Neonatal circumcision is a contentious issue in Canada. The medical risk:benefit ration of routine newborn male circumcision is closely balanced and the Canadian Paediatric Society does not recommend routine circumcision.  The procedure often raises ethical and legal considerations, in part because it has lifelong consequences and is performed on a child who cannot give consent. Infants need a substitute decision maker – usually their parents – to act in their best interests. Yet the authority of substitute decision makers is not absolute. In most jurisdictions, authority is limited only to interventions deemed to be medically necessary. In cases in which medical necessity is not established or a proposed treatment is based on personal preference, interventions should be deferred until the individual concerned is able to make their own choices. While circumcision does decrease the risk of penile cancer, penile cancer is quite rare and the risk is reduced by HPV vaccination.