Skip to main content
SpringerLink
Log in

Tortured Bodies, Tortured Doctrines: Informed Consent as a Legal Fiction Inapplicable to Neonatal Male Circumcision

  • Chapter
  • First Online:
Genital Cutting: Protecting Children from Medical, Cultural, and Religious Infringements

Abstract

The doctrine of informed consent functions reasonably within its area of applicability of competent adults, though even in that setting it suffers from some difficulties both theoretical and practical. When applied by proxy to incompetent persons such as mentally incapacitated adults and newborn babies, the doctrine becomes a legal fiction, i.e., a legal construct created to force-fit a set of facts into an established legal analysis that is not literally applicable. The conceptual, ethical and practical difficulties are maximized with proxy permission to authorize circumcision of neonates. “Proxy consent” for neonatal circumcision is a legal fiction that cloaks a usurpation of agency allowing ostensibly hallowed principles of autonomy and self-determination to be violated with impunity. Such legal fictions conceal our violations from ourselves and others under the pretenses of legal authorization and compliance with ethics and human rights, and—in the circumcision context—the further pretense of medical authorization, masking our failure to properly safeguard human dignity and autonomy.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Notes

  1. 1.

    Slater v. Baker and Stapleton, 95 Eng. Rep. 860 (1767).

  2. 2.

    See Newmark v. Williams, 588 A.2d 1108, 1115–16 (Del. 1991).

  3. 3.

    See Matter of Storar, 420 N.E.2d 64, 71 (N.Y. 1981).

  4. 4.

    See Talmage v. Smith, 101 Mich. 370, 59 N.W. 656 (1894).

  5. 5.

    Schloendorff v. Society of New York Hospital, 105 N.E. 92, 93 (N.Y. 1914).

  6. 6.

    Salgo v. Leland Stanford Jr. University Board of Trustees, 154 Cal. App. 2d 560, 317 P.2d 170 (1957).

  7. 7.

    Grounded in the ethical principle of respect.

  8. 8.

    Scott v. Bradford, 1979 OK 165; 606 P.2d 554, 559 (1979).

  9. 9.

    Rogers v. Whitaker, 175 C.L.R. 479, 489–491 (Austl. 1992).

  10. 10.

    Wecker v. Amend, 918 P.2d 658, 661 (Ka. Ct. App. 1996).

  11. 11.

    Reibl v. Hughes, 114 D.L.R. 3d 1, 15–17 [1980].

  12. 12.

    Arena v. Gingrich, 733 P.2d 75,76 (1987).

  13. 13.

    Scott v. Bradford, 1979 OK 165; 606 P.2d 554, 559 (1979).

  14. 14.

    See Cruzan v. Director, Mo. Dept. of Health, 497 U.S. 261, 284–286 (1990).

  15. 15.

    Ex Parte Whitbread in the Matter of Hinde, a Lunatic, 35 Eng. Rep. 878, 878 (Ch. 1816).

  16. 16.

    In re Quinlan, 355 A.2d 647, 661-62 (N.J. 1976).

  17. 17.

    Superintendent of Belchertown v. Saikewicz, 370 N.E.2d 417, 421, 431 (Mass. 1977).

  18. 18.

    Prince v. Massachusetts, 321 U.S. 158 (1944).

  19. 19.

    See Strunk v. Strunk, 445 S.W.2d 145, 148–149 (Ky. 1969); Hart v. Brown, 289 A.2d 386, 387-88 (Conn. Super. Ct. 1972).

  20. 20.

    Private communications on July 12, 2011 with Robert S. Van Howe, MD, Marilyn Milos, and Amber Craig.

  21. 21.

    American Academy of Family Physicians 2002.

References

  • Adler R et al (2001) Circumcision: we have heard from the experts; now let’s hear from the parents. Pediatrics 107(2): e20

    Google Scholar 

  • Alderson P (1993) Children’s consent to surgery. Open University Press, Buckingham, p 30

    Google Scholar 

  • American Academy of Pediatrics Committee on Bioethics (1995) Informed consent, parental permission, and assent in pediatric practice. Pediatrics 95:314–317 (here, pp 314–316)

    Google Scholar 

  • Annas GJ (1977) Informed consent: the patient’s most important right. Trustee 30(10):13–14

    Google Scholar 

  • Berg JW, Appelbaum PS (2001) Informed consent: legal theory and clinical practice. Oxford University Press, New York

    Google Scholar 

  • Berry RM (2005) Informed consent law, ethics, and practice: From infancy to reflective adolescence. HEC Forum 17(1):64–81

