New England Journal of Medicine, Volume 337, Page 568. Thursday, 21 August 1997.
New England Journal of Medicine, Volume 337, Page 568. Thursday, 21 August 1997.
Correspondence
To the Editor:
The study by Taddio et al. (April 24 issue)1 raises several troubling questions. First, if neonatal circumcision is not undertaken for medical reasons, is it ethical to conduct medical research on it? In the vast majority of cases, circumcision is done for religious or cultural reasons. The Canadian Paediatric Society reviewed the literature extensively and concluded that any small medical benefits do not outweigh the risks and that neonatal circumcision should not be routinely performed.2 Moreover, neonatal circumcision is done without the consent of the subject, removes healthy tissue with a unique anatomical structure and function, and leads to differences is adult sexual behavior.3
Circumcision can be deeply connected with religious belief, and any interference with this requires profound consideration and justification. We need, therefore, to address the issue directly and end the persistent effort to find a medical rationale for circumcision by removing the cloak of medicine from this procedure. Should nonmedical infant circumcision or research involving it be carried out, and if so, should it be conducted by physicians, and under what conditions?
Second, assuming that is was ethically acceptable for Taddio et al. to undertake this study, was it ethical for them to include in it a group of infants circumcised without anesthesia? Generally accepted principles governing the ethics of research require clinical equipoise4 – that is, before a randomized trial can be undertaken, the generally accepted medical opinion must be that no one treatment is superior to another, and the researchers must share this opinion. In this case, was there clinical equipoise at the outset of the study?
McGill Centre for Medicine, Ethics, and Law, Montreal, QC H3A 1W9, Canada
St. Mary's Hospital, Montreal, QC H3T 1M5, Canada
Abstract] Neonatal circumcision revisited. Can Med Assoc J 1996; 154:769-80. Abstract]The Circumcision Information and Resource Pages are a not-for-profit educational resource and library. IntactiWiki hosts this website but is not responsible for the content of this site. CIRP makes documents available without charge, for informational purposes only. The contents of this site are not intended to replace the professional medical or legal advice of a licensed practitioner.
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