Thursday, 12 April, 2001, Letters
CIRCUMCISION IS NOT JUST A MANICURE
Margaret Somerville is a bioethicist and founding director of McGill
University's Centre for Medicine, Ethics and Law.
In her column of
March 31,  "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
understanding of the ethical and legal arguments relevant to
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
cases have even resulted in death -- and the serious pain involved,
circumcision removes healthy, erogenous tissue with specialized
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
Ford accuses me of
seeking to break the covenant that circumcision
constitutes for Jews by speaking against it. She also accuses me of
to marginalize religions that mandate circumcision by my suggesting
if circumcision were generally prohibited, it might be able to be
on the basis of a charter right to freedom of religion, for those people
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
for people's religious beliefs and practices (as I also believe
The freedom of
religion charter claim raises very complex issues about
parents' rights to impose their religious beliefs on their children (see
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
his bodily integrity.
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
discriminates on the prohibited ground of sex and, therefore,
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
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 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
and of the resulting open wound which is in contact with the child's
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
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
same has been alleged in the past, many Jewish people, including rabbis,
have expressed their dismay at such labeling.
Danes Call for an End to
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:
Article in "Politiken":
Friday, August 30, 2002
by Adrian Humphreys
College to review practice of
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.
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.
guess coincidence would be the term for it," said Dr. Van Andel.
to the mix now is this particular situation. Whether it will influence
the decision, I have no idea."
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.
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.
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.
autopsy on the baby was scheduled for yesterday, but the findings were
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
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.
is also difficult to identify any other domain of medicine in which
practice patterns stand in such stark contrast to research evidence."
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.
mounting body of medical evidence suggests the procedure is largely
unnecessary and the practice is in decline.
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
Friday, August 30, 2002
The growing consensus against
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
remember the war that waged in my own mind when my son was born in the
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 --
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
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
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
The neglect we tolerate
Children have no political power, so their needs and experiences are ignored
Saturday June 22, 2002
Read the article here:
The UK's most popular newspaper website
Wednesday May 12, 2004
?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.?