    Google Scholar 

  • Binner SL et al (2002) Effect of parental education on decision-making about neonatal circumcision. South Med J 95(4):457–461

    Google Scholar 

  • Bollinger D (2010) Lost boys: an estimate of U.S. circumcision-related infant deaths. Thymos: J Boyhood Stud 4:78–90

    Google Scholar 

  • Bottrell MM et al (2000) Hospital informed consent for procedure forms. Arch Surg 135:26–33

    Article  PubMed  CAS  Google Scholar 

  • Bouclin S (2005) An examination of legal and ethical issues surrounding male circumcision: the Canadian contest. Int J Men’s Health 4(3):205–222

    Google Scholar 

  • Boyle GJ et al (2002) Male circumcision: pain, trauma and psychosexual sequelae. J Health Psychol 7(3):329–343

    PubMed  Google Scholar 

  • Braddock CH et al (1999) Informed decision making in outpatient practice: time to get back to basics. JAMA 282(24):2313–2319

    Google Scholar 

  • Canadian Paediatric Society Bioethics Committee (2004) Treatment decisions regarding infants, children, and adolescents. Paediatr Child Health 9(2):99–103

    Google Scholar 

  • Carpenter L (2010) On remedicalisation: male circumcision in the Untied States and Great Britain. Sociol Health Illn 32(4):613–630

    Article  PubMed  Google Scholar 

  • Cassileth BR et al (1980) Informed consent—why are its goals imperfectly realized. N Engl J Med 302(16):896–900

    Google Scholar 

  • Cherry M (2010) Non-consensual treatment is (nearly always) morally impermissible. J Law Med Ethics 38(4):789–798

    Google Scholar 

  • Christensen-Szalanski JJ et al (1987) Circumcision and informed consent: is more information always better? Med Care 25(9):856–867

    Article  PubMed  CAS  Google Scholar 

  • Ciesielski-Carlucci C et al (1996) Determinants of decision making for circumcision. Camb Q Healthc Ethics 5:228–236

    Article  PubMed  CAS  Google Scholar 

  • Circumcision Information and Resource Pages (2011) Circumcision policy statements. Available at URL: www.cirp.org/library/statements/. Updated 16 Jan

  • Clark SK et al (1991) A risk-specific anesthesia consent form may hinder the informed consent process. J Clin Anesth 3:11–13

    Google Scholar 

  • Committee on Bioethics (1995) Informed consent, parental permission, and assent in pediatric practice. Pediatrics 95:314–317

    Google Scholar 

  • Council on Scientific Affairs, American Medical Association (1999) Neonatal circumcision. American Medical Association, Chicago

    Google Scholar 

  • Department of Health (1991) Local research ethics committees. § 4.4. Department of Health, London

    Google Scholar 

  • Dunkelman H (1979) Patients’ knowledge of their condition and treatment: how it might be improved. Br Med J 12:311–314

    Google Scholar 

  • El Bcheraoui C et al (2010) Rates of selected neonatal male circumcision-associated severe adverse events in the United States, 2007–2009. In: 18th International AIDS Conference, Vienna, Austria

    Google Scholar 

  • El Bcheraoui CE et al (2010) Rates of selected neonatal male circumcision-associated severe adverse events in the United States, 2007–2009. AIDS 2010. Presented on 22 July

    Google Scholar 

  • Enzenauer RW et al (1986) Decreased circumcision rate with videotaped counseling. South Med J 79:717–720

    Google Scholar 

  • Epstein LC, Lasagna L (1969) Obtaining informed consent. Arch Intern Med 123:682–688

    Google Scholar 

  • Etchells E et al (1996) Bioethics for clinicians: 2. Disclosure. Can Med Assoc J 155:387–391

    CAS  Google Scholar 

  • Faden RR, Beauchamp TL (1986) A history and theory of informed consent. Oxford University Press, New York

    Google Scholar 

  • Feigenbaum MS (1992) Minors, medical treatment, and interspousal disagreement: should Solomon split the child? DePaul Law Rev 41:841–884

    Google Scholar 

  • Feinberg J (2007) The child’s right to an open future. In: Curren R (ed) Philosophy of education: an anthology, pp 112–123

    Google Scholar 

  • Fletcher C (1999) Circumcision in America in 1998: attitudes, beliefs, and charges of American physicians. In Denniston GC et al (eds) Male and female circumcision: medical, legal, and ethical considerations in pediatrics practice, Kluwer Academic/Plenum, New York, pp 259–271

