Circumcision in Australia: neither needed nor ethical

The Australian Federation of AIDS Organisations has stated that circumcision has no relevance to Australia's HIV problem, and their conclusion has been endorsed by a paper in the Australian and New Zealand Journal of Public Health, which argues that circumcision is not a surgical vaccine and is not appropriate as an HIV control tactic in Australia.

The consensus of medical authorities

Because it is a highly emotional subject, arousing deep passions on both sides, the literature on circumcision – both for and against – is vast. Like the Bible, you can find a statistic for any claim you care to make, and if you go back to the nineteenth century you can find medico-scientific evidence that the foreskin is complicit in, and circumcision can prevent, anything from epilepsy, tuberculosis and polio to bed-wetting, pimples and brass poisoning. There may be an avalanche of evidence in favour of its benefits for health, but on closer inspection much of it turns out to be dross.

Nonetheless, task forces set up by medical authorities in countries where routine circumcision became established (Britain, the USA, Australia and Canada) have attempted to sift through the piles of mullock and reach an overall conclusion as to whether it is good, bad or indifferent. They have all concluded that that circumcision as a precaution is ethically questionable and medically unnecessary, and that it should not be performed unless there is an injury, deformity or disease that cannot be treated in any other way.

The most recent statement from the British Medical Association comments:

"There is significant disagreement about whether circumcision is overall a beneficial, neutral or harmful procedure. At present, the medical literature on the health, including sexual health, implications of circumcision is contradictory, and often subject to claims of bias in research. …

"Doctors should ensure that any parents seeking circumcision for their son in the belief that it confers health benefits are fully informed of the lack of consensus amongst the profession over such benefits, and how great any potential benefits and harms are. The BMA considers that the evidence concerning health benefit from non-therapeutic circumcision is insufficient for this alone to be a justification for doing it."

The current policy (October 2010) of the Royal Australasian College of Physicians states:

"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 and New Zealand."

Summing up the pros and cons of circumcision, the statement continues: "The decision to circumcise or not to circumcise involves weighing up potential harms and potential benefits. The potential benefits include connectedness for particular socio-cultural groups and decreased risk of some diseases. The potential harms include contravention of individual rights, loss of choice, loss of function, procedural and psychological complications."

Since the harms appear to outweigh the potential benefits, and many adult men resent having been circumcised, it follows that the only person entitled to make the decision is the one who must bear the lifelong consequences. The statement agrees with the Royal Dutch Medical Association that leaving the circumcision decision to be made by the boy when he is old enough to make an informed choice has the merit of respecting individual autonomy, preserving everybody's options and respecting the "open future" principle.

Their bottom line is that (routine) preventive circumcision of minors offers no significant health benefit, carries significant risks, has an adverse effect on sexual sensation, is an affront to personal autonomy, is a violation of the right to bodily integrity, and should not be performed.