Opponents of male circumcision have increasingly used human rights positions to articulate their viewpoint. We characterize the meaning of the term “human rights.” We discuss these human rights arguments with special attention to the claims of rights to an open future and to bodily integrity. We offer a three-part test under which a parental decision might be considered an unacceptable violation of a child's right. The test considers the impact of the practice on society, the impact of the practice on (...) the individual, and the likelihood of adverse impact. Infant circumcision is permissible under this test. We conclude that infant circumcision may be proscribed as violating local norms, even though it does not violate human rights. (shrink)

This book provides a multidisciplinary analysis of the potential conflict between a government’s duty to protect children and a parent’ right to raise children in a manner they see fit. Using philosophical, bioethical, and legal analysis, the author engages with key scholars in pediatric decision-making and individual and religious rights theory. Going beyond the parent-child dyad, the author is deeply concerned both with the inteests of the broader society and with the appropriate limits of government interference in the private sphere. (...) The text offers a balance of individual and population interests, maximizing liberty but safeguarding against harm. Bioethics and law professors will therefore be able to use this text for both a foundational overview as well as specific, subject-level analysis. Clinicians such as pediatricians and gynecologists, as well as policy-makers can use this text to achieve balance between these often competing claims. The book is written by a physician with practical and theoretical knowledge of the subject, and deep sympathy for the parental and family perspectives. As such, the book proposes a new way of evaluating parental and state interventions in children's’ healthcare: a refreshing approach and a useful addition to the literature. (shrink)

Female genital alteration is any cutting, removal or destruction of any part of the external female genitalia. Various FGA practices are common throughout the world. While most frequent in Africa and Asia, transglobal migration has brought ritual FGA to Western nations. All forms of FGA are generally considered undesirable for medical and ethical reasons when performed on minors. One ritual FGA procedure is the vulvar nick. This is a small laceration to the vulva that does not cause morphological changes. Besides (...) being performed as a primary ritual procedure it has been proposed as a substitute for more extensive forms of FGA. Measures advocated or taken to reduce the burden of FGA can be punitive or non-punitive. Even if it is unethical to perform VN, we argue that it also is unethical to attempt to suppress it through punishment. First, punishment of VN is likely to cause more harm than good overall, even to those ostensibly being protected. Second, punishment is likely to exceed legitimate retributive ends. We do not argue in favor of performing VN. Rather, we argue that non-punitive strategies such as education and harm reduction should be employed. (shrink)

The justification for restrictive state intervention (RSI) such as criminal punishment or state reversal of parental decisions is called a limiting, or intervention (Buchanan and Brock 1989, 10), p...

In lieu of an abstract, here is a brief excerpt of the content:Circumcision:Ordinary and Universal in My CommunityAllan J. JacobsMy1 circumcision experiences are remarkable mostly for their ordinariness. My wife Danaë gave birth to our son Perseus2 while I was a resident in obstetrics and gynecology in a city where we had no family. Perseus was circumcised in a Jewish brit milah3 ceremony on the eighth day of his life, as were my wife's and my male ancestors back into ancient (...) times. We were relieved because Perseus had just recovered from a potentially serious condition. After a difficult forceps delivery, his blood bilirubin rose almost to the point where he might have developed the dreaded kernicterus syndrome. Kernicterus can cause permanent severe motor, intellectual and visual impairment. It was unclear whether he would be discharged from the hospital in time. He had to spend a week in restraints under a bright light whose frequency degraded bilirubin. Happily, he came home the day before the scheduled brit.Our four parents attended the brit. Danaë's father was the sandek,4 being granted the honor of holding our son on his lap during the circumcision ceremony. The mohel, or circumciser, was the local Conservative rabbi. We were mildly anxious because he didn't do many circumcisions in this city with few Jews. Perseus cried briefly after he was circumcised. The circumcision undoubtedly was far less stressful than treatment of elevated bilirubin. The circumcision certainly was less painful than the prodding and sticks for the many blood tests he had to undergo in the hospital, not to mention the pain of his difficult forceps delivery. Perseus did not seem to have much discomfort in his penis afterward, and had no circumcision complications.After the brit, our parents and my resident colleagues ate refreshments and chatted for an hour or so. A brit milah is a happy occasion, but not an elaborate one. It marks the end of the joy, anxiety, and excitement of the child's birth and its aftermath and is followed by the less exalted rhythm of feedings, diaper changes, and sleep deprivation.At the brit, our boys are assigned Hebrew names and confirmed in the Biblical covenant between God and the Hebrew people established between God and Abraham, and reaffirmed between God and Moses. Regardless of the historical truth of the formation of the covenant, it is accepted as a myth tantamount to [End Page 71] truth. In other words, regardless of its literal truth, such a myth is to be regarded as true because it concretizes God's demands or a moral truth. The covenant is real for me whether or not there was a historical Abraham. As with other religious commitments, the obligation to circumcise our sons is unprovable, but binding. On this basis, Perseus's ancestors on both sides were circumcised in brit milah ceremonies for many centuries into the past.My two grandsons were circumcised as well. Achilles was circumcised among friends and relatives. The mohel was an experienced obstetrician who was certified to officiate at a brit milah following the practices of Conservative Judaism. He administered adequate analgesia with topical local anesthetic cream followed by an injected regional block. Achilles slept through his circumcision, suffered no complications, and had little discomfort afterward. My other grandson had a circumcision performed as an infant outside the context of Judaism and is not being raised as a Jew.The two brit milah in my family were beautiful, dignified ceremonies, welcoming the infants into the Jewish fold, and bestowing their Hebrew names.5 Some of my relatives, including Perseus's son, had circumcisions performed in a medical setting without a ceremony. None of the many boys in my family had obvious short- or long-term problems with their circumcisions. My social circle has many Reform and Conservative Jews. I have never heard any Jewish man in my circle of acquaintances complain about his circumcision. Circumcision is a given. Problems are rare, and an exposed glans is the norm. Our men typically enjoy sex and have no difficulty in fathering children. Circumcision is part of the comforting cocoon of custom and tribe that helps to protect us as a group. It also reinforces Jewish endogamy... (shrink)

While all states in the United States require certain vaccinations for school attendance, all but three allow for religious exemptions to receiving such vaccinations, and 18 allow for exemptions on the basis of other deeply held personal beliefs. The rights of parents to raise children as they see fit may conflict with the duty of the government and society to protect the welfare of children. In the U.S., these conflicts have not been settled in a uniform and consistent manner. We (...) apply a test that provides a concrete and formal rubric to evaluate such conflicts. For some vaccinations, based on the individual medical characteristics of the disease and the risks of being unvaccinated, the test would suggest that permitting conscientious exemptions is ethical. However, for vaccinations protecting against other diseases that are more severe or easily transmitted, the test would suggest that the federal government may ethically impose laws that deny such exemptions. (shrink)

Health care workers or others may wish to override parental decisions because of their impact on the health or safetySafety of a child or others. Justification of such an action requires two types of principle: an authorityAuthority principle that designates the process for reversal, and anPrincipal, interventionintervention principleIntervention principle that specifies the grounds for reversal. It is generally accepted that states may overruleOverruleparentsParents’ decisions for good cause. I argue that the role of the state is to provide sufficient protection against (...) parental malfeasance. Parental malfeasance can be construed as either exposing a child to harmHarm or as insufficient defense of the child’s interestsChild's interests. I propose a test to determine what sorts of parental decisions might trigger intervention. I also propose constraints on government action to minimize government unfairness in applying the test. I show how this plays out in application. (shrink)