Circumcision of Young Boys: A Conflict between Parental and Child Rights. The Swedish Experience from a Medical Point of View

INTRODUCTION Male circumcision is practiced all over the world by approximately a billion Muslims, three hundred million Christians, at least sixteen million Jews and an indeterminate number of animists and atheists. It involves, all in all, about 30% of the world's male population. Circumcision is performed for three main reasons. (a) Circumcision is regarded to be an important cultural tradition and initiation rite. The background is undetermined, but may have to do with hygiene or sexual reasons. (b) Religious reasons, prescribed in Judaism and Islam are decisive. References are made mainly to the old testimony in the Bible. Male circumcision is, nevertheless, an older practice, even if its origins are obscure. (c) Circumcision is a non-religious, routine operation. This is the case mainly in the United States of America, where it has been widely practiced since about 1870, initially to prevent a number of alleged diseases such as epilepsy, enuresis, impotence and a variety of psychiatric diseases. It was also meant to prevent masturbation, which at the time was thought to give rise to a number of severe diseases. These circumcisions are usually done while the mother is still at the maternity ward. In 2010 about 60% of all infant boys in the US were circumcised at a total cost of 800 million dollars per year. Male circumcision of small boys, unable to personally consent to the operation, has been debated for several hundred years. The principal debate has been about the parents’ rights to decide about the intervention, contra the young boys’ right to bodily integrity. Over the last two decades, probably due to the immigration of hundreds of thousands of Muslims to the Scandinavian (Nordic) countries, oft en as refugees, this topic has gained renewed interest in Sweden and the other Nordic states. The current discussion, in the Nordic countries, is mainly centred on four topics: (a) medical reasons in favour or against circumcision, including risks of side effects; (b) parental rights versus children's rights and the importance of informed consent; (c) respect for children's bodily integrity and autonomy; (d) cultural and religious aspects.