MacDonald deserves credit for shifting the debate on circumcision away from inconclusive quibbles about the balance of risks and benefits,1 but it is not obvious that peripubertal boys are any more capable of giving consent than a baby. They lack maturity and sufficient knowledge; boys at 11 or 12 years of age are not considered competent to consent to sexual relations with others, and even if they agree to have sex, the other party will be guilty of sexual assault. If they cannot consent to sexual relations, they are certainly not competent to consent to having a part of their penis excised.
The practice with respect to genital surgeries should be no less strict than the rules governing sexual activity. If circumcision provides some protection against sexually transmitted infections (a contentious point2,3), the only logical age at which a male can legally consent to circumcision would be the same as that of consent for sexual purposes. If it is wrong to perform circumcision in infancy, it is equally wrong to perform it at any time before legal adulthood.
MacDonald’s contention that circumcision at puberty provides “the opportunity for informed choice … the boy can give assent” is contradicted by experience. Many tribal societies perform initiation rites on peripubertal boys and girls, sometimes involving circumcision, but the children have no more opportunity to decline the operation than to Ny to the moon. If they object, they are subject to violent coercion; if they run away, they are ostracized. Circumcision of boys at around 9 to 11 years of age is usual in South Korea and the Philippines, where social expectation, peer pressure and the fact that boys are still children subject to parental discipline means that they have little chance of saying, “No thanks.”4,5 Unless they can decline without prejudice to their future social status, there is no possibility of free choice.
The “medically important question” is not whether circumcision should be “routinely offered to young male adolescents rather than their baby brothers,” but how we can find an effective way of giving boys some protection against genital cutting?