article explore the role physicians play in neonatal circumcision. they state that if physicians outline all the currently known risks and benefits of the procedure to the parents and believes the procedure is indeed medically indicated, they cannot be held accountable for any harm from the procedure. they still advise against physicians recommending unnecessary, irreversible surgeries, which is a category circumcision falls in frequently. other views jme symposium on circumcision, june 2004 the journal of medical ethics published a "symposium on circumcision" in its june 2004 issue. the symposium published the original version (2003) of the bma policy statement and six articles by various individuals with a wide spectrum of views on the ethicality of circumcision of male minors. in the introduction, holm (2004) argues that we do not have the evidence available in order to truly assess the ethics behind circumcision, identifying that we do not have evidence surrounding the "effects of early circumcision on adult sexual function and satisfaction". therefore, holm states until this data is available this debate cannot be concluded as there will always be an opposition to circumcision driven by "cultural prejudices". hutson (2004) concludes that he does not believe in the risk of circumcision without reason, stating that "no operation should be done if there is no disease". he justifies this through arguing that surgery is only condoned when the risk of the disease is greater than the surgery itself. short (2004) disputes hutson's claims and argues that male circumcision has future prophylactic benefits that make it worthwhile. he concludes that there can be no debate about male circumcision, arguing that "it can bring major improvements to both male and female reproductive health". he believes that as a result of living in a developing world, we have the facilities that enable this surgery to take place without "physical cruel nor potentially dangerous". viens (2004) contends that "we do not know in any robust or determinate sense that infant male circumcision is harmful in itself, nor can we say the same with respect to its purported harmful consequences." he suggests that one must distinguish between practices that are grievously harmful and those that enhance a child's cultural or religious identity. he suggests that medical professionals, and bioethicists especially, "must take as their starting point the fact that reasonable people will disagree about what is valuable and what is harmful." hellsten (2004) describes arguments in support of circumcision as "rationalisations", and states that infant circumcision can be "clearly condemned as a violation of children's rights whether or not they cause direct pain." he argues that to question the ethical acceptability of the practice, "we need to focus on child rights protection." hellsten concludes, "rather, with further education and knowledge the cultural smokescreen around the real reasons for the maintenance of the practice can be overcome in all societies no matter what their cultural background. mussell (2004) examined the process by which the bma arrived at a position on non-therapeutic circumcision male minors, when the organisation had groups and individuals of different ethnicities, religion, culture, and widely varying viewpoints. arguments were put forward that non-therapeutic male circumcision is a net benefit for some because it helps them to integrate in the community. arguments were also put forward that non-therapeutic male circumcision is a net harm because it is seen as a breach of children's rights—the right of the child to be free from physical intrusion and the right of the child to choose in the future. this argument was given emphasis by britain's incorporation of the european convention on human rights (1950) into domestic law by the human rights act 1998. the bma produced a document that set forth legal and ethical concerns but left the final decision on whether or not to perform a non-therapeutic circumcision to the attending physician. the last document published by the journal of medical ethics in its symposium on circumcision was a reprint of the bma statement: "the law and ethics of male circumcision: guidance for doctors (2003). journal of medical ethics circumcision issue, july 2013 the journal of medical ethics devoted the entire july 2013 issue to the controversial issue of non-therapeutic circumcision of male children. the numerous articles represent a diverse variety of views. other views povenmire (1988) argues that parents should not have the power to consent to neonatal non-therapeutic circumcision. richards (1996) argues that parents only have power to consent to therapeutic procedures. somerville (2000) argues that the nature of the medical benefits cited as a justification for infant circumcision are such that the potential medical problems can be avoided or, if they occur, treated in far less invasive ways than circumcision. she states that the removal of healthy genital tissue from a minor should not be subject to parental discretion, or that physicians who perform the procedure are not acting in accordance with their ethical duties to the patient, regardless of parental consent. canning (2002) commented that "f circumcision becomes less commonly performed in north america ... the legal system may no longer be able to ignore the conflict between the practice of circumcision and the legal and ethical duties of medical specialists." benatar and benatar (2003) argue that "it is far from obvious that circumcision reduces sexual pleasure," and that "it is far from clear that non-circumcision leaves open a future person's options in every regard." they continue: "it does preserve the option of future circumcised or uncircumcised status. but it makes other options far more difficult to exercise. transforming from the