Heather Hironimus, who had been in hiding to avoid a court-mandated circumcision of her son, was arrested and jailed for contempt of court Reuters/Andy Clark

Legal and ethical consent is more than just a mark on a piece of paper. A scrawled signature is worth nothing if it does not represent freely volunteered, informed agreement. Consent offered under duress of coercion, fear or force has no meaning, no value.

The piece of paper signed by Florida mother Heather Hironimus is not a document of consent but a testament to a dysfunctional legal system that has become detached from fundamental principles of justice and human rights and which shames the United States of America in the eyes of the world.

The courtroom photos record Hironimus at the time of the signature, bound in handcuffs, sobbing uncontrollably, throwing her head back with hands clenched in a prayer for support or forgiveness. When she took the pen from her lawyer, it was subsequent to nine days held in jail with clear conditions from the presiding judge that she would be imprisoned indefinitely until she offered that signature.

Those nine days followed three months living in hiding in a domestic violence refuge. At the time of putting pen to paper, Hironimus was clearly distraught, distressed and presumably exhausted. Any document signed at such time has about as much validity as a confession to the Spanish inquisition.

What was the cause that drove the Florida justice system to such ignominious lengths? Astonishingly, the entire case hinges on a single decision resolved amicably by millions of American parents every year – whether or not to circumcise their sons.

Signing of a parental agreement

The origins of this saga lie in a parenting agreement signed by Hironimus and the boy's father, Dennis Nebus, at the time of birth. The parents were not in an ongoing relationship and they signed an agreement on shared parenting, which included a clause stating that it would be the father who would schedule and pay for any circumcision procedure.

Like ever-growing numbers of American parents, she came to believe or understand the supposed health benefits to circumcision are spurious and do not justify the risks and the loss of bodily integrity

Nebus never took up the option until the child was three years old. In the intervening time, there were two important developments. The first was Hironimus learned more about the consequences of circumcision, including risks of complications from either the procedure or the anaesthetics involved.

Like ever-growing numbers of American parents, she came to believe or understand the supposed health benefits to circumcision are spurious and do not justify the risks and the loss of bodily integrity.

Secondly, and equally significantly, her son grew old enough to have an opinion as to what should happen to his own penis and decided he did not want bits of it cut off by a doctor for no sensible reason.

Nonetheless, in 2014, a Florida judge ruled that in signing the original parenting agreement, Hironimus had signed away any right to change her mind at any time, and lost the power to object to the permanent surgical mutilation of her own son.

For refusing to comply with the judge's ruling, Hironimus was held to be in contempt of court and still faces the prospects of criminal charges for interference with custody, a felony offence with a maximum sentence of five years in prison. Her son, who has been named widely in press reports and on social media, but whose identity is formally protected in legal proceedings, is currently in the care of his father.

Lightning rod

In many respects, the Hironimus case stands as a lightning rod for the developing debate around circumcision in the US. For more than a century American baby boys were routinely circumcised immediately after birth. The justifications have changed over time, from prevention of masturbation to hygiene considerations and latterly to the prevention of disease, and it seems that as the validity of each is disproven, a new rationalisation is forthcoming.

The American Academy of Pediatrics is now just about the only organisation of its type in the developed world that continues to recommend the practice. Nonetheless, the proportion of American parents who are refusing to continue the tradition is growing rapidly with improved awareness and education.

A recent YouGov poll found only 55% of newborn boys are now circumcised and it is expected that within a generation or two, a clear majority will be left intact. The same poll found one in 10 circumcised men in the US regret having had the procedure conducted

The Hironimus case crystallises an increasingly impassioned debate between anti-circumcision campaigners (or "intactivists" as they choose to be known) and the traditions of the medical profession and cultural habits.

The debate swings on whether circumcision is considered a permanent medical and surgical intervention that brings to bear the full framework of ethics and consent or not. In no other circumstances would a signed parenting agreement, even if considered a legal contract, be considered unchangeable and permanent consent to surgical procedure at any time.

The simple truth is such documents are intended for practical management of finances and access arrangements, and in normal practice are regularly renegotiated and rewritten as circumstances change for one or other parent. In no other circumstance would parental consent for a surgical procedure be considered inviolable and irreversible even years later.

UN Declaration on the Rights of the Child

At least on face value, the son's bodily integrity would appear to be supported by the terms of the UN Declaration on the Rights of the Child, which promises to enable him to develop "in conditions of freedom and dignity". Both mother and child would also appear to have the Universal Declaration of Human Rights on their side, which ensures their life, liberty and security of person as well as their freedom from cruel or degrading treatment.

I struggle to believe that even the most ardent supporter of circumcision could accept such a procedure should be inflicted needlessly upon a terrified and distressed child

One does not need to be passionately opposed to circumcision, for oneself or one's child, to see the horrific injustice that is now being played out in Palm Springs.

I struggle to believe that even the most ardent supporter of circumcision could accept such a procedure should be inflicted needlessly upon a terrified and distressed child, or that such an irreversible operation should ever be undertaken without the express agreement of both involved parents.

Ultimately it may be practicalities that decide whether this circumcision is conducted or not – it looks increasingly likely Nebus will be unable to find a surgeon who is prepared to operate in such circumstances.

The debate on the ethics and necessity of routine infant circumcision is not yet resolved but the balance of opinion appears is shifting rapidly. It may well be that in years to come society will look back on this habit of our era as a peculiar, if not downright barbaric anomaly. When that time comes, the lasting, iconic image might not be of a bleeding baby or a surgeon's scalpel, but the brutalised, tear-stained face of a heartbroken, handcuffed mother.

Ally Fogg is a freelance writer and journalist based in Manchester, UK, who comments and blogs widely on issues of social justice, politics and male gender issues. He has previously worked in community media as a project manager and as lead author of the Community Radio Toolkit, as an editor and staff writer for the Big Issue in the North, and as an academic researcher in clinical psychology and epidemiology.

He can usually be found arguing with people on his blog at or on Twitter @AllyFogg.