Circumcision in Australia: neither needed nor ethical

6. Medical ethics and human rights

Circumcision advocates refer to the objections to circumcision on medical ethics and human rights grounds as "nebulous", but I suggest that these issues are central to the whole question. No matter how great the benefits of circumcision may be, the fact remains that the foreskin belongs to its owner as surely as his fingers, toes, ears, liver and any other organ. The only health-related situation where it can be ethically removed without consent is in a life-threatening emergency, or in order to address a deformity, injury or disease that has not responded to conservative treatments after reasonable efforts.

To be ethically acceptable a medical intervention must pass the five tests proposed by bioethicists Beauchamp and Childress:

1. Beneficence - Does the proposed procedure provide a net therapeutic benefit to the patient, considering the risk, pain, and loss of normal function?
2. Non-maleficence - Does the procedure avoid permanently diminishing the patient in any way that could be avoided?
3. Proportionality - Will the final result provide a significant net benefit to the patient in proportion to the risk undertaken and the losses sustained?
4. Justice - Will the patient be treated as fairly as we would all wish to be treated?
5. Autonomy - Lacking life-threatening urgency, will the procedure honour the patient's right to his or her own likely choice? Could it wait for the patient's assent?

Non-therapeutic circumcision of minors fails all these tests. It is not beneficent because it provides no therapeutic benefit (nor even a relevant prophylactic benefit, since a child is at zero risk of STIs). It is malefic because it diminishes the genitals. It is disproportional because the net gain (if any) is out of proportion to the loss, harm and risk of complications. It is unjust because adult preferences show clearly that if he had a choice in the matter the boy would refuse the operation. And it fails to respect the boy's autonomy and preserve his future options as an adult individual. It has been strongly argued that such unwarranted interventions are unethical, violate the individual's right to physical integrity, and are of borderline legality.

Conclusion

Even if all the benefits of circumcision claimed by its promoters were true, they would only amount to a case that might persuade a cautious adult to elect the procedure for himself. The case was never sufficient to justify doing it to children without consent. Individuals are entitled to make their own choices about how they manage their health, and should not be deprived of normal body parts merely because somebody else thinks they would be better off without them.

It may be justifiable to perform circumcision on adults who have given informed consent, and even on children who cannot give consent in situations of therapeutic necessity (i.e. to correct a pathology that has not responded to conservative treatment); and it is arguable that it is justified if the parents are devout, conscientious, practising adherents of a religion which holds that children must be circumcised. Like sexual intercourse, it depends on the circumstances: with the consent of a person above the legal age of consent, sexual intercourse is justifiable; without consent, or if the person is below the statutory age, it is sexual assault or rape. There is no reason why the rules for permanent bodily alterations, particularly in such a physically and psychologically sensitive area as the penis, should be less strict than the rules for sexual activity.