uncircumcised to the circumcised state will have psychological and other costs for an adult that are absent for a child. ... nor are these costs 'negligible', .... at the very least, they are not more negligible than the risks and costs of circumcision." the committee on medical ethics of the british medical association (2003) published a paper to guide doctors on the law and ethics of circumcision. it advises medical doctors to proceed on a case by case basis to determine the best interests of the child before deciding to perform a circumcision. the doctor must consider the child's legal and human rights in making his or her determination. it states that a physician has a right to refuse to perform a non-therapeutic circumcision. the college of physicians and surgeons of british columbia took a similar position. fox and thomson (2005) state that in the absence of "unequivocal evidence of medical benefit", it is "ethically inappropriate to subject a child to the acknowledged risks of infant male circumcision." thus, they believe, "the emerging consensus, whereby parental choice holds sway, appears ethically indefensible". the belgian federal consultative committee for bioethics (comité consultatif de bioéthique de belgique) (2017), after a three-year study, has ruled that circumcision of male children for non-therapeutic purposes is unethical in belgium. the process is irreversible, has no medical justification in most cases, and is performed on minors unable to give their own permission, according to the committee. paul schotsmans of the university of leuven, on behalf of the committee, noted "the child's right to physical integrity, which is protected by the international treaty on the rights of the child, and in particular its protection from physical injury." the belgian minister of health, maggie de block, replied that the federal institute for health insurance cannot check and know whether in (individual cases) a circumcision is medically justified or not and that she will continue to reimburse circumcision of minors as the safety of the child is her primary concern and she wants to avoid botched circumcisions by non-medical circumcisers. hiv prevention the world health organization (2007) states that provision of circumcision should be consistent with "medical ethics and human rights principles." they state that "nformed consent, confidentiality and absence of coercion should be assured. ... parents who are responsible for providing consent, including for the circumcision of male infants, should be given sufficient information regarding the benefits and risks of the procedure in order to determine what is in the best interests of the child." since babies and children are not sexually active, sexually-transmitted hiv infection is not a relevant concern. critics of non-therapeutic circumcision argue that advocating circumcision to prevent hiv infection may detract from other efforts to prevent the spread of the virus such as using condoms. if the adult chooses to remain celibate or if a couple remain monogamous, or if hiv is eliminated by the time the child is an adult, the sexual reduction surgery would not have been needed. moreover, they argue that circumcising a child purportedly to partially protect him from hiv infection in adulthood may be seen as granting permission to engage in dangerous sexual practices. obviously baby boys do not need such protection and can choose for themselves as consenting adults if they want a circumcision. this stance does not take into account the fact that adult men may already have contracted hiv before getting circumcised. the uk national health service (nhs) has stated that the african studies have "important implications for the control of sexually transmitted infections in africa", but that in the united kingdom practicing safe sex including condom use is the best way to prevent sexually-transmitted disease when having sex. surrogate consent patient autonomy is an important principle of medical ethics. some believe that consent for a non-therapeutic operation offends the principle of autonomy, when granted by a surrogate. since children, and especially infants, are legally incompetent to grant informed consent for medical or surgical treatment, that consent must be granted by a surrogate—someone designated to act on behalf of the child-patient, if treatment is to occur. a surrogate's powers to grant consent are more circumscribed than the powers granted to a competent individual acting on his own behalf. a surrogate may only act in the best interests of the patient. a surrogate may not put a child at risk for religious reasons. a surrogate may grant consent for a medical procedure that has no medical indication only if it is the child's best interests. the attending physician must provide the surrogate with all material information concerning the proposed benefits, risks, advantages, and drawbacks of the proposed treatment or procedure. the committee on bioethics of the aap (1995) states that parents may only grant surrogate informed permission for diagnosis and treatment with the assent of the child whenever appropriate. there is an unresolved question whether surrogates may grant effective consent for non-therapeutic child circumcision. richards (1996) argues that parents may only consent to medical care, so are not empowered to grant consent for non-therapeutic circumcision of a child because it is not medical care. the canadian paediatric society (2015) recommends that circumcisions done in the absence of a medical indication or for personal reasons "should be deferred until the individual concerned is able to make their own choices." regardless of these issues, the general practice of the medical community in the united states is to receive surrogate informed consent or permission from parents or legal guardians for non-therapeutic circumcision of children.