OTTAWA CITIZEN, Ottawa, Ontario, Canada,
Friday, 17 October 1997.
Friday 17 October 1997
The Ottawa Citizen
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 circumcised.
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 indicated."
"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 want it, 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 procedure.
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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