Cut circumcision from list of routine services, Saskatchewan MDs advised

Dear Editor:

      The College of Physicians and Surgeons of Saskatchewan’s decision to ask doctors to refuse to perform non-therapeutic neonatal circumcision of male infants¹ is well taken.

      The Canadian Paediatric Society (CPS) advised in 1975 that "there is no medical indication for circumcision during the neonatal period."² Then, in 1996 the CPS recommended that "circumcision of newborns should not be routinely (i.e., in the absence of a medical indication) performed,"³ so the CPS actually is saying that circumcision of the newborn should not be performed period.

      The injury inherent in every male circumcision was described in great detail by John R Taylor, a Winnipeg pathologist, in 1996.⁴ Taylor reported new anatomical and histological examinations of the foreskin tissue. He found that the foreskin is heavily vascularized, innervated specialized mucosa with a structure that suggests an important role in human sexual response. He documented the amount of tissue lost to circumcision. Thus, the inherent injury is now well documented in the medical literature. Everyone has a legal right to bodily integrity. Non-therapeutic neonatal circumcision excises healthy functional tissue, thus violating bodily integrity and creates a cause of action.

      The Council on Scientific Affairs of the American Medical Association now describes male neonatal circumcision as a non-therapeutic procedure.⁵ Parents may not have the legal power to grant proxy consent for non-therapeutic procedures.⁶ If parents lack power to grant proxy consent for non-therapeutic procedures, then the most meticulous attention to informed consent requirements⁷ may be of no avail should a lawsuit occur.

      Kendel’s remarks about ‘long-tail liability’ are well-taken.⁸ One who is injured while yet a minor has a right to institute litigation to recover damages upon reaching the age of majority. Thus, a child injured as an infant in 2002 may institute litigation in 2020 and perhaps later.

      The danger of litigation is more than theoretical. A young man in the state of New York has instituted litigation in Federal Court to recover damages from the obstetrician who circumcised the man as an infant and the hospital where the circumcision was performed.⁹ The suit has survived a motion for dismissal and is moving to trial.

      Concern also has been expressed in other countries. Legato, in the United States, has called for a searching reexamination of circumcision of the newborn.¹⁰ Bates has sounded the alarm in Australia,¹¹ and Edge has done likewise in the United Kingdom.¹²

      In view of the gravity of the matter, one is surprised that other Canadian provincial colleges of physicians and surgeons have not acted to warn their doctors of the risks involved in the continued performance of non-therapeutic circumcision on minors.

George Hill
Executive Secretary
Doctors Opposing Circumcision
Suite 42, 2442 NW Market Street
Seattle, Washington 98107
USA
Web: http://www.doctorsopposingcircumcision.org/

References

1. Kendel, D. A. Caution Against Routine Circumcision of Newborn Male Infants (Memorandum to physicians and surgeons of Saskatchewan). Saskatoon: College of Physicians and Surgeons of Saskatchewan, February 20, 2002. Photocopy
2. Foetus and Newborn Committee. FN 75-01: Circumcision in the Newborn Period. CPS News Bull Suppl 1975; 8(2):1-2.
3. Fetus and Newborn Committee, Canadian Paediatric Society. Neonatal circumcision revisited . (CPS) Canad Med Assoc J 1996; 154(6): 769-780.
4. Taylor JR, Lockwood AP, Taylor AJ. The prepuce: specialized mucosa of the penis and its loss to circumcision. Br J Urol 1996;77:291-29.
5. Council on Scientific Affairs, American Medical Association. Report 10: Neonatal circumcision. Chicago: American Medical Association, 1999.
6. Somerville MA. Therapeutic and Non-Therapeutic Medical Procedures -- What are the Distinctions?Health Law in Canada 1981;2(4):85-9.
7. Reibl v. Hughes, [1980] 2 S.C.R. 880.
8. Ehman AJ. Cut circumcision from list of routine services, Saskatchewan MDs advised. CMAJ 2002; 167 (5):
9. Anonymous. Suing Over Circumcision: Man Says Lack Of Foreskin Hurts Sex Life. ABC News, 12 March 2001.
10. Legato MJ. Rethinking Circumcision: Medical Intervention, Religious Ceremony, or Genital Mutilation?J Gend Specif Med 2002;5(4):8-10.
11. Bates F. Males, medical mutilation and the law: some recent developments. 9 J Law Med 2001;9:68-75.
12. Edge PW Male circumcision after the human rights act 1998. 5 J Civil Liberties 2000;5: 320-337.