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Ann R Coll Surg Engl. 2009 September; 91(6): 539–540.
PMCID: PMC2966233

Consent of Children for Non-Therapeutic Surgical Procedures – General Issues

I read with interest the article by Robinson et al. which audited the use of two parent consent for childhood circumcision on religious or ritual grounds. This paper raises more general questions about the consent of children for a surgical procedure for non-therapeutic reasons.

The Hippocratic oath states ‘I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone’. Performing a circumcision is associated with well-documented complications: postoperative bleeding, wound infection, meatal stenosis, poor cosmesis and the affect on altered sensation are described in up to 10% of children undergoing circumcision.1 On top of this there may be an adverse psychological impact that the hospital stay and postoperative pain may have on the boy. By performing non-therapeutic circumcision, surgeons are asked to ‘do harm’ and breach the Hippocratic oath for a non-medical condition, albeit with the tacit support of the General Medical Council and British Medical Association.

Whilst a child's parent(s) may be of a particular faith there is no guarantee their offspring will be of the same, or indeed have any, faith. Inflicting a circumcision on a boy for religious reasons is inflicting potential harm on someone who is unable to weigh up the risks of surgery and who may not go on to adopt the same religious beliefs.

In our society, where individuals have a right to choose, I do not think non-therapeutic circumcision should be permissible until the individual himself is able to give informed consent. The argument that, by not allowing non-therapeutic circumcision in hospital may drive parents to seek surgery in a non-clinical setting, may be negated if the surgery is more freely available to consenting children after the age of 16 years.


1. Stenram A, Malmfors G, Okmian L. Circumcision for phimosis: a follow-up study. Scand J Urol Nephrol. 1986;20:89–92. [PubMed]

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