, and public health.DiscussionThe TLRI report ignores the scientific consensus within medical literature about circumcision. It contains legal and ethical arguments that are seriously flawed. Dispassionate ethical arguments and the United Nations Convention on the Rights of the Child are consistent with parents being permitted to authorize circumcision for their male child. Uncritical acceptance of the TLRI report’s recommendations would strengthen and legitimize efforts to ban childhood male circumcision not just in Australia, but in other countries as well. The medical profession should be concerned about any attempt to criminalize a well-accepted and evidence-based medical procedure. The recommendations are illogical, pose potential dangers and seem unworkable in practice. There is no explanation of how the State could impose criminal charges against doctors and parents, nor of how such a punitive apparatus could be structured, nor how strength of ethnic or religious ties could be determined. The proposal could easily be used inappropriately, and discriminates against parents not tied to the religions specified. With time, religious exemptions could subsequently be overturned. The law, governments and the medical profession should reject the TLRI recommendations, especially since the recent affirmative infant male circumcision policy statement by the American Academy of Pediatrics attests to the significant individual and public health benefits and low risk of infant male circumcision.SummaryDoctors should be allowed to perform medical procedures based on sound evidence of effectiveness and safety with guaranteed protection. Parents should be free to act in the best interests of the health of their infant son by having him circumcised should they choose.

CDC's Male Circumcision Recommendations Represent a Key Public Health Measure

“…Convincing arguments have been made that it would be unethical to withhold information about the risks and benefits of MC from parents of boys 130 – 132 , 134 , 135 . as recommended by the AAP and CDC.…”

Critical evaluation of arguments opposing male circumcision: A systematic review

“…Legal, human rights and other arguments (presented below) have been invoked in opposing EIMC . Evaluation of those arguments have revealed flaws . Arguments criticizing the AAP's policy statement on ethical and legal grounds were followed by evaluations undermining the arguments used .…”

“…Evaluation of US and international statutes as well as US case‐law, including of cases used by a lawyer to support his arguments against MC, revealed no precedent for outlawing parent‐approved MC of minors . A report by the Tasmanian Law Reform Commission was shown by legal, public health, and medical experts to be seriously flawed . If it was “ unlawful for physicians to circumcise ,” then EIMC would not be one of the most common medical procedures in the United States .…”

“…26,69,320,[357][358][359][360][361][362] Evaluation of those arguments have revealed flaws. 342,[363][364][365][366][367][368][369][370][371][372][373][374] Arguments criticizing the AAP's policy statement on ethical and legal grounds 1,2,26,311,320,357,375,376 were followed by evaluations undermining the arguments used. 363,364,367,374,[377][378][379] Articles critical of the CDC's draft recommendations in 2014 69,329,358 have also been shown to contain serious flaws.…”

Circumcision Is a Religious/Cultural Procedure, Not a Medical Procedure

“…We have published hypotheses on these. 2,6 For now, we have good indications that population coverage and targeting pregnant women are important aspects of delivery, and home care practices, particularly hygienic behaviors, are probably crucial mechanisms. Multiple cluster randomized clinical trials with high rates of follow-up and robust statistical analyses 2 mean the intervention can now be scaled successfully where there are persistently high rates of maternal and neonatal mortality.…”