Anonymised Summary of Court of Appeal (Criminal Division) Judgment
Factual and Procedural Background
This is an appeal from the Crown Court at Southwark before Judge Perrins. The Appellant was indicted on numerous counts arising from performing non-therapeutic male circumcisions on babies and young children. The original indictment included allegations of fraud, wounding with intent (s.18), assault occasioning actual bodily harm (ABH), offences under the Human Medicines Regulations 2012 and possession of an article for use in fraud.
On 28 February 2025 the Appellant pleaded guilty to multiple offences under the Human Medicines Regulations 2012 (parenteral administration and supply of prescription or pharmacy medicines). A 28-count indictment proceeded to trial (10 March–8 May 2025) at which the Appellant was convicted on 20 counts: including fraud, s.18 wounding with intent and ABH. On 16 July 2025 the Crown Court imposed sentences which produced an aggregate term of 9 years' imprisonment. The Appellant appealed against conviction and sentence; leave to appeal on both matters was granted by referral to the full court.
Legal Issues Presented
- Whether evidence and jury directions permitting conviction via "Route two" (i.e. that the manner of performing a non-medical religious circumcision could be so unsafe as to render parental consent ineffective and make the act unlawful) were legally permissible and whether the judge erred in leaving that route to the jury.
- Whether the judge's Route two directions provided an appropriate and sufficiently clear standard for the jury to apply in assessing the safety of a non-medical circumcision.
- Whether the injection of local anaesthetic was a separate assault preceding the circumcision (potentially reducing culpability) or an integral part of a single continuing circumcision procedure.
- Whether the total sentence of 9 years was excessive, including alleged double-counting by making sentences for s.18, fraud and medicines offences consecutive.
Arguments of the Parties
Appellant's Arguments (as advanced by Attorney Jackson and Attorney Mattin)
- The judge should not have left Route two to the jury; in the absence of parliamentary regulation non-medical religious circumcisions performed in a recognised manner cannot be criminalised by reference to medical standards.
- The judge's Route two direction was insufficiently clear; the jury lacked a legally certain standard (they should have been directed to apply the standard of a competent and careful non-medical circumciser).
- The administration of local anaesthetic was a separate act from the cutting and removal of the foreskin, and thus could not support s.18 liability (at most s.20) in respect of the anaesthetic injection.
- On sentence: the overall 9-year term was excessive, involved double-counting and failed properly to apply totality; the starting points for s.18 and fraud sentences were too high.
Respondent's Arguments (as advanced by Attorney Douglas-Jones and Attorney Sumnall)
- The Appellant's procedures fell far below acceptable standards and the evidence (including accounts of unsanitary conditions and unauthorised use of anaesthetics) justified leaving Route two to the jury and calling medical expert evidence.
- Expert evidence was necessary to explain the risks of anaesthetic administration by an unqualified person and other procedural shortcomings.
- The overall sentencing structure properly reflected separate aspects of culpability (deception/fraud on parents; unsafe procedures; unauthorised use of strong medicines) and the aggregate sentence was not excessive given the scale and persistence of offending.
Table of Precedents Cited
| Precedent |
Rule or Principle Cited For |
Application by the Court |
| Reg. v Coney (1866) 10 Cox CC 371 |
Public interest can render consent ineffective where activity presents significant risk (example: prize-fighting). |
Used to illustrate that public policy can limit consent as a defence and to show historic treatment of risky consensual activities. |
| Attorney General's Reference (No 6 of 1980) [1981] 715 |
Consent is no defence where public interest requires prohibition of causing actual bodily harm (e.g. fights causing ABH). |
Applied to explain limits of consent defence and to support that some consensual harmful acts remain unlawful. |
| R v. Brown [1994] 1 AC 212 |
Consent cannot be a defence to wounding/causing ABH for no good reason; identified exceptions (including ritual circumcision) where consent may legitimize harm. |
Discussed to show existing exceptions and to situate ritual circumcision as an identified exception; guided analysis of what constitutes a lawful consensual activity. |
| R v BM [2019] 1 QB 1 |
Refusal to create a new exception for body modification; established approach to consent and exceptions is judge-crafted and limited. |
Relied upon to show courts will not extend exceptions easily and to compare body modification to established exceptions like ritual circumcision. |
| McCarthy [2019] EWCA Crim 2202 |
(Decision on sentence following R v BM appeal) |
Referenced as the subsequent appellate decision on sentence in the BM context for comparative sentencing discussion. |
Court's Reasoning and Analysis
The court accepted that ritual/non-therapeutic male circumcision is an identified exception to the general rule that consent will not justify inflicting serious harm, but emphasised that exceptions have historically been qualified by identifiable standards or regulatory frameworks. The central question was where on the spectrum of practices a non-medical religious circumcision becomes unlawful despite parental consent.
The court found that a valid Route two (liability based on the manner of performance rendering the act unsafe and exposing the child to a significant and unnecessary risk of additional harm) exists in principle. However the court criticised the trial judge's Route two direction for lacking an explicit standard: inviting jurors to assess safety without specifying the benchmark risked them applying inappropriate medical standards.
The court held that the appropriate benchmark is the conduct of a "competent and careful non-medical circumciser." It concluded that expert evidence from hospital-based medical practitioners was not the right comparator and that evidence from experienced non-medical religious circumcisers would have been more appropriate, although neither party had adduced it at trial.
Despite these criticisms, the court analysed the evidence in this particular case and concluded that the Appellant's unauthorised administration of local anaesthetic (an offence to which he had pleaded guilty) was sufficiently far from the standard of a competent non-medical circumciser that, even if the jury had been directed by reference to that non-medical standard, they would have convicted. The court therefore found the Route two-based convictions safe.
On the sentence appeal the court determined that the trial judge erred in effect by producing an overall sentence that involved some double-counting: making the s.18, fraud and medicines sentences consecutive created overlap because the fraud and unauthorised medicines use substantially overlapped with the aggravating features of the s.18 offending. The judge appeared to have been influenced by the total number of procedures performed (541) rather than restricting sentence to the specific offences of conviction. Taking totality into account, the Court reduced the overall sentence.
Holding and Implications
Conviction Appeal: The appeal against conviction is dismissed. The court concluded that Route two liability is a permissible basis for s.18 conviction, that the correct comparative standard is that of a competent and careful non-medical circumciser, and that, on the facts of this case (notably the unauthorised administration of anaesthetic), the Appellant's Route two convictions are safe.
Sentence Appeal: The appeal against sentence is allowed. The court found the aggregate sentence of 9 years excessive due to overlap/double-counting and inappropriate reliance on the total number of procedures. The court quashed the existing s.18 sentences and replaced them so that the lead s.18 sentence is 6 years (concurrent as before) and ordered that all other sentences run concurrently with that sentence, producing an overall term of 6 years' imprisonment. All other ancillary orders were left unchanged.
Implications: The judgment confirms that (i) courts can convict for non-therapeutic religious circumcisions where the manner of performance exposes a child to significant and unnecessary risk (Route two), (ii) the correct comparator for Route two is a competent non-medical circumciser rather than hospital-based medical standards, and (iii) sentencing must avoid double-counting overlapping elements of multi-faceted offending; totality must be assessed with reference to the offences of conviction.