Circumcision and cruelty to children

SIR,—Conscientous surgeons and paediatricians have listed the complications of neonatal circumcision both in this journal (Drs P M Fleiss and J Douglass (1 September, p 554)) and in other scientific papers. Without anaesthetic the operation in babies causes pain, intense and prolonged crying, air swallowing, vomiting sometimes followed by apnoea and sometimes permanent local complications. With anaesthetic the procedure should not be considered minor because of both local and anaesthetic complications. There is a small risk of death following circumcision, which means that there must be clear-cut immediate medical indications to justify that risk. Some arguments in favour of circumcision for long-term reasons smack of sophistry.

Drs Fleiss and Douglass dispassionately described a cruel practice. If circumcision without anaesthetic had not been sanctioned by authority, there would be grounds for criminal prosecution of the operator for inflicting unnecessary cruelty, and grounds (in the UK) for a care order removing the child from parental authority. Indeed, such action has been taken in the UK against parents who inflict bizarre (but less common) tribal mutilations on their young children. Doctors do not supervise or administer facial cicatrisation (with the appropriate sterile precautions and antibiotics) to help the child identify with his ancestral tribe. They do not remove toes because of a long-term risk of bunions, ingrowing toenails, or toe cancer.

If circumcision for non-medical reasons has died out in Scandinavia and is dying out in the UK, why has the practice persisted in parts of the UK and much of the United States? Do religious and social pressures perpetuate unnecessary circumcision (or any other unnecessary mutilation or operation)? It may be true that the stress to a child in a Moslem enclave in the UK would be great if he were excluded from being the same as his peers, and made a pariah from his group. If this is correct, cannot circumcision for religious (or social) reasons be delayed until 16 years when the young man can take the positive decision? He may then be determined to accept risk and pain for the sake of his beliefs. It just seems wrong for authority to continue to encourage certain parents to subject young children to unnecessary risk, pain, and distress, and for young children to be denied any protection from the law just because a malpractice is rather common.

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