Bulletin of Medical Ethics, Volume 28, Pages 13-19. May 1997.
Bulletin of Medical Ethics, Volume 28, Pages 13-19. May 1997.
The origins of circumcision are lost in antiquity. Male circumcision is depicted in Egyptian tombs 5,000 years ago, while Gairdner1 refers to evidence that it originated in prehistory up to 15,000 years ago. Well before it acquired its religious overtones, it was clearly sacrificial, demanding the loss of something of great value.
The words of Rabbi Maimonides2 from the 12th century support this view of the losses: As regards circumcision, I think that one of its objects is to limit sexual intercourse, and to weaken the organ of generation as far as possible, and thus cause man to be moderate....This commandment has not been enjoined as a complement to a deficient physical creation, but as a means for perfecting man's moral shortcomings. The bodily injury caused to that organ is exactly that which is desired; it does not interrupt any vital function, nor does it destroy the power of generation. Circumcision simply counteracts excessive lust; for there is no doubt that circumcision weakens the power of sexual excitement, and sometimes lessens the natural enjoyment ... .
In the 19th century circumcision was advanced, in Britain and other English-speaking countries, as a preventive for masturbation and the ills believed to be caused by masturbation, and was labelled as 'hygienic', a misdescription which persists. Thereafter it became a procedure credited with a wide range of supposed benefits. Even today the prepuce is popularly seen as no more than a piece of vestigial skin of no, or minimal, function and whose removal causes no real pain, involves few or no risks and produces no short or long-term harm. It is usually claimed that when done in infancy it confers benefits. The practice is still widespread in the USA where currently 60% (down from 90% in the 1970s) of male neonates are circumcised; the increasingly bizarre attempts to justify this routine mutilation3 only raise questions as to the psychopathology of the procedure.
From the perception of harmlessness flows the belief that it represents a cheap, easy and appropriate solution to medical problems with the prepuce, and that its removal for ritual, cultural or social reasons is ethical and legal, giving rise to neither criminal nor civil liability since the operator may rely on parental consent to the procedure.
Brazier4 encapsulates the misconceived discussion of the medical facts and legal issues that is common:
Medical opinion on male circumcision is divided. Until recently many doctors regarded it as rarely medically indicated. Now it seems circumcision provides some protection against venereal disease, at any rate for the circumcised man's partner! Male circumcision is a matter of medical debate. For Jewish and Muslim parents it is an article of faith. The child suffers momentary pain. Although medical opinion may not necessarily regard it as positively beneficial, it is in no way medically harmful if properly performed. The community as a whole regards it as a decision for the infant's parents.
Even the more thoughtful view of Poulter5 errs:
The basic right to bodily integrity which everyone possesses under the English common law means that any interference with this right amounts to an assault or battery... The question raised in cases of circumcision, excision or infibulation is whether the operation can be justified as constituting lawful as opposed to unlawful interference with this right... Although there are no precedents in this field there would appear to be three possible grounds upon which a defence of lawfulness might succeed at common law. The first is that the procedure is therapeutic. If this can be established a parent can validly consent to it on behalf of a child who is too young to understand what is being done. It would appear unlikely that this defence could generally succeed other than in comparatively rare instances of physical defect or abnormality. Second ... it seems that a parent may equally validly authorise a non-therapeutic operation, provided it is not actively against his child's interests. This would appear to be the basis upon which the vast majority of male infants have been circumcised in this country with impunity from time immemorial. There is no need under this heading for the parent to establish that the operation is positively beneficial for the child, merely that he was acting reasonably in authorising it. Third, it has been tentatively suggested that a parent may even authorise something that is against his child's interests if it is compensated by sufficient advantage to others and is not seriously detrimental to the child... It seems extremely unlikely that it could justify the more remote and controversial benefit of satisfying a deeply-felt community attachmentto traditional customs.
Poulter concludes that male circumcision is lawful. This can only be so if he is correct both in his analysis of the legal right of a parent to assent to an assault on his child for non-therapeutic reasons (i.e. his grounds 2 and 3), and in the view that male circumcision is harmless and not to be equated with female circumcision. His view of parental consent is open to doubt; but even if correct, the evidence of harm would defeat his conclusion on 'ground' 2, and more so for 'ground' 3. I shall not attempt to review here all the medical studies on the adverse effects of circumcision, nor the issues raised when doctors perform circumcision to treat a medical condition, for which a less invasive treatment would have been effective. There is however an extensive literature.6
This paper proceeds from the basis that circumcision incontrovertibly:
Since it is clear that traditional
thinking as to the supposed legality of the procedure for non-therapeutic reasons is predicated on conventional beliefs about the nature of circumcision, this paper examines the consequences that flow from a recognition of the harmfulness of circumcision.
