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Some items on this page:
Calgary Herald: Circumcision is Not Just a Manicure
Danes Call for an End to Ritual Circumcision
National Post:
College to review practice of circumcision
National Post: The growing consensus against circumcision
The Guardian: The neglect we tolerate

http://www.guardian.co.uk/


Calgary Herald, Thursday, 12 April, 2001, Letters
 
>http://www.calgaryherald.com/

  CIRCUMCISION IS NOT JUST A MANICURE

Margaret A. Somerville
Margaret Somerville is a bioethicist and founding director of McGill University's Centre for Medicine, Ethics and Law.

In her column of March 31, [2001] "Ancient ritual does no harm," Catherine Ford provides a stunning example of ignorance regarding the current medical knowledge about infant male circumcision. She demonstrates a similar lack of understanding of the ethical and legal arguments relevant to circumcision that are set forth in my book, The Ethical Canary.

She is wrong when she says there is medical evidence the procedure does no harm to the child. Leaving aside circumcisions that go wrong -- and in rare cases have even resulted in death -- and the serious pain involved, circumcision removes healthy, erogenous tissue with specialized mechanical, protective and sexual functions.

But even if Ford were correct about the medical evidence, it would not justify circumcision. To justify, ethically and legally, carrying out surgery on persons unable to consent for themselves, the surgery must be necessary therapy and the least harmful and invasive way to obtain the therapeutic benefit. Routine circumcision fulfils neither of these requirements.

Ford accuses me of seeking to break the covenant that circumcision constitutes for Jews by speaking against it. She also accuses me of wanting to marginalize religions that mandate circumcision by my suggesting that, if circumcision were generally prohibited, it might be able to be justified on the basis of a charter right to freedom of religion, for those people for whom it is a religious obligation.

In other words, I'm damned if I speak against it (as I believe ethically I must) and I'm damned if, in doing so, I act on the basis of a deep respect for people's religious beliefs and practices (as I also believe ethically I must).

The freedom of religion charter claim raises very complex issues about parents' rights to impose their religious beliefs on their children (see the Sheena B case, Supreme Court of Canada). And such a right is in conflict with the child's charter right to security of his person and protection of his bodily integrity.

Ford obviously does not understand the legal basis of the charter challenge to circumcision that is based on the Criminal Code prohibition on female genital mutilation. The argument is that in passing a law to protect the bodily integrity of girls and not giving similar protection to boys, the law discriminates on the prohibited ground of sex and, therefore, is unconstitutional.

The aim is certainly not to wipe out the protection of genital integrity given to girls, but to have a respectful discussion of what we owe to boys in terms of protecting them. No reasonable, properly informed person, including rabbis who strongly support infant male circumcision, believes it is like a manicure, as Ford describes it.

Ford might like to consider that the reason the baby was so quiet after the procedure was he was in a state of shock. The serious pain of circumcision, and of the resulting open wound which is in contact with the child's acid urine for about a week, is a matter of common sense.

There is also medical evidence of the impact of the pain, with possibly life-long effects. We can speak of a human right not to have pain unjustifiably inflicted on us, and this includes children. The fact that circumcision has such important religious significance makes it an extraordinarily difficult and sensitive issue to discuss. But sometimes it is unethical to avoid such discussions, which must be carried out in an atmosphere of deep mutual respect.

I was not sure whether Ford was implying that my statements were anti-Semitic. But if she were, she might be interested to know that when the same has been alleged in the past, many Jewish people, including rabbis, have expressed their dismay at such labeling.

Margaret A. Somerville,
Montreal, Que.

 

Danes Call for an End to Ritual Circumcision
November 20, 2002

The newly-appointed head of the Danish Council of Ethics, Dr. Ole Hartling, has called for an end to the ritual circumcision of boys: >http://www.courtchallenge.com/news/dagmed1.html Article in "Politiken": >http://www.courtchallenge.com/news/politik1.html

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 National Post
Friday, August 30, 2002

by Adrian Humphreys

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

                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 Van Andel, registrar of the B.C. college.

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

                "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. Van Andel.

