Circumcision is Assault, Ethicist Says

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Sharon Kirkey
Montreal Gazette, p. A9, October 18, 1997 (originally from Ottawa Citizen)

Ottawa - One of the country's leading medical ethicists says circumcision of baby boys if criminal assault and that doctors should stop doing it.

"It's a bodily wounding on a tiny infant that has given no consent itself, and it is not a medically necessary (procedure)," say Margaret Somerville, founding director of the McGill Centre for Medicine, Ethics and Law.

In a letter published in a recent issue of the New England Journal of Medicine, Somerville and Montreal physician David Alwin say it's time the "cloak of medicine" surrounding male circumcision was removed and the medical profession decided whether non-medical circumcision and research surrounding it should even be carried out.

In an interview, Somerville went farther and said society should question whether there is any rationale for cutting away a newborn baby boy's healthy foreskin.

The Montreal ethicist said she has decided, "gradually and with some reluctance," to enter the intensifying debate over the issue.

"I know you run a terrible risk of being thought to be anti-Semitic in talking against circumcision," Somerville said.

In the Jewish faith, circumcision is a religious ritual. It also has been practiced for centuries by Moslems. However, most circumcision in Canada are for non-religious reasons, according to the nonprofit Circumcision Information Resource Centre in Montreal.

"We have to start from the basic premise of the utmost respect for people's religious beliefs and traditions and rituals," Somerville said.

"But there's a point at which we also have the utmost duties to protect those unable to protect themselves. And sometimes that means we have to trespass on those other things."

Somerville says non-medical infant circumcision is technically criminal assault.

"(Infant male circumcision) is a wounding, and it's clearly a serious wounding - some kids die from this."

A recent study by researchers at the Hospital for Sick Children in Toronto found that circumcising a newborn without anesthetic - which is normal practice in hospitals across Canada - creates a lasting pain reflex. Children who were circumcised as infants showed significantly more pain when they received vaccinations.

"If you're really looking at something that is traumatic enough that you've got to use anesthetic to do it, should you really be doing that on a newborn baby when it's not needed for his health?" Somerville asked.

Circumcision, virtually unheard-of in Scandinavian countries and uncommon in Europe and Great Britain, is a largely North American phenomenon. Before the turn of the century, it was recommended as a way to curtail masturbation; later, doctors believed it would reduce the risk of urinary tract infections, sexually transmitted diseases and penile cancer.

Rates vary across Canada. In Newfoundland, the procedure is almost never done; in some Western provinces a majority of boys are circumcised.

The procedure involves cutting away the inner and outer layers of the foreskin. Minor complications, like bleeding and infection, occur in 5 to 10 percent of cases; in extremely rare cases, the procedure can result in damage to the penis, ranging from lacerations to permanent deformity, or, in even rarer cases, amputation.

Circumcision takes just minutes, "but there's no question it's painful, in case anyone thinks otherwise," said Robin Walker, chief of neonatalogy at the Children's Hospital of Eastern Ontario in Ottawa.

He is a member of a committee of the Canadian Paediatric Society that last year issued a statement saying there is no valid medical justification for routine infant male circumcision.

The only benefit the committee found was a reduced risk of urinary tract infection, a condition that affects only one to 2 percent of male infants and can be treated easily.

There was some evidence that circumcision can reduce the risk of penile cancer, a rare form of cancer that afflicts only 0.3 to 1.1 males per 100,000.

But ultimately, the procedure is justified only in rare cases, the committee found - for example, an abnormality of the foreskin that prevents urination.

"The short answer is because they're asked to," Walker said. "Certainly don't ask me to defend it. I don't do them. I will not do them. I don't do procedures that I don't consider to be medically indicated."

"But it's not just that parents request it. They often demand in very forceful terms that the baby be circumcised. I understand if it's a religious reason, that there is a clear reason why it would be very important to them. But where it is purely because dad had it or the brother had it or grandfather had it or we just want it, the emotions are very strong. People absolutely insist upon this."

In fact, even though most provinces have removed circumcisions from provincial health plans, parents are still willing to pay the $100 fee. De-listing, Walker said, had had virtually no effect on circumcision rates.

Many pediatricians try to discourage circumcision when they talk to parents, he said. But he added that it is not unethical for doctors to perform what is considered, in non-religious cases, a cosmetic procedure.

Those opposed to circumcision, however, say that doctors have no right to remove normal tissue from a healthy individual without the patient's consent.

"The people who are the most responsible and who are the least accountable are doctors, because they know better," said John Antonopoulos, president of the Circumcision Information Resource Centre.

He says the foreskin is a "normal, functional, healthy, helpful and erogenous" part of the penis that helps maintain the surface, texture and sensitivity of the glans.

Somerville says Canadians should re-examine male circumcision with the same "open eyes" that the nation used to assess female genital mutilation, a practice that is now banned in Canada.

Debate is also building within the Jewish community and has started to surface in mainstream Jewish publications.