In Collins v. Wilcock8 Robert Goff LJ said:
the fundamental principle, plain and incontestable, is that every person's body is inviolate. It has long been established that any touching of another person, however slight, may amount to a battery. ....As Blackstone wrote in his Commentaries, 17th ed.(1830)vol. 3, p 120: 'the law cannot draw the line between different degrees of violence, and therefore totally prohibits the first and lowest stage of it; every man's person being sacred, and no other having a right to meddle with it, in even the slightest manner.' The effect is that everybody is protected not only against physical injury but against any form of physical molestation. But so widely drawn a principle must inevitably be subject to exceptions.
Lord Lane CJ9 has said that:
...Nothing we have said is intended to cast doubt upon the accepted legality of properly conducted games and sports, lawful chastisement or correction, reasonable surgical interference, dangerous exhibitions, etc. These apparent exceptions can be justified as involving the exercise of a legal right, in the case of chastisement or correction, or as needed in the public interest, in the other cases.
Although earlier cases10 indicated common law exceptions to the general rule that it was not permissible to inflict injury even with the victim's consent, circumcision was not mentioned as one. The first specific mention of it arose in the prosecution of a mother for scarifying the cheeks of her sons in accordance with tribal custom11. Judge King-Hamilton QC said that the potential for serious injury was great because the slightest movement might lead to an eye injury; in distinction, he considered, from the 'accepted practices of ear-piercing and ritual circumcision'. But there is an obvious difference between piercing an ear-lobe and amputating a prepuce; and even in 1974 there was enough evidence of the harm from neonatal circumcision. Indeed, unattractive as ritual scarification of a child's body might be (it clearly was to Judge King-Hamilton), it is far less unacceptable than ritual circumcision: it amputates no flesh and causesno loss of function.
Lord Templeman said in R v. Brown:12
In some circumstances violence is not punishable under the criminal law ... Surgery involves intentional violence resulting in actual or sometimes serious bodily harm but surgery is a lawful activity. Other activities carried on with consent by or on behalf of the injured person have been accepted as lawful notwithstanding that they involve actual bodily harm. Ritual circumcision, tattooing, ear-piercing and violent sports .. are lawful activities.
The express inclusion of circumcision as lawful was not essential to the finding of the majority of the law lords that consensual sado-masochistic injuries were criminal. Further, as Lord Templeman observed, some activities, once thought of as legal, were no longer regarded as such: In earlier days other forms of violence were lawful ... when they ceased to be lawful they were tolerated until well into the 19th century. Duelling and fighting were at first lawful and then tolerated provided the protagonists were voluntary participants
.
Lord Templeman's view clearly depended on a perception that the harm caused by circumcision was minimal, that parental consent sufficed and, it would seem, on a tacit belief that religious and/or multicultural tolerance demanded its continuing acceptance; he was bolstered no doubt by doctors whose readiness to circumcise for spurious reasons provided a misplaced respectability.
His remarks, both about ritual circumcision per se and as contrasted with the sado-masochistic practises in Brown, were made without regard to the ordinary law of assault to the person, to the criminal offence of wilful harm to children (
Children and Young Persons Act 1933) or to the limits on parental consent implicit in the duty to treat the child's welfare as paramount ( Children Act 1989).
The Law Commission,13 in its consultation paper on consent in the criminal law, asserts that Male circumcision is lawful under English common law.. It is generally accepted that the removal of the foreskin of the penis has little, if any, effect on a man's ability to enjoy sexual intercourse, and this act is not, therefore, regarded as mutilation
.
Male circumcision was also considered by the Queensland Law Reform Commission14 (QLRC) - a common law jurisdiction. QLRC made no claim for its legality at common law. In Queensland a person can consent to what would otherwise be a simple assault, but consent does not remove criminal responsibility for more serious injuries such as wounding. QLRC stated that: In the absence of
real
consent, circumcision of male infants would fall within the definition of assault under s.245 of the Queensland Criminal Code. It might also be an offence endangering life or health. A number of criminal offences may be committed depending on the circumstances.
