Sask. college wants circumcision rates reduced

MDs should know they can refuse to perform procedure

By Deana Driver

Regina - Saskatchewan's College of Physicians and Surgeons wants doctors to reduce the province's high rate of circumcisions.

If a procedure has shown little evidence of expected benefit and there's a recognized risk of surgical complications, "it would generally be considered imprudent if not improper for a surgeon to perform such a surgical procedure," said a memo to physicians from the college registrar, Dr. Dennis Kendel.

The Canadian Pediatric Society has cautioned against routine circumcision for the past 25 years, but that has not drastically affected the rate of circumcision in Saskatchewan where 27.6% of newborn males were circumcised in 2000/01.

Even though circumcision became a non-insured service in 1996, the rate dropped only moderately over the past five years, said the memo.

In contrast, Nova Scotia's rate is 1.5% of male infants and Newfoundland/Labrador's rate has dropped to 0.6%.

The fact the rate of circumcision remained high despite the evidence "generally means the indications of optimal surgery are very unclear," said Dr. Kendel.

The college will implement an education program to reduce the high rate of circumcisions in the province, beginning with Dr. Kendel's memo. It reminds physicians they have a duty to inform parents of the risk and lack of benefits of the procedure and that they may refuse to perform the procedure just as they would other requested medical acts they regard to be inappropriate.

"They aren't obligated to carry out a procedure simply because parents want it done," said Dr. Kendel.

If religious beliefs are stated as the reason for wanting the surgery performed, the physician should obtain a parental signature on a consent document "which clearly stipulates the circumcision in question is not medically indicated and is being performed in accordance with parental religious practices. In such cases, physicians would be prudent to consult with and seek advice from the Canadian Medical Protective Association before proceeding," said Dr. Kendel's memo.

© The Medical Post 2002