    Google Scholar 

  • Gorske AL (1980) Circumcision and patient education [letter]. Am J Dis Child 134:527

    Google Scholar 

  • Haberfield L (1997) Informed consent and infant male circumcision. Australasian Law Teachers Conference

    Google Scholar 

  • Harrington JA (1996) Privileging the medical norm: liberalism, self-determination and refusal of treatment. Legal Stud 16(3):348–367

    Google Scholar 

  • Herrera AJ, Trouern-Trend JBG (1979) Routine neonatal circumcision. Am J Dis Child 133:1069–1070

    Google Scholar 

  • Herrera AJ et al (1982) The role of parental information in the incidence of circumcision. Pediatrics 70(4):597–598

    PubMed  CAS  Google Scholar 

  • International Coalition for Genital Integrity (2011) US adult circ rate. Available at URL: www.icgi.org/information/us-adult-circ-rate. Updated 10 June

  • Jackson E (2006) ‘Informed consent’ to medical treatment and the impotence of tort. In: McLean SAM (ed) First do no harm: law, ethics and healthcare. Ashgate, Burlington, pp 273–286 (here, pp 273–274)

    Google Scholar 

  • Jones MA (1999) Informed consent and other fairy stories. Med Law Rev 7:103–134

    Google Scholar 

  • Jones RB (2000) Parental consent to cosmetic facial surgery in Down’s syndrome. Journal of Medical Ethics 26:101

    Google Scholar 

  • Kant I (1956) Critique of practical reason. 1788. Bobbs-Merrill Educational Publishing, Indianapolis

    Google Scholar 

  • Kaplan GW (1977) Circumcision—an overview. Curr Probl Pediatr 7:1–33

    PubMed  CAS  Google Scholar 

  • Karako-Eyal N (2010) Physicians’ duty of disclosure: a deontological and consequential analysis. Quinnipiac Health Law J 14:1–47

    Google Scholar 

  • Katz J (1994) Informed consent—must it remain a fairy tale. J Contemp Health Law Policy 10(4):69–91

    Google Scholar 

  • Katz JN et al (1992) Informed consent and the prescription of nonsteroidal anti-inflammatory drugs. Arthritis Rheum 35(11):1257–1263

    Google Scholar 

  • Lareau AC (2003) Who decides? Genital-normalizing surgery on intersexed infants. Georgetown Law J 92:129–151

    Google Scholar 

  • Leditschke JF (1996) Guidelines for circumcision. Australasian Association of Paediatric Surgeons, Hersion

    Google Scholar 

  • Liacos PJ (1989) Is ‘substituted judgment a valid legal concept? Issues Law Med 5(2):215–224

    PubMed  CAS  Google Scholar 

  • Longley G (2009) Framing the foreskin: A content analysis of circumcision information handouts for expectant parents. Thesis, University of Colorado Denver

    Google Scholar 

  • Lovell JE, Cox J (1979) Maternal attitudes toward circumcision. J Family Pract 9(5):811–813

    Google Scholar 

  • Lustig A, Scardino P (1998) Elective patients. In: McCullough LB et al (eds) Surgical ethics, Oxford University Press, New York, pp 133–151

    Google Scholar 

  • Maclean A (2009) Autonomy, informed consent and medical law. Cambridge University Press, New York, pp 198–209

    Google Scholar 

  • Maisels MJ et al (1983) Circumcision: The effect of information on parental decision making. Pediatrics 71:453–455

    Google Scholar 

  • Mantravadi AV et al (2007) Accuracy of surrogate decision making in elective surgery. J Cataract Refract Surg 33:2091–2097

    Article  PubMed  Google Scholar 

  • Marshall W (2009) Non-therapeutic male circumciison. Tasmania Law Reform Institute, Hobart, p 6

    Google Scholar 

  • McDermott RJ et al (1982) Neonatal circumcision. Patient Counselling Health Educ 3(4):132–136

    Google Scholar 

  • Medical Ethics Committee, British Medical Association (2006) The law and ethics of male circumcision. British Medical Association, London

    Google Scholar 

  • Moore DL (1995) Challenging parental decisions to overtreat children. Health Matrix 5:311–323

    Google Scholar 

  • Muss HB et al (1979) Written informed consent in patients with breast cancer. Cancer 43(4):1549–1556

    Google Scholar 

  • Olver IN et al (1995) Impact of an information and consent form on patients having chemotherapy. Med J Aust 162:82–83

    PubMed  CAS  Google Scholar 

  • Pappworth MH (1967) Human guinea pigs. Routledge & Kegan Paul, London, pp 31–32