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. Van Andel 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. Van Andel. [To think people with such faulty reasoning are making life and death decisions on our healthcare!]

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.

Copyright  2002 National Post

 

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 National Post
Friday, August 30, 2002
Jackie Smith

The growing consensus against circumcision

        Just 30 years ago, male circumcision was all the rage; as many as 90% of boys in the United States, 70% of those in Australia, 48% in Canada and 24% in the United Kingdom were circumcised (often without any anesthesia).

I remember the war that waged in my own mind when my son was born in the 1980s.

I had no religious reasons for choosing circumcision; I wasn't trying to guard against "unhealthy masturbation," as early proponents of circumcision were. I didn't care if he looked like dad, as some parents do. I wanted to know only one thing: What would be best for him -- medically.

If he wasn't circumcised, would I be responsible for increasing his chances of urinary tract infections and sexually transmitted disease, as some physicians had suggested? Would it mean he might need the operation later in life, when circumcision is more uncomfortable, not to mention unpleasant?

What if he had the operation and got an infection? What if the knife slipped? How would I live with myself?

More important, how would he live with himself?

It's the nature of parenting to always think, "What could I have done better?" So once I made a decision I worried over whether it was the right one. Like all parents, I tried to act in the best interests of my child.

When the Canadian Pediatric Society (CPS) reviewed the medical literature and came out against routine circumcision in 1996, I thought the matter was settled. The CPS looked at the effects of newborn circumcision on the rate of urinary tract infections, sexually transmitted diseases, cancer of the penis, penile problems, and decided the practice was inadvisable. This was in line with a recommendation made earlier by its Fetus and Newborn Committee and with 1971 and 1975 recommendations of the American Academy of Pediatrics.

Nevertheless, debates about the ethics of circumcision remain unresolved because of its connection to religion and culture -- because medical studies sometimes turn up different results, and because parents do think their kids should look like dad.

Still, I believe a consensus against circumcision is steadily emerging. In this new era of patient rights, circumcision has come to seem like an anachronism. Among doctors, there is a greater emphasis on informed decision-making, the limits on parents' rights to make decisions about their kids' health and the  rights of children to be protected from parents who make wrong decisions. Even some adult men who were unnecessarily circumcised as children are asserting their rights to restitution. And since the balance of medical evidence suggests those who oppose circumcision have the facts on their side, doctors are increasingly refusing to perform circumcisions.

Complications from bleeding, amputation, renal failure, sepsis and death are powerful incentives to stop.

With the death of an infant in B.C., possibly as a result of circumcision and currently under coroner's investigation, there will be more questions of circumcision's benefits and risks -- with a more pronounced focus on the latter.

Parents who opt for circumcision must, as a matter of both law and morals, make their decision based on the principle of respect for the rights and best interests of their child, according to the available information concerning risks and benefits. The death of the Kamloops baby may bring new awareness about the risks of circumcision (though the baby's death may ultimately turn out to have arisen from something far more complicated than a botched circumcision).

Indeed, the media coverage of the incident may speed circumcision for non-religious reasons into the dustbin of medical practice -- alongside many other once-popular procedures, such as the removal of the ovaries for hysteria, tonsillectomy for a sore throat, lobotomy for mental retardation, etc. In a few years, looking like dad or wanting to keep a boy "clean" may no longer be legally legitimate rationales for circumcision. It's about time they weren't. Parents who have had their kids circumcised can't be faulted for doing what they thought was right. But it is unethical to continue a practice that is no longer medically defensible and could harm our kids.

Copyright  2002 National Post

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The neglect we tolerate
Children have no political power, so their needs and experiences are ignored

Judith Williamson
Saturday June 22, 2002

Read the article here: >The Guardian
The UK's most popular newspaper website
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Being Brenda
Wednesday May 12, 2004
The Guardian

?They were meant to show that gender was determined by nurture, not nature - one identical twin raised as a boy and the other brought up as a girl after a botched circumcision. But two years ago Brian Reimer killed himself, and last week David - formerly Brenda - took his life too. Oliver Burkeman and Gary Younge unravel the tragic story of Dr Money's sex experiment.?

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