Informed Consent for Neonatal Circumcision: an Ethical and Legal Conundrum

Journal of Urology, Volume 168, Issue 4 Pt 1, Pages 1650-1651. October 2002.

Douglas A. Canning, M.D.; J. S. Svoboda; R. S. Van Howe; J. G. Dwyer
Attorneys for the Rights of the Child, Berkeley, California, Department of Pediatrics,
Marshfield Clinic-Lakeland Center, Minocqua, Wisconsin,
and William & Mary School of Law, Williamsburg, Virginia

This lengthy legal document illustrates the danger surgeons accept when operating for a nonmedical indication in minors. The authors carefully make the argument that circumcision, in the absence of a medical indication, may be unwise and may actually be illegal. The continued widespread practice of circumcision hangs in the legal balance of valid permission from the parents to perform the procedure in their incompetent (in the eyes of the law) children. Valid permission requires that parents be provided with and fully comprehend the potential risks and complications, and appreciate the consequences of their decision.

The authors further indicate that Regardless of the motivations and desires of the physicians and parents, the only interventions for which parents may grant their permission are those conferring benefits that clearly outweigh the short and long-term costs for the infant patient. It is the impression of the authors that Physicians today routinely fail to provide informed consent adequate to support the amputation of a highly sensitive and functional part of the body in a helpless infant.

If circumcision becomes less commonly performed in North America, the legal system may no longer be able to ignore the conflict between the practice of circumcision and the legal and ethical duties of medical specialists. This document is worth a read by all of us who perform newborn circumcision. I suspect that it will be used to support the argument of those who would favor outlawing routine circumcision.

Citation:

Canning DA, Svoboda JS, Van Howe RS, et al. Informed Consent for Neonatal Circumcision: an Ethical and Legal Conundrum. J Urol. 2002-10;168(4 Pt 1):1650-1.

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