19 Winter 2015-2016 desirability of performing circumcision, other than in cases where it is medically indicated.21 One of the most up-to-date and authoritative reports on the subject is that published in 2012 by the American Academy of Pediatrics (AAP) following a thorough investigation of the subject by a taskforce set up for this purpose.22 They summarize their conclusions as follows: Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks; furthermore, the benefits of newborn male circumcision justify access to this procedure for families who choose it. Specific benefits from male circumcision were identified for the prevention of urinary tract infections, acquisition of HIV, transmission of some sexually transmitted infections, and penile cancer. Male circumcision does not appear to adversely affect penile sexual function/ sensitivity or sexual satisfaction . . . Significant acute complications are rare. Similarly, an article published in 2014 in the prestigious U.S. medical journal Mayo Clinical Proceedings, strongly supports neonatal circumcision.23 In particular, this paper draws attention to the fact that whilst there has been a decrease in neonatal circumcision, there has been an increase in the incidence of circumcision in the male population as a whole.24 In light of the considerable medical advantages of performing the procedure at a young age, the paper calls for newborn circumcisions to be funded by healthcare schemes and argues that this is cost-effective in the long term.25 Opponents of circumcision dispute the scientific validity of the findings on which these and earlier pro-circumcision medical papers are based. Discussion of the competing claims is clearly outside the scope of this article. For current purposes, it is sufficient to note that a considerable body of reputable medical opinion supports neonatal circumcision.23 The Child's Right to Physical Integrity The child’s right to physical integrity is derived inter alia from the obligation imposed on State Parties by Article 19 of the CRC to take all appropriate measures to “[p] rotect the child from all forms of physical or mental violence, injury or abuse, neglect or negligent treatment, maltreatment or exploitation, including sexual abuse, while in the care of parent(s), legal guardian(s) or any other person who has the care of the child.”26 There is no official definition of physical integrity, which like its synonym bodily integrity, is an inherently ambiguous notion.27 The claim that ritual circumcision infringes this right ignores the fact that beneficial interference with a child's body, such as medically indicated surgery, is not considered to be a violation of the child's right, or is treated as a permissible violation, because the benefit to the child’s health justifies the invasion.28 By analogy, procedures which are not medically necessary, but which benefit the child, should not be treated as a forbidden violation of bodily integrity,29 at least where the degree of interference is proportional to the benefit.30 Indeed, it seems that this is the basis upon which immunization of infants has been justified.31 Since there is evidence that circumcision has 21. Michael Benatar & David Benatar, Between Prophylaxis and Child Abuse: The Ethics of Neonatal Male Circumcision, 3 AM. J. OF BIOETHICS 35, 48 (2003). 22. American Academy of Pediatrics, Technical Report: Male Circumcision, 130 PEDIATRICS, e756 (2012), available at pediatrics.aappublications.org/content/pediatrics/130/3/ e756.full.pdf (last visited Dec. 3, 2015). 23. Brian J. Morris, Stefan A. Bailis & Thomas E. Wiswell, Circumcision Rates in the United States: Rising or Falling? What Effect Might the New Affirmative Pediatric Policy Statement Have? 89 MAYO CLINIC PROC. 677, 684 (2014). 24. Id. at 678. 25. Id. at 684. 26. Comm. on the Rights of the Child, General Comment No. 13 (2011) The Right of the Child to Freedom From All Forms of Violence, ¶ 3(b)(c), (e)(f), U.N. Doc. CRC/C/ GC/13 (Apr. 18, 2011), available at www2.ohchr.org/ english/bodies/crc/docs/CRC.C.GC.13_en.pdf (last visited Nov. 11, 2015). 27. Wim Dekkers, Cor Hoffer & Jean-Pierre Wils, Scientific Contribution, Bodily Integrity and Male and Female Circumcision, 8 MED. HEALTH CARE PHIL, 179, 181 (2005), at 189. For discussion of the various approaches to physical integrity, see Schuz, supra note 3, at 364-6. 28. Between Prophylaxis, supra note 21, at 36 (giving the example of amputation of a gangrenous leg). 29. Joseph Mazor, The Child’s Interests and the Case for the Permissibility of Male Infant Circumcision, 39 J. MED. ETHICS 421(2013), at 422; see also R v. Brown, 1 A.C. 212 (1994) (supporting the analogy between surgery, such as to correct a cleft lip, and that of circumcision, and commenting obiter dictum that both are lawful even though they involve actual bodily harm). 30. Between Prophylaxis, supra note 21, at 36 (arguing that the moral acceptability of a procedure can only be assessed by weighing the benefits against the harm). 31. Id.
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