Fighting for Foreskin

News  The Medical Post (Toronto), Volume 37, Issue 29. Tuesday, 4 September 2001.

Alison DeLory

An Ontario doctor is crusading to have circumcision criminalized—just like female genital mutilation

If the only way to stop routine circumcision of male infants is to make it illegal, then Dr. Arif Bhimji is willing to fight to have the procedure criminalized.

Dr. Bhimji is part of the Association for Genital Integrity, a Canadian group advocating that section 268 of the Criminal Code of Canada—which bans female genital mutilation—be amended to include a ban on circumcision. To not do so, says Dr. Bhimji, is sexual discrimination.

We're challenging the law so it offers equal protection to males and females, says Dr. Bhimji, adding he feels a moral and ethical obligation to protect one of the most vulnerable sectors of society—male infants.

In Canada, under  External link section 268, doctors who perform female genital mutilation (FGM) are breaking the law and could face prison terms of up to 14 years. But Dr. Bhimji says certain forms of FGM, those involving mere nicks of the clitoris, are less physically and psychologically damaging than circumcision. If we say these are abhorrent, why say it's OK for males? asks Dr. Bhimji, who says he objects equally to female and male genital mutilation (a term he uses interchangeably with circumcision).

About 30 individuals and groups make up the  External link Association for Genital Integrity. They share the belief that it is unethical to remove a normal body part from a non-consenting individual.

The  External link Canadian Pediatric Society also recommends circumcision of newborns should not be performed, citing lack of medical evidence to support the procedure. Dr. Bhimji feels doctors, as medical practitioners, should follow the recommendation. But, he says, doctors take a paternalistic attitude toward circumcisions, and many remain ill-informed about the foreskin's anatomy and functionality.

When I was in med school in 1988 (Dr. Bhimji graduated from the  External link University of Saskatchewan in 1989 and now practises primarily occupational medicine in Concord, Ont.), I was told Circumcision is healthy; circumcision is cleaner,  says Dr. Bhimji. It wasn't until years later when a patient asked him about circumcision that Dr. Bhimji began his research. Saying he found no strong evidence to support circumcision, but plenty of evidence to suggest the foreskin is a sensual, innervated organ and that infants suffer pain during the procedure, he began speaking out against circumcision.

We have a medical obligation to do what's in the patient's best interest and to do no harm. The propensity for harm (due to complications from the surgery) is greater than the health benefit.

The Association for Genital Integrity doesn't want a total ban on circumcision, and would support it in cases of phimosis or balanitis. But Dr. Bhimji states as a medically required procedure, it would only be performed in less than 10% of male births. Estimates put the current rate of circumcision at about 25% of infant males in Canada.

He also speaks cautiously about the role of circumcision in religion, cognizant that certain groups, especially Jews and Muslims, consider it a sacred rite. It's not a religious argument. It's a medical issue, says Dr. Bhimji. In Canadian society, religion has its limitations. Muslims say if you have a thief, chop off his hand. Do we allow that to continue? asks Dr. Bhimji, himself a Muslim. Let's deal with it on an evidence-based level. Is it an ethical, medically necessary procedure for non-consenting adults? No.

The association applied to the  External link Court Challenges Program, a special fund that helps groups wanting to bring language and equality rights cases before the courts, for assistance. It was denied. As part of its response, in a letter dated March 30, the Court Challenges Program said the applicants did not demonstrate that section 236 of the Criminal Code provides inadequate protection to male infants from aggravated assaults involving male genitalia.

But the association is launching an appeal and if again unsuccessful, Dr. Bhimji says members will raise the necessary funds (about $47,000, he estimates) on their own. It has launched an aggressive letter-writing campaign (see  External link www.courtchallenge.com) targeting government, regulatory bodies, academic and human rights groups and others. The responses it has received have been polite but non- committal. According to Dr. Bhimji: No one is willing to answer the basic question being put forward as to whether it is ethical to remove a body part from an infant.

He wishes the provincial licensing bodies would take a clear position on the issue, but says they refuse. He's asked the provincial ministries of health to force the medical colleges to take a leadership position on circumcision, but they haven't done so.

Which leaves Dr. Bhimji and the association with no choice but to challenge the Criminal Code. It would be ideal not to go to court, says Dr. Bhimji, who's nonetheless willing to take his battle to the  External link Supreme Court of Canada if he must.

— Alison DeLory is a desk editor at the Medical Post.

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