Male Genital Mutilation

[Rhiannon]

And I wouldn't be surprised if there's a test case before long.

[ProfessorDavey]

And I wouldn't be surprised if there's a test case before long.

Perhaps although I wouldn't hold your breath.

Don't forget that FGM is clearly unlawful yet the CPS seems extremely reluctant to prosecute.

That said it could be that the case in the OP provides the opportunity, although I suspect that the courts may 'fudge' the issue - with the brush off of requiring consent of both parents - which is (to my knowledge) pretty well unique in medical ethics and law and actually makes no sense.

[Bubbles]

No you are a long way from reality.

If a parent asks a doctor to circumcise their child (except where it is therapeutic) then the doctor does not simply accept the parent's request as 'being in the child's best interests' - no they are obliged themselves to come to a view and I suspect in many circumstance the doctor will take the view that it is not in the child's best interests and will refuse. And the parents simply saying they want it and they'll consent is also not good enough - consent is only valid if sufficiently informed (which must include clear indication of risks) and also completely voluntary, so there should be no external pressures, for example from a community that 'expects' boys to be circumcised.

So I suspect many parents trawl around to find a willing doctor, or more likely communities with high circumcision rates already know the 'tame' doctors who will be willing to circumcise and likely will turn a blind eye to the actual requirements for valid consent.

Actually it isn't even completely clear that non therapeutic infant circumcision is lawful in the UK.

Yes it is

https://www.circinfo.org/documents/BMA-Circ.pdf

Why you insist on misrepresenting the situation, I've no idea!

From the BMA link

"4.1 The law
Male circumcision is not grounded in statute, however judicial review assumes that, provided both parents consent, non-therapeutic male circumcision is lawful:
"

[Rhiannon]

Perhaps although I wouldn't hold your breath.

Don't forget that FGM is clearly unlawful yet the CPS seems extremely reluctant to prosecute.

That said it could be that the case in the OP provides the opportunity, although I suspect that the courts may 'fudge' the issue - with the brush off of requiring consent of both parents - which is (to my knowledge) pretty well unique in medical ethics and law and actually makes no sense.

What about adults suing retrospectively?

[wigginhall]

I was wondering how it can be lawful, since presumably, it is technically assault.   I know that assault can be legal, if it's consented to, and is therapeutic, as in surgery, or for cosmetic purposes, e.g., tattooing.

But these involve either adults giving consent, or children having consent given by parents, as in the case of surgery.   

But clearly you can't consent to an assault such as tattooing, in a child.   How does it become legal for MGM?  Custom and practice, I guess.

[Bubbles]

I was wondering how it can be lawful, since presumably, it is technically assault.   I know that assault can be legal, if it's consented to, and is therapeutic, as in surgery, or for cosmetic purposes, e.g., tattooing.

But these involve either adults giving consent, or children having consent given by parents, as in the case of surgery.   

But clearly you can't consent to an assault such as tattooing, in a child.   How does it become legal for MGM?  Custom and practice, I guess.

If you look at my BMA link you will find out.

[Gordon]

If you look at my BMA link you will find out.

Dated 2006 - perhaps now would be a good time for the UK legislatures to grow a pair and legislate to stop babies being mutilated due to 'ritual' (as in noted in your link) circumcision. Time to stop kow-towing to religious superstitions that involve barbarism.

In my view 'ritual' circumcision is utterly indefensible in an allegedly civilised society.

[Shaker]

It's not your call, Floo.

As important as you think you are!

It's not your call Rose.

As important as you think you are!

[ProfessorDavey]

If you look at my BMA link you will find out.

Which makes it clear that the issue of whether non therapeutic circumcision is lawful is not completely settled.

[Bubbles]

It's not your call Rose.

As important as you think you are!

No at the moment, it's the parents call.

Not yours , not mine, not Floo's.

[wigginhall]

No at the moment, it's the parents call.

Not yours , not mine, not Floo's.

I guess that will be the nub of future legal challenges.   I mean, parents cannot give consent to certain types of wounding such as tattoos or piercing, on their children, which are non-surgical.    So MGM should be likewise.   No doubt the authorities fear the wrath of religious groups.   Well, freedom is often hard won, and child abuse has been very resistant to exposure.  It will come. 

http://jme.bmj.com/content/medethics/31/8/469.full.pdf

[Shaker]

No doubt the authorities fear the wrath of religious groups. Well, freedom is often hard won, and child abuse has been very resistant to exposure. It will come.

To me, the perfect end to the thread.

Unless Rose fetches up demanding a parent's right to chop off the end of it.

[ProfessorDavey]

Yes it is

https://www.circinfo.org/documents/BMA-Circ.pdf

Why you insist on misrepresenting the situation, I've no idea!

From the BMA link

"4.1 The law
Male circumcision is not grounded in statute, however judicial review assumes that, provided both parents consent, non-therapeutic male circumcision is lawful:
"

Note assumes that.

Where the law is clear there is no need to add assumes that.

