Doctors plan to revisit circumcision issue

BY DERWIN GOWAN
Telegraph-Journal

The College and Physicians and Surgeons of New Brunswick will revisit the issue of circumcising infant males.

An item on the college's website says it received a request to take another look at the matter after the British Columbia College of Physicians and Surgeons published new guidelines.

The British Columbia college issued its new policy last year following a coroner's report on the death of five-week-old Ryleigh Roman McWillis, who bled to death following the operation in Penticton, B.C., in August 2002.

Dr. Ed Schollenberg, registrar of New Brunswick college, which regulates medical practice in the province, says the college's council didn't like the wording of the new British Columbia policy.

He said the New Brunswick college will await the outcome of a review by the Canadian Paediatric Society.

In the meantime, New Brunswick will stick with society's current policy in place since 1996.

Pending the outcome of its current review, the national paediatric society recommends against routinely circumcising male infants.

"The overall evidence of the benefits and harms of circumcision is so evenly balanced it does not support recommending circumcision as a routine procedure for newborns," says the current national guideline.

"When parents are making a decision about circumcision, they should be advised of the present state of medical knowledge about its benefits and harms. The decision may ultimately be based on personal, religious, or cultural factors."

The New Brunswick college noted "several valuable comments" in the new British Columbia policy, particularly the suggestion to require clear informed consent from both parents.

The new British Columbia policy states that infant male circumcision is "assumed to be legal if it is performed competently, in the child's best interest, and after valid consent has been obtained."

However, the British Columbia guideline states that circumcising baby boys for non-medical reasons presents ethical and human rights concerns, and that "parental preference alone" does not justify non-therapeutic intervention.

"You are not obliged to act upon a request to circumcise an infant, but you must discuss the medical evidence and the current thoughts in bioethics that dissuade you from performing this procedure. You must also inform the parents that they have the right to see another doctor."

"We weren't particularly fond of the way they worded their policy," Dr. Schollenberg said, describing the British Columbia document as too "philosophical" and "ambiguous" with not enough practical advice for practising doctors.

So, New Brunswick will stick with the Canadian Pediatric Society guideline pending further review.

"Our policy has tended to be to look to these national bodies . . . they're smart people, they tend to be a little less politically involved," Dr. Schollenberg said.

He said circumcising infant boys for non-medical reasons was already falling out of fashion at the time that he wound up his own paediatric practice in Winnipeg in 1987.

"It's dropped and dropped and dropped over the years . . . it used to be a medically insured service," he said.

Dennis Harrison, spokesman for the Association for Genital Integrity, a Canadian anti-circumcision lobby group, agreed in a telephone interview from Vancouver that the rate of non-therapeutic infant male circumcision is dropping in Canada - from 16.9 per cent of males born in Canada in 1999 to 13.9 per cent in 2003.

However, he said the national figures hide regional anomalies, especially on the East Coast.

Citing numbers from the association's website, he said that in the most recent fiscal year, 14.9 per cent of male New Brunswick newborns went under the knife compared to only 1.1 per cent in Nova Scotia.

The contrast widens in the rest of Atlantic Canada: 29.5 per cent on Prince Edward Island, none in Newfoundland and Labrador. The Quebec rate was 3.2 per cent.

Dr. Schollenberg questions these figures.

New Brunswick Medicare stopped paying for routine infant circumcision on Sept. 15, 1994, and Nova Scotia on Jan. 20, 1997. Dr. Schollenberg, questioned who is counting with no Medicare billing statistics.

Mr. Harrison said the Department of Health and Wellness provided the New Brunswick numbers.

The Nova Scotia data came from the Canadian Institute for Health Information Discharge Abstract Database.

Mr. Harrison said about 60 per cent of newborn American baby boys are circumcised. The average is in the 30% range in California but as high as 90 per cent in some midwestern states.

"When it comes down to it, this is incredibly cultural . . . there're always differences from one place to another," Dr. Schollenberg said.

"Social conformity seems to be at the root of it . . . studies have shown that the major factor is the attitude of the doctors," Mr. Harrison said.

"At the end of the day, this is not an issue that has come from anyone local having a problem," Dr. Schollenberg said, referring to the New Brunswick review. "Just realize that you're dealing with a cultural issue, not a medical one."