QLRC concluded:
Whether or not circumcision would be for the benefit of the particular child and whether or not it would be reasonable having regard to the child's state at the time and to all the circumstances of the case would need to be assessed on a case-by-case basis
. It appears to have based the permissibility of male circumcision on the exemption given by law to medical procedures, rather than on some general rule of common law that it is an exception to the general prohibition on consensual infliction of injury.
QLRC also discussed the limits on parental consent:
The common law operating in Queensland appears to be that if a young person is unable, through lack of maturity or other disability, to give effective consent to a proposed procedure and if the nature of the proposed treatment is invasive, irreversible and major surgery and for non-therapeutic purposes, then court approval is required before such treatment can proceed. The court will not approve the treatment unless it is necessary and in the young person's best interests ... The basis of this attitude is the respect which must be paid to an individual's bodily integrity...Unless there are immediate health benefits to a particular child from circumcision, it is unlikely that the procedure itself could be considered as therapeutic ... The circumcision is invasive, irreversible and major. It involves the removal of an otherwise healthy organ part. It has serious attendant risks... On a strict interpretation of the assault provisions of the Queensland Criminal Code, routine circumcision of a male infant could be regarded as a criminal act. Further, consent by parents to the procedure being performed may be invalid in the light of the common law's restrictions on the ability of parents to consent to the non-therapeutic treatment of children.
It is clear that the QLRC believes non-therapeutic circumcision to be unlawful.
The law recognises limits on the parental discharge of responsibilities for children. First, the law sees parents as having duties (from which flow rights in order to discharge those duties). As Lord Scarman says in Gillick15:
The principle of the law, as I shall endeavour to show, is that parental rights are derived from parental duty and exist only so long as they are needed for the protection of the person and property of the child. ...Giving consent to medical treatment of a child is a clear incident of parental responsibility arising from the duty to protect the child.
Professor Dwyer16 convincingly argues that the view that parents have rights over their children is incorrect and untenable: the rights reside in the children with the parents acting as agents for the children to enforce those rights. Dwyer writes from a culture and constitution (that of the US) which sets great store on freedom from state interference and on religious freedom, to the point that the correct position has been blurred. Dwyer echoes English law as to thenature of the parent-child relationship.
Approaches to medical interventions involving children are discussed also by Linda Delany.17 Those who would apply to all non-therapeutic circumcisions a different and/or lower level of protection of the child than either of those identified by Delany must clearly articulate this, demonstrating why such a differing approach would be necessary, proper and justified against general legal principles and civilised legal norms.
The factual situation discussed by Delany is the practice of requiring a child to donate an organ or bodily material for the benefit of another, such as a seriously-ill sibling; whilst these procedures may often involve reduction in function (at least potentially, as when a kidney is donated) they may also merely involve the loss of body fluids which the donor will restore naturally. One approach, wholly consistent with the Children Act 1989, is that of the House of Lords in Gillick, permitting a medical procedure only if it serves the best interests of the child who undergoes it. The second, stemming from S v. S, W v. Official Solicitor,18 accepts that parents can give valid consent to treatments which are not against the interests of the child
.
Applying either approach to non-therapeutic circumcision (where the loss and risks are significant, there is no recipient to benefit and, at best, the 'benefit' to the victim is an intangible cultural identity) leads to the conclusion that a parent cannot give a valid consent to a non-therapeutic circumcision.
The law has for many years also recognised the need to protect children from the wilful infliction of harm by parents, guardians or those in loco parentis. Thus, under section 1(1) of the Children and Young Persons Act 1933, a person who 'wilfully assaults' a child or 'causes or procures him to be assaulted..... in a manner likely to cause him unnecessary suffering or injury to health' commits an offence. As Brigman19 has observed, routine circumcision is child abuse.
It is hard to see why criminal liability should not properly attach to all those complicit in the non-therapeutic circumcision of a boy, including the consenting parent, as well as the circumciser, since the parent causes or procures him to be assaulted
. Irrespective of any criminal liability the circumcised child would seem to have a strong claim for substantial damages against all those involved in his mutilation.
Doctors who perform ritual circumcisions usually plead 'necessity': in its least repellent form the argument runs that since boys will be ritually circumcised anyway, it is 'better' that this be done by doctors in a clinical setting; alternatively that it is a 'service' to the community which 'ought to be made available'. The Bradford Royal Infirmary provides such a service, with the knowledge and, seemingly, encouragement of the NHS Executive.
