College to review practice of circumcision
It was not prompted by baby's death, doctor says

Adrian Humphreys
National Post

Friday, August 30, 2002

A review of the practice of infant circumcision by the College of Physicians and Surgeons of British Columbia was not prompted by the surprising death last week of a five-week-old baby shortly after undergoing the procedure, the college spokesman says.

The issue was placed on the agenda of the doctors' regulatory board weeks ago, prompted by a sternly worded letter issued by Saskatchewan's college, warning physicians away from performing circumcisions, said Dr. Morris VanAndel, registrar of the B.C. college.

"I guess coincidence would be the term for it," said Dr. VanAndel.

"Added to the mix now is this particular situation. Whether it will influence the decision, I have no idea."

A five-week-old boy was released from Penticton Regional Hospital after a circumcision on Aug. 20, but his parents went back to talk to the doctor later that day with concerns about bleeding.

The situation worsened overnight, forcing them to rush the child back to hospital early the next day. The infant was flown to B.C. Children's Hospital in Vancouver. He died two days after the procedure.

The death is under investigation by the coroner's office, said Ian McKichan, regional coroner. The college is also investigating the circumstances of the case, said Dr. VanAndel.

An autopsy on the baby was scheduled for yesterday, but the findings were not available.

Rates of circumcision vary across Canada, from a high of 27.6% in Saskatchewan to a low of 0.6% in Newfoundland, according to the Saskatchewan college.

Dr. VanAndel warned, however, against letting emotion over the incident interfere with making a sound policy decision.

"Should all decisions be made on an emotional basis because a very tragic and most regrettable complication occurred? Every time somebody dies in a car accident, should we outlaw driving?" said Dr. VanAndel.

The College of Physicians and Surgeons of Saskatchewan sent a two-page letter to its members in February, titled Caution Against Routine Circumcision of Newborn Male Infants.

The letter says: "It is difficult to identify any other domain of medicine in which physicians would feel comfortable playing such a passive role in a decision pathway culminating in surgery.

"It is also difficult to identify any other domain of medicine in which practice patterns stand in such stark contrast to research evidence."

A spokesman for a Canadian anti-circumcision lobby group said the death may serve as a wake-up call for parents who treat the decision to circumcise their babies lightly.

"Infant circumcision is not medically necessary except in the rarest of situations. It should be remembered that all surgical procedures have risks, no matter how trivial they may seem at the time," said Arif Bhimji, a Toronto-area emergency room doctor who is a spokesman for the Association for Genital Integrity.

A mounting body of medical evidence suggests the procedure is largely unnecessary and the practice is in decline.

In 1996, the Canadian Pediatric Society published an extensive report in the Canadian Medical Association Journal that concluded, as an official stance, that routine circumcision is not recommended.

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