    Google Scholar 

  • Patel H (1966) The problem of routine circumcision. Can Med Assoc J 95:576–581

    Google Scholar 

  • Rand CS et al (1983) The effect of an educational intervention on the rate of neonatal circumcision. Obstet Gynecol 62:64

    Google Scholar 

  • Rawls J (1971) A Theory of justice. Harvard University Press, Cambridge

    Google Scholar 

  • Rawls J (1993) Political liberalism. Columbia University Press, New York

    Google Scholar 

  • Robertson G (1981) Informed consent to medical treatment. Law Q Rev 97:102–126

    Google Scholar 

  • Rosato J (2000) Using bioethics discourse to determine when parents should make health care decisions for their children: is deference justified. Temple Law Rev 73(1):1–68

    Google Scholar 

  • Schuck PH (1994) Rethinking informed consent. Yale Law J 103(4):899–959

    Article  PubMed  Google Scholar 

  • Seckler AB et al (1991) Substituted judgment: how accurate are proxy predictions. Annals Intern Med 115(2):92–98

    Google Scholar 

  • Shalowitz DI et al (2006) The accuracy of surrogate decision makers. Arch Intern Med 166:493–497

    Article  PubMed  Google Scholar 

  • Solomon D (2007–2008) Informed consent for routine infant circumcision: a proposal. New York Law School Law Rev 52:215–245

    Google Scholar 

  • Somerville M (1981) Structuring the issues in informed consent. McGill Law J 26(4):740–808

    PubMed  Google Scholar 

  • Stein MT et al (1982) Routine neonatal circumcision: the gap between contemporary policy and practice. J Fam Pract 15(1):47–53

    Google Scholar 

  • Suhl J (1994) Myth of substituted judgment. Arch Intern Med 154:90–96

    Article  PubMed  CAS  Google Scholar 

  • Svoboda JS et al (2000) Informed consent for neonatal circumcision: an ethical and legal conundrum. J Contemp Health Law Policy 17:61–132

    PubMed  CAS  Google Scholar 

  • Van Howe RS (1997a) Variability in penile appearance and penile findings: a prospective study. Br J Urol 80:776–782

    Google Scholar 

  • Van Howe RS (1997b) Response to ‘Determinants of decision making for circumcision’ by C. Ciesielski-Carlucci, N. Milliken, and N.H Cohen. Cambridge Q Healthcare Ethics 6:88–92

    Google Scholar 

  • Van Howe RS (2006) Incidence of meatal stenosis following neonatal circumcision in a primary care setting. Clin Pediatr 45:49–54

    Google Scholar 

  • Van Howe RS (2011) Why does neonatal circumcision persist in the United States? In: DennistonGC, Milos MF (eds) Sexual mutilations: a human tragedy pp 111–119 [here, at p. 115] (Also private communications on July 12, 2011 with Robert S. Van Howe, MD, Marilyn Milos, and Amber Craig)

    Google Scholar 

  • Wear S (1998) Informed consent: patient autonomy and clinician beneficence within health care, 2nd edn. Georgetown University Press, Washington

    Google Scholar 

  • Williams N, Kapila L (1993) Complications of circumcision. Br J Surg 80:1231

    Article  PubMed  CAS  Google Scholar 

  • Wu WC, Pearlman RA (1988) Consent in medical decision making: the role of communication. J Gen Intern Med 3:9–14

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Attorneys for the Rights of the Child, Berkeley, CA, USA

    J. Steven Svoboda

Authors
  1. J. Steven Svoboda
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Steven Svoboda .

Editor information

Editors and Affiliations

  1. Department of Family Medicine, University of Washington, Norland, Washington, USA

    George C. Denniston

  2. Berkeley, California, USA

    Frederick M. Hodges

  3. Information Resource Centers, National Organization of Circumcision In Information Resource Centers, San Anselmo, California, USA

    Marilyn Fayre Milos

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media Dordrecht

About this chapter

Cite this chapter

Svoboda, J.S. (2013). Tortured Bodies, Tortured Doctrines: Informed Consent as a Legal Fiction Inapplicable to Neonatal Male Circumcision. In: Denniston, G., Hodges, F., Milos, M. (eds) Genital Cutting: Protecting Children from Medical, Cultural, and Religious Infringements. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-6407-1_1

Download citation

  • DOI: https://doi.org/10.1007/978-94-007-6407-1_1

  • Published:

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-007-6406-4

  • Online ISBN: 978-94-007-6407-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation