Legal Position is Unclear (letter)

BMJ, Volume 315, Page 750. Saturday, 20 September 1997.

John D Dalton
Research Archivist, NORM UK, Stone, Staffs. ST15 0SF

GUIDELINES ON CIRCUMCISION

Lawfulness of Circumcision is Unclear

EDITOR- In the news item by Linda Beecham the chairman of the General Medical Council standards committee, Professor Sir Cyril Chantler, assures readers that male circumcision is legal¹. The position is not, however, as clear as he claims. There is no doubt that parents have the power to give proxy consent for removal of an incompetent child's foreskin or any other tissue when removal is strictly necessary for therapeutic reasons. When the removal of tissue is not necessary for treating or diagnosing disease a parent only has the legal power of consent to a procedure which causes negligible risk and minimal burden ². Male circumcision causes at least a 2% risk of clinically important complications³, removes specialised tissue⁴, and may be later regretted by the patient⁵. It therefore meets neither the requirement for negligible risk nor that for minimal burden.

It is difficult to see how the GMC could escape the conclusion that it is impossible for doctors to obtain valid consent for the non-therapeutic circumcision of healthy infants. The claim that parents would turn to people who lacked the skills to perform the procedure competently is superficially attractive, but the therapeutic context does not render ethical surgery which has no therapeutic intent and which is performed without the consent of the patient. No matter how great the benefits of the procedure it is bad medicine if it is performed without consent.

References

Beecham L. GMC issues guidelines on circumcision. BMJ 1997; 314:1569 (31 May). (Link to www.bmj.com)
Nuffield Council on Bioethics. Human tissue: ethical and legal issues. London: Nuffield Council on Bioethics, 1995.
Williams N, Kapila L. Complications of circumcision. Br J Surg 1993;80: 1231-6.
Taylor JR, Lockwood AP, Taylor AJ. The prepuce: specialised mucosa of the penis and its loss to circumcision. Br J Urol 1996; 77: 291-5.
Warren JP, David Smith P, Dalton JD, Edwards GR, Foden M, Preston R et al. Circumcision of children. BMJ 1996; 312: 377.

Citation:

Dalton JD. Legal Position is Unclear (letter). BMJ. 1997-09-20;315:750.

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