Prophylactic interventions on children: balancing human rights with public health (original) (raw)

The child's right to bodily integrity

2019

In this chapter, an infringement of bodily integrity (BI) is defined as any penetration into a bodily orifice, breaking of the skin, or alteration of a person’s physical form. A violation of a person’s right to BI is any infringement of their BI that wrongs them. An autonomous person is wronged by an infringement of their BI if they did not consent to it. If a person is incapable of consenting because they are temporarily non-autonomous – as in the case of an intoxicated adult or a pre-autonomous child – the infringement should be delayed until the individual becomes autonomous and can make their own decision. It is only when the infringement cannot be delayed without putting the person into a situation they would be even less likely to consent to (if they were autonomous) that the infringement does not wrong them. Given the seriousness of violating anyone's right to BI, and especially that of the most vulnerable persons, the appropriate likelihood-of-consent for proceeding with a BI infringement on a child is argued to be at or near the ‘medically necessary’ threshold.

Informed Consent for Neonatal Circumcision: An Ethics and Legal Conundrum

Neonatal circumcision is the surgery most commonly performed on children, yet reliable information regarding the surgery is not usually made available to parents when they are asked to consent to the procedure for their newborn sons. Often, parents are simply presented with a paper to sign permitting the physician to perform the surgery, without any discussion of the health risks or alternatives. Many medical professionals, medical ethicists and legal scholars now dispute the advisability, and even permissibility, of circumcising newborn boys.1 Margaret Somerville, a prominent Canadian medical ethicist, recently went so far as to assert that neonatal circumcision constitutes assault under the Canadian criminal code.2 Numerous legal scholars have concluded that routine neonatal circumcision falls within the legal definition of child abuse and violates children's civil and human rights 3 under national and international law. Consent to a procedure that is per se illegal is, of course, invalid regardless of the motives of the consenting 4 party. But even if it were legally and ethically permissible for parents to authorize circumcision of their sons, empirical studies have shown that the manner in which doctors typically obtain "informed consent" for neonatal circumcision from parents falls far below the standard of care required of the medical profession. 5 This article examines whether and when parental consent to circumcision should be legally effective. It begins by identifying the legal and ethical requirements for consent that apply when medical professionals treat competent adult patients; requirements such as full disclosure, adequate capacity to consent, and voluntariness. It then analyzes how the rules and principles applicable in that context translate into legal and ethical requirements for consent to treatment of incompetent persons, and, in particular, treatment of children. It shows that, under normal circumstances, medical professionals may not prophylactically remove healthy tissue from even consenting adult patients, and that as a general rule, parents, regardless of their religious convictions, may not authorize medically unnecessary procedures on their children. The article then assesses the implications of those requirements for the practice of "routine circumcision" - that is, circumcision of infant males born with normal genitalia. It concludes that, because routine circumcision causes significant harm while providing no appreciable medical benefits, parental consent to the procedure is invalid. If circumcision can ever ethically and legally be performed, it is only when the male reaches adulthood and is capable of deciding for himself to undergo the procedure.

Medically unnecessary genital cutting and the rights of the child: moving toward consensus

American Journal of Bioethics, 2019

We seek to clarify and assess the underlying moral reasons for opposing all medically unnecessary genital cutting of female minors, no matter how severe. We find that within a Western medicolegal framework, these reasons are compelling. However, they do not only apply to female minors, but rather to non-consenting persons of any age irrespective of sex or gender. Keeping our focus exclusively on a Western context for the purposes of this article, we argue as follows: Under most conditions, cutting any person’s genitals without their informed consent is a serious violation of their right to bodily integrity. As such, it is morally impermissible unless the person is non-autonomous (incapable of consent) and the cutting is medically necessary.

Targeting Patients Who Cannot Object? Re-Examining the Case for Non- Therapeutic Infant Circumcision

Recent restatements of the case for routine circumcision of normal male infants and boys typically base their arguments on a range of medical evidence showing circumcision to have a protective effect against certain pathological conditions. It is then assumed that this evidence leads automatically to a clinical recommendation that circumcision should either be “considered” or strongly urged. Closer analysis reveals that the recommendation of infant or child circumcision has less to do with the medical benefits than with the historic origins of the procedure, the convenience to the operator and the status of the patient. It is further suggested that it is not clear that the medical benefits of infant or child circumcision outweigh the risks and harms, and that this style of advocacy fails to pay due regard to basic principles of bioethics and human rights that are accepted in other areas of medical practice.

On the Strength of Children's Right to Bodily Integrity: The Case of Circumcision

Journal of Applied Philosophy, 2017

This article considers the question of how much weight the infringement of children's right to bodily integrity should be given compared with competing considerations. It utilizes the example of circumcision to explore this question, taking as given this practice's opponents' view of circumcision's harmfulness. The article argues that the child's claim against being subjected to (presumably harmful) circumcision is neither a mere interest nor a right so strong that it trumps all competing interests. Instead, it is a right of moderate strength. Indeed, even the aggregate strength of children's rights against the practice of (presumably harmful) circumcision as a whole is not so weighty so as to always trump competing interests. The harms are not sufficiently serious to justify such a status. And the expressive wrongs associated with non-negligently benevolent harming are much less serious than those associated with intentional harming. The debate over banning circumcision thus cannot be conducted only in terms of competing rights. Competing interests, such as those that would be set back by the departure of religious citizens, should be considered as well and might plausibly justify allowing even a rights-infringing practice to continue.

On the Child’s Right to Bodily Integrity: When Is the Right Infringed?

The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine, 2021

This article considers two competing types of conceptions of the pre-autonomous child’s right to bodily integrity. The first, which I call encroachment conceptions, holds that any physically serious bodily encroachment infringes on the child’s right to bodily integrity. The second, which I call best-interests conceptions, holds that the child’s right to bodily integrity is infringed just in case the child is subjected to a bodily encroachment that substantially deviates from what is in the child’s best interests. I argue in this article that best-interests conceptions are more plausible than encroachment conceptions. They have more attractive implications regarding the permissibility of interventions in children’s bodies that are beneficial for the child but are not medically necessary. They are better able to explain the moral distinction between cases in which an encroachment on a child’s body is needed to benefit that child and cases in which an encroachment on one child’s body i...

Ending Forced Genital Cutting of Children and Violation of Their Human Rights Ethical....pdf

Neonatal male circumcision has no medical indication, is non-therapeutic, and violates the child's right to bodily integrity. No national or international medical association anywhere in the world recommends routine neonatal male circumcision. Female circumcision has been outlawed in a several Australian jurisdictions. Failure to provide equal protection under the law for male minors is discriminatory. Parents cannot give legal consent for a non-therapeutic surgical intervention performed on an unconsenting minor. All forms of genital cutting imposed on children (including unnecessary sex-reduction circumcision surgery, as well as sex-assignment/reassignment surgery) may have serious life-long adverse physical, sexual and psychological consequences. Genital cutting imposed on normal, healthy children causes grievous bodily harm (genital mutilation), and in the absence of medical necessity, amounts to criminal sexual assault