Quite where the interests of the child-patient figure in this, and how this approach is compatible with the ethical principle that the doctor owes his duty solely to his patient - the child - and not to a parent and/or some religious behest, is hard to see.
Even the American Academy of Pediatrics in guidance on treating children20 has said:
Thus 'proxy consent' poses serious problems for pediatric health care providers. Such providers have legal and ethical duties to their child patients to render competent medical care based on what the patient needs, not what someone else expresses ... the pediatrician's responsibilities to his or her patient exist independent of parental desires or proxy consent.
Those who advance the plea of necessity and/ or expediency might wish to consider how they would rebut comparison with unethical behaviour by other doctors, such as those involved in torture, who also use such excuses. They might also explain why abusive behaviour towards a child is less abusive when performed by a doctor.
Perhaps the antiquity and religious overtones of the procedure, coupled with the continuing unease at masturbation that provided the 19C arguments for routine circumcision in the name of hygiene
, provide the oil for this slippery slope
where the interests of the patient are subordinated to demands of the State, religion, or parents. Thus we should be alarmed but not surprised that the Royal College of Physicians requires as a condition of admission to fellowship the completion of a 'form of faith' in which the doctor promises to 'do everything ... to the honour of the College and welfare of the State' without mention of responsibilities to individual patients.
21
Discrimination against boys in permitting inevitably damaging mutilation of their genitals, whilst enacting legislation22 to criminalise a similar procedure when done to girls, is as offensive as any other expression of discrimination. Kluge23 compares female with male circumcision and, expressing similar views on both, writes: To argue differently is to be guilty of discrimination on the basis of sex...Both involve what in other contexts would be called nonconsensual mutilation of a minor for nonmedical reasons
. Circumcision further discriminates - between those boys who, because of an accident of birth, face non-therapeutic circumcision and those more fortunate boys who do not.
Rejoicing in our multicultural society does not mean that we should be blind to practices, whatever their source and motive, which are them-selves abusive and discriminatory of others, directly and inevitably diminishing the freedoms, human rights, integrity and dignity of others.
Certain rights are recognised as so fundamental that they are part of customary international law, as well as being found in a host of international conventions on human rights: these include the right to bodily integrity, freedom from cruel and inhuman treatment (which would include circumcision once its harmful effects were recognised), and freedom from discrimination on a variety of grounds including birth, sex, race, creed.24
The UN Convention on the Rights of the Child makes the position clearer in respect to circumcision. Article 24(3) provides: States Parties shall take all effective and appropriate measures with a view to abolishing traditional practices prejudicial to the health of children.
Some have sought to argue that this provision was only aimed at female circumcision; but this argument cannot hold when the Convention is read with the interpretative provisions of the Vienna Convention on the Law of Treaties 1969.25
God commands it
Since the Holocaust it has been regarded as virtually impossible to criticise any Jewish practice, or even ritual circumcision by the two main religions that perform it (Judaism and Islam). Any such criticism is seen as essentially racist and/or a denial of religious freedom. But it is not. Rather it is an assertion of the rights of the individual over the perceived rights of others to behave towards that individual in any way that they think fit.
Customary international law provides that an individual's exercise of his freedoms can legitimately be restrained when so to exercise them is to damage or deny those freedoms to another. Thus Article 9(2) of the European Convention on Human Rights provides:
Freedom to manifest one's religion or beliefs shall be subject only to such limitations as are prescribed by law and are necessary in a democratic society in the interests of public safety, for the protection of public order, health or morals, or for the protection of the rights and freedoms of others
(emphasis added). The Convention thus distinguishes between the unfettered right to freedom of thought, and the more restricted right to manifest one's religion.
As Dwyer26 says: ... even if it does on the whole further parents' interests to possess rights to direct their children's lives in ways that are harmful to the children, the state should deem such interests illegitimate and refuse to give them precedence over the interests of children. The problem with such
interests
is that they entail treating children instrumentally, using children in ways that sacrifice their welfare interests in order to further the ulterior interests of parents....This is true whether the parents' motives are self-regarding or solely concerned with the well-being of the child (e.g. if the parents believe they are sacrificing the child's temporal interests in order to further the child's spiritual interests)....The reluctance of liberals in particular to take a stand against religiously motivated parenting of which they personally disapprove is, I believe, due largely to their believing that liberal values of tolerance and respect for diverse ideological views require the state to defer to the viewpoint of the parents in determining whether particular parenting practices should be permissible. This might be a defensible position from which to determine the permissibility of what individuals do to themselves or what consenting adults do to each other. However, it is a mistake in the case of children, who are not the same persons as their parents, nor, in general, consenting participants in the religious practices of their parents.