But adding more of the same document makes the situation much less clear cut with the  assumption that:

'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 or may cause serious bodily harm. Ritual circumcision, tattooing, ear-piercing and violent sports including boxing are lawful activities'

Problem for you is that the other example used are largely not lawful for infants. So tattooing isn't lawful under the age of 18 regardless of parental consent, while ear piercing is genital piercing (much more close to circumcision) isn't lawful under the age of 18 regardless of parental consent and boxing isn't permitted under the age of 10.

So while all are lawful in the broadest terms all carry restrictions relating to age. The the judicial review can be interpreted as ritual circumcision is lawful but (like some of the other examples) only for adults with direct consent.

[ProfessorDavey]

So at the moment then, when parents ask the medical profession to circumcise their child, they are considered as acting in the best interests of the child.

As I've said before you are wrong. But don't just take my word for it, this from the BMA guidance:

'The BMA does not believe that parental preference alone constitutes sufficient grounds for performing a surgical procedure on a child unable to express his own view. Parental preference must be weighed in terms of the child’s interests.'

Further:

'that parental preference alone is not sufficient justification for performing a surgical procedure on a child.'

So a request for circumcision by parent most definitely is not considered as being necessarily in the best interests of the child. The doctor has to assess best interests.

Actually the BMA provides 9 criteria to be used in determining best interests - the views of the parent is only one of those, which can easily b outweighed by the other 8.

[Bubbles]

It's not a problem for me, but it will be a problem for the 270,000 + who have their sons circumcised.
( not even counting Muslims and others)
The country is going to needs lots of resources to discover which boy children have been circumcised, ( unacceptably violating all children's privacy) to investigate each one, to prosecute and imprison parents or take the children away.

Lots of Jewish and Muslims don't go to a state school, they have their own schools, and I can't see them allowing social workings in to meddle with their children.

It's unworkable.

It's one thing to make something against the law, quite another to police it.

At least while it's legal it can be done in hygienic conditions, by professionals. Babies are not being circumcised furtively.

You are recommending changing the law, which isn't in the interests of those children affected.

[floo]

It's not a problem for me, but it will be a problem for the 270,000 + who have their sons circumcised.
( not even counting Muslims and others)
The country is going to needs lots of resources to discover which boy children have been circumcised, ( unacceptably violating all children's privacy) to investigate each one, to prosecute and imprison parents or take the children away.

Lots of Jewish and Muslims don't go to a state school, they have their own schools, and I can't see them allowing social workings in to meddle with their children.

It's unworkable.

It's one thing to make something against the law, quite another to police it.

At least while it's legal it can be done in hygienic conditions, by professionals. Babies are not being circumcised furtively.

You are recommending changing the law, which isn't in the interests of those children affected.

Too bad if it is a problem for the parents, it should be the  boy's decision if it isn't for genuine medical reasons.

[ProfessorDavey]

It's not a problem for me, but it will be a problem for the 270,000 + who have their sons circumcised.

What planet are you on - those numbers are fanciful.

The total number of circumcisions in the UK is estimated to be around 12,000 per year (about 3.5% of boys) so massively different to your 270,000 which is not far off the total birth rate of boys.

( not even counting Muslims and others)

What do you mean by that (do you mean not Jewish - ooh that's telling of your prejudices) - given that the vast majority of the 12,000 circumcisions a year are performed on boys of Muslim parents, again you are talking junk. Given that there are under 4000 births to Jewish parents in the UK per year (and less than 2000 circumcisions) again you ill-informed non-sense statistics are rather telling of you lack of knowledge.

[ProfessorDavey]

Lots of Jewish and Muslims don't go to a state school ...

Depends what you mean by 'lots' but I think the reality is actually very few.

Once again let's look at the actual data rather than you plucked out of thin air nonsense.

About 97% of children of muslim parents attend state schools. Somewhat smaller proportion of children of jewish parents, but still around 70% attend state schools. Given that about 2000 of the current circumcisions a year are for boys of jewish parents, and about 10,000 for children of muslim parents, that equates to over 92% of circumcised boys attending state school. In effect over 92% of the children of muslim and jewish parents are in state school.

Doesn't really back up your 'Lots of Jewish and Muslims don't go to a state school' hand waving.

[Rhiannon]

I think Rose is saying that she thinks a change in the law will mean social services going into schools ('meddling') to inspect the penises of Jewish boys and 'others' and throw their parents into jail if they've been circumcised.

[ProfessorDavey]

I think Rose is saying that she thinks a change in the law will mean social services going into schools ('meddling') to inspect the penises of Jewish boys and 'others' and throw their parents into jail if they've been circumcised.

Well I presume were MGM to be made unlawful in the same manner as FGM then it would include a requirement to report - so there wouldn't be a need for social services to actively go into schools as the schools themselves would, under the law, be required to report as they currently are for FGM or any concerns about abuse.

Secondly I suspect it would be doctors performing the circumcision that would be charged rather than parents.

