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The foreskin is a complex structure that protects and moisturizes the head of the penis, and, being the most densely innervated and sensitive portion of the penis, is essential to providing the complete sexual response. Circumcision—the removal of this structure—is non-therapeutic, painful, irreversible surgery that also risks serious physical injury, psychological sequelae, and death. Men rarely volunteer for it, and increasingly circumcised men are expressing their resentment about it.Circumcision is usually performed for religious, cultural and personal reasons. Early claims about its medical benefits have been proven false. The American Academy of Pediatrics and the Centers for Disease Prevention and Control have made many scientifically untenable claims promoting circumcision that run counter to the consensus of Western medical organizations.Circumcision violates the cardinal principles of medical ethics, to respect autonomy (self-determination), to do good, to do no harm, and to be just. Without a clear medical indication, circumcision must be deferred until the child can provide his own fully informed consent.In 2012, a German court held that circumcision constitutes criminal assault. Under existing United States law and international human rights declarations as well, circumcision already violates boys› absolute rights to equal protection, bodily integrity, autonomy, and freedom to choose their own religion. A physician has a legal duty to protect children from unnecessary interventions. Physicians who obtain parental permission through spurious claims or omissions, or rely on the American Academy of Pediatrics' position, also risk liability for misleading parents about circumcision.

Nontherapeutic circumcision (NTC) of male infants and boys is a common but misunderstood form of iatrogenic injury that causes harm by removing functional tissue that has known erogenous, protective, and immunological properties, regardless of whether the surgery generates complications. I argue that the loss of the foreskin itself should be counted, clinically and morally, as a harm in evaluating NTC; that a comparison of benefits and risks is not ethically sufficient in an analysis of a nontherapeutic procedure performed on patients unable to provide informed consent; and that circumcision violates clinicians' imperatives to respect patients' autonomy, to do good, to do no harm, and to be just. When due consideration is given to these values, the balance of factors suggests that NTC should be deferred until the affected person can perform his own cost-benefit analysis, applying his mature, informed preferences and values.

All forms of genital cutting – female genital cutting (FGC), intersex genital cutting, male genital cutting (MGC), and even cosmetic forms of FGC – are performed in a belief that they will improve the subject’s life. Genital autonomy is a unified principle that children should be protected from genital cutting that is not medically necessary. Safeguarding genital autonomy encompasses helping societies and individuals to explore wounds common across different forms of genital cutting regarding gender, power, the quest for cultural belonging, and social and sexual control. A desire to prevent alternative sexualities helps explain the origins of MGC’s medicalization starting in the nineteenth century, as well as the roots of the failed attempt to similarly medicalize FGC. The child with ‘ambiguous’ genitalia brings us face to face with the failure of the attempted alignment of sex and gender. Medical ethics, law, and human rights suggest a path forward toward genital autonomy.

Every infant has a right to bodily integrity. Removing healthy tissue from an infant is only permissible if there is an immediate medical indication. In the case of infant male circumcision there is no evidence of an immediate need to perform the procedure. As a German court recently held, any benefit to circumcision can be obtained by delaying the procedure until the male is old enough to give his own fully informed consent. With the option of delaying circumcision providing all of the purported benefits, circumcising an infant is an unnecessary violation of his bodily integrity as well as an ethically invalid form of medical violence. Parental proxy 'consent' for newborn circumcision is invalid. Male circumcision also violates four core human rights documents-the Universal Declaration of Human Rights, the Convention on the Rights of the Child, the International Covenant on Civil and Political Rights, and the Convention Against Torture. Social norm theory predicts that once the circumcision rate falls below a critical value, the social norms that currently distort our perception of the practice will dissolve and rates will quickly fall.

The American Academy of Pediatrics recently released a policy statement and technical report on circumcision, in both of which the organisation suggests that the health benefits conferred by the surgical removal of the foreskin in infancy definitively outweigh the risks and complications associated with the procedure. While these new documents do not positively recommend neonatal circumcision, they do paradoxically conclude that its purported benefits 'justify access to this procedure for families who choose it,' claiming that whenever and for whatever reason it is performed, it should be covered by government health insurance. The policy statement and technical report suffer from several troubling deficiencies, ultimately undermining their credibility. These deficiencies include the exclusion of important topics and discussions, an incomplete and apparently partisan excursion through the medical literature, improper analysis of the available information, poorly documented and often inaccurate presentation of relevant findings, and conclusions that are not supported by the evidence given.