At a time when society is wrestling with legal and ethical issues such as those of conception for infertile couples, xenotransplants and animal cloning, it may seem trivial to look critically at male circumcision. But so to look (combining the state of medical knowledge of the inevitable harm of the procedure, and the absence of benefits from non-therapeutic circumcision, with a return to a critical examination of the law and ethical principles in the light of the known medical position) reveals current attitudes which do no credit either to doctors, lawyers or ethicists. The BMA guidance on circumcision, published in September 1996 by its Medical Ethics Committee, and the recent GMC guidelines, are but examples of shabby and sectionalist attempts by the medical profession to pander to the ritual circumcisers, at the expense of the child-patient. Non-therapeutic circumcision is clearly discriminatory, unethical and illegal. Its pre-historic origins, and its kinship with subincision and other forms of penile mutilation, show its essential barbarity. It should no longer be tolerated, despiteits religious overtones.
Personal View. BMJ (1994) 309, 676....we would like to discourage the American Academy of Pediatrics from promoting routine circumcision as a preventative measure for penile and cervical cancer. Research suggesting a pattern in the circumcision status of partners of women with cervical cancer is methodologically flawed, outdated, and has not been taken seriously in the medical community for decades. Penile cancer rates in countries which do not practice circumcision are lower than those found in the United States. Fatalities caused by circumcision accidents may approximate the mortality rate from penile cancer.(Letter from American Cancer Society to American Academy of Pediatrics, 16 Feb 1996).
Female circumcision: when medical ethics confronts cultural values. CMA Journal (1993)148, 288-9.Freedom to manifest one's religion or beliefs may be subject only to such limitations as are prescribed by law and are necessary to protect ... the fundamental rights and freedoms of others.
For reasons of space, the following sources were not included in the article as published but are given here for further reading:
There can be no doubt of [masturbation's] injurious effect, and of the proneness to practice it on the part of children with defective brains. Circumcision should always be practiced. It may be necessary to make the genitals so sore by blistering fluids that pain results from attempts to rub the parts.
~ Angel Money. Treatment Of Disease In Children. Philadelphia: P. Blakiston.1887. p. 421.
In consequence of circumcision the epithelial covering of the glans becomes dry, hard, less liable to excoriation and inflammation, and less pervious to venereal viruses. The sensibility of the glans is diminished, but not sufficiently to interfere with the copulative function of the organ or to constitute an objection...It is well authenticated that the foreskin...is a fruitful cause of the habit of masturbation in children... I conclude that the foreskin is detrimental to health, and that circumcision is a wise measure of hygiene.
~ Jefferson C. Crossland, MD, The Hygiene of Circumcision,
New York Medical Journal, 1891;53:484-485.
Implies the cutting off or removal of a part essential to completeness, not only of a person but also of a thing, and to his or its perfection, beauty, entirety or fulfilment of function.' Webster's New Dictionary of Synonyms: a Dictionary of Discriminated Synonyms and Analogous and Contrasted Words (1968)
Mutilation:
The act of depriving an individual of a limb, member, or any other important part; deprival of an organ; severe disfigurement.' Dorland's Illustrated Medical Dictionary (28th Edition) 1994
We may circumcise the male patient with present and probably with future advantage; the operation, too, should not be performed under chloroform, so that the pain experienced may be associated with the habit we wish to eradicate.
~ Athol A.W. Johnson, On An Injurious Habit Occasionally Met with in Infancy and Early Childhood, The Lancet, vol. 1 (April 7, 1860) pp. 344-345.
A remedy [for masturbation] which is almost always successful in small boys is circumcision...The operation should be performed by a surgeon without administering an anaesthetic, as the pain attending the operation will have a salutary effect upon the mind, especially if it be connected with the idea of punishment...
~ John Harvey Kellogg, MD. Treatment for Self-Abuse and Its Effects, Plain Facts forOld and Young. Burlington, Iowa: F. Segner & Co.1888. p. 295.
Measures more radical than circumcision would, if public opinion permitted their adoption, be a true kindness to many patients of both sexes.
