Circumcising Baby Boys 'Criminal Assault'

Friday 17 October 1997

Circumcising baby boys 'criminal assault'
Ethicist says society must consider ban

Sharon Kirkey

One of the country's leading medical ethicists says circumcision of
baby boys is criminal assault and that doctors should stop doing it.

"It's a bodily wounding on a tiny infant that has given no consent
itself, and it is not a medically necessary (procedure)," Dr. Margaret
Somerville, founding director of the McGill Centre for Medicine,
Ethics and Law, said in an interview yesterday.

And in a lead letter published in a recent issue of the prestigious
New England Journal of Medicine, Dr. Somerville and Montreal physician
David Alwin say it's time the "cloak of medicine" surrounding male
circumcision was removed.

She said the medical profession must decide whether non-medical
circumcision and research surrounding it should even be carried out.

In an interview, Dr. Somerville went further and said society should
start questioning whether there is any rationale for cutting away a
newborn baby boy's healthy foreskin.

"We as a society have to decide" whether to stop circumcisions, Dr.
Somerville said.

The Montreal ethicist has decided, "gradually and with some
reluctance," to enter the intensifying debate over routine,
non-medical male circumcision.

"I know that you run a terrible risk of being thought to be
anti-Semitic in talking against circumcision," Dr. Somerville said.
(In the Jewish faith, circumcision is a religious ritual, and one
which almost all Jews follow. It has also been practised for centuries
by Muslims; however, most circumcisions in Canada are for
non-religious reasons, according to the Circumcision Information
Reference Centre in Montreal.)

"We have to start from the basic presumption of the utmost respect for
people's religious beliefs and traditions and rituals. I think we've
had far too little respect for a lot of those," Dr. Somerville said.

"But there's a point at which we also have the utmost duties to
protect those unable to protect themselves. And sometimes that means
that we have to trespass on those other things."

Dr. Somerville says non-medical infant male circumcision is
technically criminal assault.

"It's a wounding, it's clearly a serious wounding -- some kids die
from this -- and the person hasn't given any consent themselves."

A recent study by researchers at the Hospital for Sick Children in
Toronto found that circumcising a newborn without first administering
any painkillers -- which is normal practice in hospitals across
Canada, including Ottawa-Carleton -- creates a lasting pain reflex in
children.  Infants who were circumcised showed significantly more pain
when they received their childhood vaccinations.

"If you're really looking at something that is traumatic enough that
you've got to use anesthetic to do it, should you really be doing that
on a newborn baby when it's not needed for his health or health care?"
Dr. Somerville asked.

"And should doctors be doing it? Is this an ethical practice of
medicine? I don't think they should do it. I've reluctantly come to
that conclusion."

Circumcision, which is uncommon in Europe and Great Britain, is a
largely North American phenomenon. In non-religious cases, it was
considered a way to significantly reduce the risk of urinary tract
infections, sexually transmitted diseases and penile cancer.

Rates vary across Canada. In Ottawa, about one boy in two is
circumcised; in Newfoundland, the procedure is almost never done.

In some western provinces, including Alberta, a majority of boys are

The procedure involves cutting away the inner and outer layers of the
foreskin. Minor complications, such as bleeding and infection, occur
in between five to 10 per cent of cases; in extremely rare cases, the
procedure can result in damage to the penis, ranging from lacerations
to permanent deformity or, in even rarer cases, amputation.

Circumcision takes just minutes, "but there's no question it's
painful, in case anyone thinks otherwise," says Dr. Robin Walker,
chief of neonatology at the Children's Hospital of Eastern Ontario.

He is a member of a special committee of the Canadian Pediatric
Society that last year issued a statement saying there is no valid
medical reason to justify routine infant male circumcision.

The only benefit the committee found was a reduced risk of urinary
tract infection, a condition that affects only one to two per cent of
male infants and can be easily treated.

There was some evidence that circumcision can reduce the risk of
penile cancer, an extremely rare form of cancer that afflicts only 0.3
to 1.1 males per 100,000.

But ultimately, the committee found no real medical reason to justify
male circumcision, except in rare cases -- for example, an abnormality
of the foreskin that prevents urination.

So why do doctors do it?

"The short answer is because they're asked to," Dr. Walker said.

"Certainly don't ask me to defend it.  I don't do them.  I will not do
them.  I don't do procedures that I don't consider to be medically

"But it's not just that parents request it," Dr. Walker said.  "They
often demand in very forceful terms that the baby be circumcised.

"I understand if it's a religious reason, that there is a clear reason
why it would be very important to them.  But where it is purely
because dad had it or the brother had it or grandfather had it or we
just wantit, the emotions are very strong.  People absolutely insist
upon this."

In fact, even though most provinces, including Ontario, have removed
circumcisions from provincial health plans, parents are still willing
to pay the $100 fee.  De-listing, Dr. Walker said, has had virtually
no effect on circumcision rates.

Dr. Walker said many pediatricians try to discourage circumcision when
they talk to parents.  But he said it's not unethical for doctors to
perform what he says is considered, in non-religious cases, a cosmetic

But anti-circumcision advocates say doctors have no right to remove
normal tissue from a healthy individual without their consent.

"The people who are the most responsible and who are the least
accountable are doctors because they know better," says John
Antonopoulos, president of the Circumcision Information Resource
Centre, a non-profit group in Montreal.

He says the foreskin is a "normal, functional, healthy, helpful and
erogenous" part of the penis that helps maintain the surface, texture
and sensitivity of the glans.

More and more men who were circumcised as infants are "feeling a sense
of resentment that their right to their normal body, given that
nothing was diseased, nothing needed to be removed, was violated, and
permanently," he said.

He said the debate isn't just a men's issue, or one of "men
boo-hoo-hooing over their penises."

In fact, one of the key people behind the anti-circumcision movement
in the U.S. is a former nurse who was fired when she started giving
parents candid, up-to-date information on circumcisions.  Debate is
also building within the Jewish community and has started to surface
in mainstream Jewish publications.

Dr. Somerville says Canadians should re-examine male circumcisions
with the same "open eyes" that the nation used to assess female
genital mutilation, a practice that is now banned in Canada.

"Maybe we have to have some sort of consultation to decide that this
is not on," she said.

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