Circumcision

Josiah Flatt, like about 60% of other newborn American boys, was circumcised soon after he was born in the spring of 1997. Two years later, his parents sued the doctor and the hospital.

They did not contend that the circumcision was botched or deny that Josiah’s mother, Anita Flatt, had consented to the procedure in writing. They said, instead, that the doctor had failed to tell them enough about the pain, complications and consequences of circumcision, the removal of the foreskin of the penis.

The suit will be heard by a jury next month. In declining to dismiss the suit before trial, Judge Cynthia Rothe-Seeger acknowledged that the case is unusual in that nothing “went ‘wrong’ during the procedure.’’ The main harm the suit seeks compensation for, Rothe-Seeger noted, is “diminished sexual-sensation injury.”

The suit is but one of several efforts by a small but energetic group of loosely affiliated advocates and lawyers to use the legal system to combat the practice. Most newborn American boys are circumcised when they are days old.

The advocates have been active in state legislatures, too. Ten states, including Arizona, no longer allow Medicaid to pay for circumcision.

Steven Svoboda, director of Attorneys for the Rights of the Child, a group devoted to the issue, contends that circumcision is wrong as a matter of law, medicine and philosophy. Children of both sexes, Svoboda said, should be entitled to “bodily integrity.”

Josiah’s case appears to be the first to go to trial based on the theory that the absence of an exhaustive medical briefing about the risks and benefits of circumcision is tantamount to a lack of informed consent.

Among the possible complications in the operation are excess bleeding, infection and ulceration and occasional permanent damage to the penis. Opponents also cite reduced sexual sensitivity, although the evidence on that is mixed.

Josiah’s father, James, died in 2001 in an automobile accident, but the boy’s mother, Anita, decided to proceed with the suit.

The physician who performed the circumcision, Dr. Sunita Kantak, and representatives of the hospital, Merit-Care Medical Center, issued this statement:

“Anita Flatt was given information about circumcision, and the circumcision was done because she requested it.”

About 1.2 million newborns are circumcised in the United States every year, at a cost of $150 million to $270 million, the American Academy of Pediatrics says.

Circumcision for other than religious reasons is a relatively recent phenomenon in the U.S. It began in the late 19th century and peaked in the 1960s at 90% of newborn boys.

Circumcision rates vary widely. They are highest in the Midwest, about 80%, and lowest in the West, under 40%.

The medical rationales in favor of circumcision have been a moving target. Dr. Thomas Wiswell, a professor of pediatrics at the State University of New York at Stony Brook and a proponent of the procedure, said efforts to restrict circumcision in the courts and state legislatures were misguided.

There is powerful evidence, Dr. Wiswell said, that circumcision helps prevent urinary tract infections, penile cancer and sexually