~ Jonathan Hutchinson, On Circumcision as Preventive of Masturbation,
Archives of Surgery 1891;2: 267-268
Clarence B. was addicted to the secret vice practiced among boys. I performed an orificial operation, consisting of circumcision...He needed the rightful punishment of cutting pains after his illicit pleasures.N. Bergman, MD.
Report of a Few Cases of Circumcision,Journal of Orificial Surgery 1898;7:249-251 5. That it causes loss was as well known in the 19th and the first part of the 20thC, as it was to Maimonides, but today vehemently denied, is shown by:
In consequence of circumcision the epithelial covering of the glans becomes dry, hard, less liable to excoriation and inflammation, and less pervious to venereal viruses. The sensibility of the glans is diminished, but not sufficiently to interfere with the copulative function of the organ or to constitute an objection...It is well authenticated that the foreskin...is a fruitful cause of the habit of masturbation in children... I conclude that the foreskin is detrimental to health, and that circumcision is a wise measure of hygiene.
~ Jefferson C. Crossland, MD, The Hygiene of Circumcision,
New York Medical Journal, 1891;53:484-485
Finally, circumcision probably tends to increase the power of sexual control. The only physiological advantage which the prepuce can be supposed to confer is that of maintaining the penis in a condition susceptible to more acute sensation than would otherwise exist. It may increase the pleasure of coition and the impulse to it: but these are advantages which in the present state of society can well be spared. If in their loss increase in sexual control should result, one should be thankful.
~ Jonathan Hutchinson. Our London Letter.
Medical News 1900;77:707-708
It has been urged as an argument against the universal adoption of circumcision that the removal of the protective covering of the glans tends to dull the sensibility of that exquisitely sensitive structure and thereby diminishes sexual appetite and the pleasurable effects of coitus. Granted that this be true, my answer is that, whatever may have been the case in days gone be, sensuality in our time needs neither whip nor spur, but would be all the better for a little more judicious use of curb and bearing-rein.
~ E. Harding Freeland. Circumcision as a Preventive of Syphilis and Other Disorders,
The Lancet (December 29, 1900):1869-1871.
I suggest that all male children should be circumcised. This is
against nature,
but that is exactly the reason why it should be done. Nature intends that the adolescent male shall copulate as often and as promiscuously as possible, and to that end covers the sensitive glans so that it shall be ever ready to receive stimuli. Civilization, on the contrary, requires chastity, and the glans of the circumcised rapidly assumes a leathery texture less sensitive than skin. Thus the adolescent has his attention drawn to his penis much less often. I am convinced that masturbation is much less common in the circumcised. With these considerations in view it does not seem apt to argue that God knows best how to make little boys.
~ R.W. Cockshut. Circumcision,
British Medical Journal, 2 (1935): 764.
methodologically flawed.
There are no valid medical indications for circumcision in the neonatal period.
~ Committee On Fetus And Newborn. Standards and Recommendations for Hospital Care of Newborn Infants, 5th Ed. Evanston: American Academy of Pediatrics. 1971. 110.
Secretary, Dept. of Health and Community Services v. JWB and SMB: 1992 175 CLR 218 [Marion's Case]Everyone is entitled to all the rights and freedoms set forth in this Declaration, without distinction of any kind, such as: race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status.
In the UN Convention on the Right of the Child, Art 2 provides:
States Parties shall respect and ensure the rights set forth in the present Convention to each child within their jurisdiction without discrimination of any kind, irrespective of the child's or his or her parent's or legal guardian's race, colour, sex, language, religion, political or other opinion, national, ethnic or social origin, property, disability, birth or other status.
States Parties shall take all appropriate measures to ensure that the child is protected against all forms of discrimination or punishment on the basis of the status, activities, expressed opinions, or beliefs of the child's parents, legal guardians, or family members.
Despite the obviously irrational cruelty of circumcision, the profit incentive in American medical practice is unlikely to allow science or human rights principles to interrupt the highly lucrative American circumcision industry. It is now time for European medical associations loudly to condemn the North American medical community for participating in and profiting from what is by any standard a senseless and barbaric sexual mutilation of innocent children.
~ Paul M. Fleiss, MD, MPH. Circumcision Lancet, 1995;345:927.
(Christopher Price read law at Oxford University, qualified as a solicitor in 1971 and has practiced mainly in government service, with a particular interest in international law and human rights.)
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