Jacobs and Arora (2015) offer an impassioned defense of infant male circumcision, yet their article falls short of being very convincing. The authors employ a highly selective reading of the releva...

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.

Infant male circumcision continues despite growing questions about its medical justification. As usually performed without analgesia or anaesthetic, circumcision is observably painful. It is likely that genital cutting has physical, sexual and psychological consequences too. Some studies link involuntary male circumcision with a range of negative emotions and even post-traumatic stress disorder (PTSD). Some circumcised men have described their current feelings in the language of violation, torture, mutilation and sexual assault. In view of the acute as well as long-term risks from circumcision and the legal liabilities that might arise, it is timely for health professionals and scientists to re-examine the evidence on this issue and participate in the debate about the advisability of this surgical procedure on unconsenting minors.

Barriers of many different types make successful circumcision-related lawsuits extremely difficult to bring. Actual cases we and others have brought show that among factors impeding progress are (1) financial risks; (2) procedural difficulties; (3) misconceptions and compassion misallocation among judges, lawyers, jury members, the media, and the general public; (4) constraints unique to circumcision lawsuits that are imposed by statutes of limitation and statutes of repose; (5) need for parental participation in lawsuits; (6) problem of damages not being atrocious enough to justify litigation; and (7) the scarcity of helpful case law. Players whose roles we will be scrutinizing include clients, lawyers, judges, juries, courts and procedures, doctors, media, and fellow activists. We will discuss the many reasons why potential plaintiffs never even make it to the filing stage. We will look at why judges and juries are starting to understand that just having a foreskin is not reason enough to have a circumcision.

In this article, we offer a critical examination of the tendency to segregate discussion of surgical alterations to the male and female genitals into separate compartments--the first known as circumcision, the second as genital mutilation. We argue that this fundamental problem of definition underlies the considerable controversy surrounding these procedures when carried out on minors, and that it hinders objective discussion of the alleged benefits, harms, and risks. We explore the variable effects of male and female genital surgeries, and we propose a scale of damage for male circumcision to complement the World Health Organization's categorization of female genital mutilation. The origins of the double standard identified are placed in historical perspective, and in a brief conclusion we make a plea for greater gender neutrality in the approach to this contentious issue.

One of the greatest challenges facing lawyers and other activists advocating a halt to male “circumcision,” or male genital mutilation, is achieving universal agreement that this practice constitutes a human rights violation. A straightforward reading of numerous human rights treaties demonstrates that circumcision constitutes a violation of numerous international agreements. Acknowledgments of this fact have been recorded by scholars, non-governmental organisations, courts, and the United Nations. To date, neither the United Nations nor any other major, internationally recognised human rights agency or non-governmental organisations has initiated any program to pursue the eradication of male genital mutilation. The organisation to which such a campaign must ultimately be addressed is, of course, the United Nations.

In August 2001, NOCIRC submitted an oral address and a written “intervention” to the United Nations’ Sub-Commission for the Promotion and Protection of Human Rights, which became part of the official UN record. We provide the text of our written intervention. At this point in time, the Sub-Commission is the most favorable forum in which to seek UN recognition of male genital cutting (MGC) as a human rights violation. The UN and the Sub-Commission are to be congratulated for their progress in acknowledging the importance of MGC. Further work remains to expand on the UN’s and the Sub-Commission’s statements that (1) at least, under certain circumstances, MGC can constitute a human rights violation; and (2) anti-male sex discrimination violates human rights. Analysis of reports regarding MGC is provided by the Sub-Commission’s Special Rapporteur on Traditional Practices Affecting the Health of Women and the Girl Child. We review the Sub-Commission’s 1998 excision of male children from the Special Rapporteur’s mandate, in apparent violation of both its own procedures and leading human rights documents.

