Background:The United Kingdom (UK) does not have an evidence-based policy on circumcision for non-medical reasons. The aim of this systematic review is to address the question "Is non-therapeutic male circumcision (NTMC) a beneficial public health intervention for the UK?". Methods:A PRISMA-compliant, PROSPERO-registered, systematic review was conducted involving PubMed, EMBASE, SCOPUS and Cochrane databases searches for male circumcision articles to January 2024. Those rated high-quality by the Scottish Intercollegiate Grading Network (SIGN) system were included in results. Results:Searches retrieved 183 articles rated as high-quality and relevant to the objectives. These showed early circumcision provided immediate and lifetime medical benefits by protecting against urinary tract infections, penile dermatological inflammation, phimosis, inferior penile hygiene, candida, sexually transmitted infections (STIs) such as human papillomavirus, genital herpes virus type-2, human immunodeficiency virus, and penile and prostate cancers. NTMC had no long-term adverse effect on sexual function or pleasure. Female partners were at lower STI and cervical cancer risk. A risk-benefit analysis for the UK found benefits of early circumcision exceeded procedural risks by over 200 to one, and that as many as half of uncircumcised males may be affected during their lifetime from an adverse medical condition attributable to foreskin retention. Costs for treatment of these exceeds procedural costs for early NTMC. A recent systematic review found NTMC of male minors is legal and supported by ethical arguments as well as the United Nations Convention of the Rights of the Child which emphasizes the right to health. Routine provision of accurate, evidence-based information on risks and benefits should assist parents in making an informed decision about circumcision should they have a boy. Cost coverage is warranted. Conclusions:In summary, the medical evidence supports early circumcision as a public health recommendation in the UK.

In “Between Prophylaxis and Child Abuse: The Ethics of Neonatal Male Circumcision,” Michael and David Benatar (2003) stake out a moderate position, proposing that, arst, the choice of whether to circumcise a male child is an acceptable choice and a choice appropriately left to parental prerogatives, and, second, that the participation of the physician is permissible as well. The basis upon which such a conclusion is viewed as acceptable is the empirical evidence that tips in favor of perceiving circumcision as providing a beneat and not a signiacant risk, and also that not all medical service has to be in response only to what is medically indicated. An important part of the paper is the dispassionate, thoughtful, and apparently fair manner in which the empirical evidence on either side of the question is carefully analyzed. Of course, much turns on the question of whether what seems to be the case regarding the analysis of the empirical studies is in fact the case. That is, if the studies in question did and serious harms associated with male circumcision and no beneats, a very different conclusion regarding parental choice and physician involvement might be in order, or, at least, a different set of arguments would have to be developed in order to support the same conclusion. With the latter point in mind, I want to address two issues that were touched on in the paper but need to be developed more fully. The arst has to do with the religious dimension that is associated with the practice and what complications follow if one permits a consideration of this association. The second has to do with medical interventions that occur, at parental discretion, that are not actually medically indicated. My purpose is not to put forward conclusions that I want to defend (at least not at this time) but to point out issues that would seem to require further discussion. What if it were the case that male circumcision posed a real risk and was a religious requirement? Would it still be a matter for parental choice or discretion? Probably most would argue that it should not be. The Benatars would likely argue to this conclusion, as well. But, as I pointed out elsewhere (Sheldon 1996; 2000), when religion is involved, matters become complicated. Different perspectives come into play that are simply incompatible, that pass each other as a result of operating within a different set of priorities. Most perceive the refusal of a blood transfusion by a Jehovah’s Witness parent as the gold standard for unacceptable parental choice. The reason for this is that there is no perceived ambiguity regarding harm to the child. If the child does not receive the blood transfusion, he or she will die and death is a harm. There might be signiacant acceptance of this parental discretion if death were only vaguely possible. But since it is just about certain that death will occur, almost all people will push for intervention that would oppose parental discretion. The problem, however, is that as soon as one brings religion into the mix one ands that what constitutes harm becomes complicated, becomes a matter of perspective. For instance, in the case of the Jehovah’s Witnesses, harm occurs when one receives a blood transfusion, not when one dies. While this might, to many, sound preposterous, the fact is that we actually do not know who is correct on this question. We might actually suffer a harm when we receive a blood transfusion—the harm of being cut off from eternal life—but not when we die physically. Furthermore, we currently have no way to settle the differing claims on this question, to determine, actually, which is right. We would have to die in order to determine an answer to the question, and, even then, our personal fate might be such that we will never be availed of a position that would enable us to answer the question. What does this mean for the question of male circumcision? What it means is that if we intervene in parental decision making in this case, where the reason for male circumcision is religious in nature, we might have to intervene without appealing to what appears to be an unbiased view of what constitutes a harm. And male circumcision no longer remains a practice that can be assessed from the perspective of an agreed-upon standard of harm. If the claim that parents make is that circumcision is required in order to ensure that their child is put into proper relationship to God, on what basis could such a claim be questioned or challenged successfully? Certainly it could not be questioned without bias—in this case, a secular bias. The discussion above poses no problem for the position developed in the Benatars’ paper, since the empirical evidence to which they point describes no signiacant harm associated with male circumcision, and, in fact, suggests a beneat. Therefore, parental discretion does seem acceptable. The second issue, medical intervention that is not medically indicated but results from parental preference,

The paper is an attempt to review the basis for the claim that physicians have a professional obligation to treat AIDS patients. Considered are the historical record, two professional codes of ethics, and several recent articles. The paper concludes that the arguments considered, which attempt to support the claim that physicians have an obligation to treat, fail. It is suggested, rather, that common humanity, which physicians share with those who suffer from AIDS, ought to be the basis for engaging in the care of AIDS patients.