Stop the chop

Cornelia Koch, a senior lecturer at the University of Adelaide Law School, argues that circumcision of underage boys should be discouraged.

'Will he be vaccinated?' 'Will he be circumcised?'. These were among the routine questions that the midwife asked my partner and me shortly after the birth of our baby boy in 2010. Even in our slightly dazed state as new parents, we found the second question rather bizarre, exchanged a surprised look and answered with a definitive 'No!'.

As we are both from continental Europe, it seems peculiar to us to even consider cutting a piece off a tiny, wonderfully complete newborn. 'You would not cut the tip of his finger off either, would you?' was the question that went through our heads.

On the European continent, non-therapeutic male circumcision is virtually unheard of, except if it is done for religious reasons, which occurs mostly in Muslim and Jewish communities.

The situation is of course different in Australia, where non- therapeutic circumcision of baby boys was a routinely performed mainstream procedure for a significant period of time. In the 1950s about 85 per cent of newborns were circumcised, in the 1970s the rate dropped to about 50 per cent and today the circumcision rate in underage boys is between 10 and 20 per cent. It is estimated that around 50 per cent of all males living in Australia today are without foreskin.

While fewer and fewer parents choose to have their young boys circumcised, it is still a culturally accepted practice in Australia. The most common reasons put forward by proponents are potential health benefits for the child, their sexual partners or the general public, religious reasons or broader cultural reasons such as
'looking like your peers', 'looking like the other males in your family' or 'being preferred by women'.

For non-indigenous Australians, the origins of this practice lie in Victorian England, where circumcision was promoted for medical reasons. Over time, the procedure was believed to prevent or cure many 'conditions', for example, epilepsy, malnutrition, tuberculosis, impotence, sterility, masturbation and venereal disease.

While any connection between circumcision and conditions like these has been discredited, some still promote circumcision of young children on medical grounds today, particularly to prevent urinary tract infections, penile cancer and the contraction of some sexually transmitted diseases. Notably, the American Academy of Pediatrics released a new policy statement on male circumcision last August in which it moved from a neutral to a more positive stance on newborn male circumcision, arguing that the health benefits listed above outweigh the risks associated with the procedure.

However, most medical bodies in developed countries, including in Australia, New Zealand and the United Kingdom, take the opposite view. They do not recommend circumcision because they believe that the potential benefits of the procedure are outweighed by the associated risks. Serious medical complications caused by male circumcision are rare, but they include fistula formation, the loss of all or part of the penis and even death. More common side effects are post operative bleeding and infection.

Australian law takes a laissez faire approach to underage circumcision. It is perfectly legal to circumcise little boys. While public hospitals in all states except Queensland have stopped offering procedure, it is still financially supported by the Federal Government through the Medicare Benefits Scheme. This is despite the fact that Medicare's own guidelines state that benefits are not payable for 'medical services which are not clinically necessary' or for 'surgery for cosmetic reasons'.

The majority of medical opinion suggests that circumcision is not medically necessary for a person living in Australia, except if there is a pressing medical need in his individual case. Therefore, the surgery can be regarded as one done for cosmetic reasons. I therefore believe that the procedure should be removed from the Medicare Benefits Scheme.

In my view, circumcision of underage boys should be discouraged for reasons of personal autonomy. It should be left to the boy to make an informed decision about whether he would like to lose his foreskin when he is old enough to decide. Under South Australian law, the age of consent to medical treatment is 16 years.

However, younger children can also validly consent if their doctor believes that the child is capable of understanding the nature, consequences and risks of the treatment and that the treatment is in the best interest of the child's health and wellbeing. Another medical practitioner must support this opinion.

The law therefore offers ways for 16-year-olds or even younger males to decide for themselves whether they would like to be circumcised, after weighing up the arguments for and against the practice. Why should we take this right from them by cutting off the foreskin when they are too young to protest in a legally relevant way? Article 3 of the United Nations Convention on the Right of the Child that Australia states that in all actions concerning children, the best interests of the child shall be of primary consideration.

Based on the medical knowledge available today and the fact that personal autonomy is an important value in Australian society, the best interest of boys is served by allowing them to determine their own circumcision status, rather than making an irreversible decision on their behalf when they are too little to say 'no!'.