Throughout history and throughout the world, a wide range of body mutilation practices have been carried out by adults on children. Many such practices involve sexual mutilation, including female genital mutilation in present-day Africa, male circumcision in the present-day United States, penile skin stripping in nineteenth-century Arabia, female genital mutilation in the twentieth-century United States, subincision among Australian aborigines, and others. Practices involving non-sexual body mutilation include footbinding in China, infant cranial deformation in ancient Central Asia, infant swaddling in ancient Central Asia, forced bone deformation in Malaysia, and others. Arguably includable here is the drastic practice of infanticide, for which (obviously) no benefit to the individual is claimed but which has taken root in a wide variety of cultures and periods. I will examine infanticide as practiced in nineteenth-century India. These practices are allegedly performed for the benefit of the child but result in overall harm to the child while producing actual or imagined benefits only for others, i.e., parents, surgeons/midwives, and/or society. The practice adopted by a particular culture receives social, cultural and/or legal endorsement within that culture’s set of mores and values. Analytical tools provided by a range of disciplines including law, sociology, human rights, anthropology, and psychology are applied to explore how a broad variety of bizarre and extremely harmful practices on children are justified and rationalized into consistency with a culture’s asserted values.

Human rights agreements—applicable either through ratification or through customary law—forbid circumcision based on such important principles as the rights of the child, the right to freedom of religion, the right to the highest attainable standard of health, and the right to protection against torture. Cultural blindness facilitates the perpetuation of many barbaric and/or egregiously discriminatory practices and conditions. The many laws against female sexual mutilation, and the discriminatory failure to outlaw and vilify male sexual mutilation, violate equal protection under both international human rights law and American legal doctrines.

Different from hemimetabolous insects in which the adult central nervous system (CNS) is essentially a replica of the embryonic CNS, most of the adult brain in holometabolous insects develops during postembryonic neurogenesis (Panov, 1963). Postembryonic neurogenesis has been well-described in various insects (Panov, 1963; Technau and Heisenberg, 1982; Booker and Truman, 1987). Since postembryonic neurogenesis in Lepidoptera is a critical period of terminal neuroblast differentiation, neuronal cell death and synaptogenesis for transformation of larval neurons into adult neurons, we have been interested in identifying proteins and genes that influence this developmental process in M. sexta. In this paper, we review our previous work concerning: 1) changes in expression of Manduca intracellular brain polypeptides, and of Manduca brain polypeptides that are secreted into an incubation medium at different stages of post-embryonic neurogenesis (Davis, submitted), and 2) cloning, from a Manduca brain cDNA library, genes that are activated during metamorphosis (Davis and Svoboda, 1989). Since it is not known how many of the secreted polypeptides are actual neurosecretory polypeptides, the secreted polypeptides will be referred to as putative neurosecretory polypeptides.

It is generally accepted that insects lack the capacity for de novo biosynthesis of the steroid nucleus, and to date all insects that have been examined critically have been shown to require an exogenous source of sterol to achieve normal growth, develop­ ment, and reproduction--except in those cases where associated symbiotes may provide a source of sterol. In all but two known exceptions, which will be discussed elsewhere in this chapter, this critical need for sterol can be satisfied by dietary cholesterol or some sterol that can be converted to cholesterol by the insect. Several reviews published since 1970 (17, 39, 42, 54, 56) provide detailed coverage on virtually every facet of the utilization and metabolism of steroids in insects. As the title implies, this chapter will be primarily devoted to a discussion of progress that has been made in this area of insect biochemistry since the last reviews on the subject were written. In the present chapter we will repeat that material covered in previous reviews only when it is required for background information, clarification, discus­ sion, or to emphasize the importance of an aspect that is being considered in detail. This review will be concerned with three major areas of insect steroid research: the metabolism and utilization of phytosterols and other neutral sterols; the in vivo metabolism of the ecdysones; and the in vitro metabolism of ecdysones. These were selected since most of the recent developments and advances in insect steroid metabolism have been in these three areas.

Two vertebrate hypocholesterolemic agents (triparanol and 22,25-diazacholesterol) block the conversion of beta-sitosterol to cholesterol in the larva of the tobacco hornworm, Manduca sexta (Johannson). A primary site of inhibitory action is the terminal step in this conversion-the reduction of desmosterol (24-dehydrocholesterol) to cholesterol. This is also the site at which these compounds inhibit de novo cholesterol biosynthesis in higher animals. Both agents severely inhibit growth and maturation of the tobacco hornworm.