In an article published recently on this site, “Male circumcision policy ignores research showing benefits”, the authors stated some alleged benefits of infant male circumcision and argued the Royal Australasian College of Physicians’ policy (that infant male circumcision is not warranted in Australia and New Zealand) is misguided and not based on evidence.
The article itself ignores not just research and good policy, but also law – in particular, international human rights law, which Australia is bound to uphold.
The importance of holistic policy
Developing good public health policy is more than simply making conclusions based on risks and benefits to physical health. It requires consideration of what is meant by health. The World Health Organization defines health as not only physical, but also mental and social well-being. Any debate about infant male circumcision should take into account the potential long-term trauma (conscious or subconscious) of such a procedure, as well as the sense of violation it engenders.
And if scientific research is used as justification for a medical procedure, it should be applicable to the context. The research cited as showing the utility and benefit of male circumcision for disease prevention is limited exclusively to developing countries, including HIV/AIDS-prevalent societies. This doesn’t make infant male circumcision a necessary procedure in Australia.
The Royal Australasian College of Physicians (the policy paper of contention in the article in question), the Paediatric Society of New Zealand, the British Medical Association, the Canadian Paediatric Society, American Academy of Pediatrics and the American College of Obstetricians and Gynecologists all deem infant male circumcision for religious, appearance or even perceived preventative medical reasons as unnecessary medical procedure. They all consider it to be either elective or non-therapeutic surgery.
Male circumcision and infant male circumcision both ultimately boil down to choice – and that is a human rights issue. At the heart of human rights is the concept of human dignity, and rights such as those to physical integrity, to the highest attainable standard of physical and mental health, and, in the case of children, the obligation to act in their best interests.
These are not only protected under international human rights law, but are entrenched in criminal law systems in various forms. Criminal laws consider interference with the physical integrity of another human being as the most serious of offences.
Human rights law reflects the importance placed on such violations and a forced medical procedure on an individual is in breach of a number of human rights. Circumcision without consent or any immediate medical necessity on a healthy adult male would clearly be in breach of his human rights. So how is infant male circumcision without consent any different?
Children are entitled to the same basic rights as adult individuals. Indeed, they have special protections that recognise their unique vulnerability, as made clear under the Convention on the Rights of the Child, which Australia has ratified.
The rights of parents?
While parents and legal guardians provide consent on behalf of children for necessary medical procedures (such as immunisations) the removal of healthy, functioning genital tissue from an infant (many years before any purported protections from sexual disease are even relevant) is clearly not a necessary medical procedure.
Parental consent to infant male circumcision is insufficient justification in contemporary Australia. It also ignores doctors' duties to the child to do no harm, is arguably an inconsistent interpretation of the limitations of parental consent and a breach of the child’s human rights. If the purported benefits are, on balance, enough to warrant a male circumcision, then this is a decision for which he, whether as an adolescent or an adult, is solely entitled to.
For some, the medical benefit debate is irrelevant. Infant male circumcision is seen as a fundamental ritual in the practise of religion, which is also a human right. While some may interpret the right to freedom of religion as including the right to practise infant male circumcision, it has clearly been accepted under international human rights law that one individual’s right to freedom of religion does not trump another’s right not to have their bodily integrity interfered with.
In the seminal United States child rights case Prince v Massachusetts, the Court held that “[t]he right to practice religion freely does not include liberty to expose the… child to ill health or death… Parents may be free to become martyrs themselves. But they may not make martyrs of their children before they have reached the age of full and legal discretion when they can make that choice for themselves”.
And in May this year, the regional court of Cologne in Germany applied the same reasoning in a case about infant male circumcision. It said “the right of the parents to raise their child in their religious faith does not take precedence over the right of the child’s bodily integrity and self-determination” (translated from German).
Restricting male circumcision to informed adolescents and adults is in no way a restriction on the freedom of religion. If anything, it’s upholding the child’s right to that freedom.
Whether for perceived medical benefit, religious or cultural reasons, until the informed consent of the individual can be freely given, infant male circumcision is plainly, and simply, a violation of human rights. It ignores the child’s rights to bodily integrity, to physical and mental health and to freedom of religion.
Advocates for infant male circumcision in Australia are failing to act in the best interests of Australian children.