23. Of course, the question is a different one when the family seeks to have the treatment imposed on a child. Traditionally, female circumcision, which is always performed by women, is carried out during a child's teenage years or, increasingly, much before. A decision to perform this unusual medical procedure on a child ought to be measured by the standards usually applied to providing medical care to children. Medical authorities readily allow parents to make most medical decisions on behalf of their children. For example, parent's decisions to have their male babies circumcised is always accorded respect, although, of course, it is a far less significant decision than the one to have a female child circumcised. However, competent adults are generally not permitted to choose a course of treatment that will result in the death of their children, even if they would be permitted to make that choice for themselves. For example, a competent adult Jehovah's Witness is permitted to die rather than to undergo a blood transfusion, but the parent may not make that choice on behalf of his child. If a parent attempts to make such a choice, the state, often through a child protective services agency, will step in to assure that the treatment is provided. There are two theories behind the rule that says that a state will step in to make certain important healthcare decisions for children, despite the wishes of the parents. First, the state has a special obligation to protect children – an obligation it does not possess with regard to adults. Second, if autonomy has any meaning, it ought to be applied in such a way that children can grow into competent and autonomous adults, who can then decide what kind of treatment they desire. The first theory provides a reason to allow for intervention to prohibit a parent's request that a child be circumcised only if circumcision is determined to be abuse – in other words, it begs the question. The second theory provides a reason to allow for intervention to prohibit the parent's request only if circumcision can be analogized to life-sustaining treatment. Although the decision to have a female child circumcised is far more significant that the decision to have a male child circumcised, for example, it does not put the life of the child at risk if it is done by a competent medical practitioner. Some courts have ordered medical treatment over parents' objections even when the conditions sought to be treated are not life threatening, when the issue is “necessary” plastic surgery for example. These courts have found, directly or indirectly, that the parents' decision to deny treatment – a decision sometimes based on religious beliefs or cultural obligations – does constitute abuse. Whether those decisions are correct remains a subject of some debate. The question is different yet again when the child herself makes the request for treatment. Children are not permitted to put their lives at risk by choosing inadequate medical treatment, even with the agreement of their parents. A Jehovah's Witness child will be provided a blood transfusion even if the child and parents agree that one should not be given other kinds of medical decisions. A child may have a constitutional right to choose to have an abortion, even if her parents disagree, when the same child would not be legally permitted to have an appendectomy without parental consent. Clearly, there is more reason to protect a child from decisions regarding female circumcision than to protect an adult; still, the reasoning applied to protect children from decisions of parents that puts their lives at risk cannot be so easily applied to unanimous family decisions to seek female circumcision, especially when the family raises other social and cultural arguments in favor of the circumcision.