She is right that there are concerns about the law working in practice, using FGM as an example - we are so timid and tip-toe around religious sensibilities that there is a reluctance to charge, as seen with (I think) no prosecutions for FGM yet.

[The Accountant, OBE, KC]

As I've said before you are wrong. But don't just take my word for it, this from the BMA guidance:

'The BMA does not believe that parental preference alone constitutes sufficient grounds for performing a surgical procedure on a child unable to express his own view. Parental preference must be weighed in terms of the child’s interests.'

Further:

'that parental preference alone is not sufficient justification for performing a surgical procedure on a child.'

So a request for circumcision by parent most definitely is not considered as being necessarily in the best interests of the child. The doctor has to assess best interests.

Actually the BMA provides 9 criteria to be used in determining best interests - the views of the parent is only one of those, which can easily b outweighed by the other 8.

I see the discussion has not moved on much.

Regarding best interest - as I pointed out a few pages back, there is an increase in HIV rates in the UK among certain parts of the black community, members of those communities travel back and forth between the UK and their ancestral home, and there are inadequate resources and funding in the UK to address the HIV increase in those communities living in the UK. Here is the link again.

https://www.theguardian.com/world/2005/sep/10/aids.adrianlevy

Meanwhile in parts of Africa e.g. Rwanda, Uganda, Kenya - there is a campaign to promote male circumcision, and given the lower risks if circumcision is carried out on an infant rather than an adult, it seems unlikely that infant circumcision will be discouraged any time soon, whether in the UK or in Africa,  unless there is scientific consensus that the benefit does not justify the risks associated with infant male circumcision. https://www.theguardian.com/world/2013/nov/27/rwanda-non-surgical-circumcision-hiv

The BMA guidance for best interests of the child seems to include that it may be in the social, psychological and emotional best interest of the child to be brought up as part of their parents' culture - possibly because that creates family and community bonds that provide emotional security for the child - very hard to quantify and therefore dispute:

Guidance from the General Medical Council (GMC) recognises that there are
“procedures which may be undertaken by doctors mainly for religious, cultural, social
or emotional reasons”; it states that “both the GMC and the law permit doctors to
undertake procedures that do not offer immediate or obvious therapeutic benefits for
children or young people, so long as they are in their best interests”.

The guidance also states that, “To assess their best interests you should consider
the religious and cultural beliefs and values of the child or young person and their
parents, as well as any social, psychological and emotional benefits. This may be
relevant in circumcision of male children for religious or cultural reasons, or surgical
correction of physical characteristics that do not endanger the child's life or health”.
In addition, GMC guidance on personal beliefs and medical practice (2013) states
that, with regard to circumcision of male children for religious or cultural reasons,
“Many people within the Jewish and Islamic faiths consider male circumcision to be
essential to the practice of their religion; they would regard any restriction or ban on
male circumcision as an infringement of a fundamental human right”.

It is on similar principles that the British Medical Association (BMA) states that:
“Circumcision of male children has been generally assumed to be lawful, provided
that it is performed competently; it is believed to be in the child’s best interests; and
there is valid consent”.

Doctors and GP practices carrying out circumcision for religious observance must be
registered with CQC to carry out the regulated activity of surgical procedures...

Page 3 https://www.whatdotheyknow.com/request/309163/response/757132/attach/4/Circumcision%20advice%20for%20inspectors.pdf

[floo]

Gabby even if that was true, it is still no excuse for hacking off the foreskin of babies.

[The Accountant, OBE, KC]

Gabby even if that was true, it is still no excuse for hacking off the foreskin of babies.

Depends on how various professionals view what is in the best interests of the child. No doubt future research will one day reach a definitive conclusion on the medical benefits. But one of the considerations is whether it is in the best interests of children to be brought up in the culture of their parents.

[floo]

Depends on how various professionals view what is in the best interests of the child. No doubt future research will one day reach a definitive conclusion on the medical benefits. But one of the considerations is whether it is in the best interests of children to be brought up in the culture of their parents.

It isn't in the best interests of the child unless he has a medical problem.

[ProfessorDavey]

Regarding best interest - as I pointed out a few pages back, there is an increase in HIV rates in the UK among certain parts of the black community, members of those communities travel back and forth between the UK and their ancestral home, and there are inadequate resources and funding in the UK to address the HIV increase in those communities living in the UK. Here is the link again.

Sorry but you are wrong, or if I am being charitable, misunderstanding the details.

The only credible evidence for reduction in HIV transmission due to circumcision is for infection of men during heterosexual sex with a woman. There is no evidence that circumcision reduces transmission for homosexual sex nor for infection of women during heterosexual sex.

So the critical issue isn't overall infection rates, but infection rates of men from heterosexual sex. And those rates have reduced dramatically over the past decade, indeed they have halves since 2005.

And in fact overall infection rates have been gentle reducing over time, so for example in 2016 6,095 people  were diagnosed with HIV in the UK compared to 7,892 in 2005. And yet levels of circumcision have also reduced in the sexually-active population during this time.

But, of course the best way to prevent infection is to use a condom.