Cut circumcision from list of routine services, Saskatchewan MDs advised

The College of Physicians and Surgeons of Saskatchewan is asking family doctors to consider the physical risk to the patient and the legal risk to the physician before becoming involved in the routine circumcision of infants.

Figure. See you in court Photo by: Carole Lalonde

It warns that circumcision poses a greater risk of harm than benefit and could form the basis of lawsuits by circumcised adults. The college says physicians should perform circumcisions only when medically indicated or, in the case of religious and cultural reasons, after thorough discussion with parents.

“It's a bit of an awkward situation, and we simply suggest physicians get reliable advice from the [Canadian Medical Protective Association] about how they should structure the informed-consent process,” said Dr. Dennis Kendel, the college registrar.

About 27% of infant males in Saskatchewan are circumcised, one of the highest rates in the country. Kendel said most parents request the procedure because “daddy had it,” but many would not choose it if fully informed of the medical risks.

Benefits of circumcision may include a reduced incidence of urinary tract infections and a reduced risk of HIV/AIDS in adults. Risks may include bleeding, infection and a blocked urinary tract. “There are not too many areas in medicine where we undertake surgery based on culture and tradition,” says Kendel.

Dr. Joel Yelland, vice-president of the Saskatchewan Medical Association, says parents pressure FPs to perform circumcisions, but because of the medical and legal risks involved he cannot understand why FPs would give in.

Kendel says the threat of litigation is now producing “a great deal of sober second thought” among physicians. “It could have what we call ‘long-tail liability’ if this societal movement takes on more steam and more men become angry because they think they ought not to have been circumcised.” There are numerous Web sites opposing circumcision, including Doctors Opposing Circumcision (faculty.washington.edu/gcd/DOC) and Mothers Against Circumcision (www.mothersagainstcirc.org).

Rates of circumcision in Saskatchewan have dropped by about 10% since the procedure was delisted as an insured service in 1996. Today parents pay $50 to $100 to have their infants circumcised. Manitoba is the only province that still covers the procedure under its medicare plan. — Amy Jo Ehman, Saskatoon