EDITOR--The new British Medical Association (BMA) guidance on circumcision ¹ replaces a sadly outmoded 1996 guidance. It provides new and welcome information that doctors need to comply with court decisions regarding child circumcision,² the Human Rights Act 1998,³ and new consent regulations promulgated by the General Medical Council.⁴

      The guidance is not perfect, however. The BMA disingenuously claims that it does not know if male neonatal circumcision (excision of healthy functional erogenous tissue from a non-consenting minor) is a violation of human rights.¹ The Norwegian Council for Medical Ethics, however, suffers from no such disability and has forthrightly advised that the circumcision of male children is an offence against the child’s human rights, and, therefore, an unethical medical practice.⁵ The BMA guidance also fails to adequately address concerns that circumcision of children under 16 years of age may be an offence under the Children and Young Person’s Act 1933.⁶

      The guidance fails, moreover, to give proper weight to the risks incurred with child circumcision, even when performed in a hospital setting.⁷ Although rare in hospital, children who are circumcised are exposed to risk of infection, loss of blood, penile mutilation, or penile necrosis. There is even risk of death.⁸ Given the lack of medical value, the exposure of children to such unnecessary risk shows poor medical judgment and is unethical.

      Nature put the prepuce there for a purpose. The BMA guidance fails to give adequate weight to new findings regarding the physiological value and utility of the prepuce in protection against disease, and in sexual intercourse.⁹¹⁰ Moreover, circumcision recently has been shown to contribute to erectile dysfunction,¹¹¹² but no mention is made of these findings.

      The BMA has failed to adequately recognize that the child and his parents are separate persons - each with his own set of rights. The child will not necessarily adopt his parents’ religious views, so he should be protected from non-therapeutic circumcision until he is of age to decide for himself.

      The BMA guidance on circumcision is a welcome and needed step forward, but more work remains to be done to fully protect the bodily and genital integrity of male children.

Very truly yours,

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

References:

• Committee on Medical Ethics. The law & ethics of male circumcision - guidance for doctors. London: British Medical Association, 2003.
• Re J [2000] 1 FCR 307.
• Human Rights Act 1998, HMSO, London.
• General Medical Council. Seeking patients' consent: the ethical considerations. London: General Medical Council, 1998.
• Gulbrandsen P. Rituell omskjæring av gutter. [Ritual circumcision of boys.] Tidsskr Nor Lægeforen [Journal of the Norwegian Medical Association] 2001;121(25):2994.
• Edge PW. Male circumcision after the human rights act 1998.J Civil Liberties 2000;5:320-337.
• Williams N, Kapila L. Complications of Circumcision.Brit J Surg 1993; 80: 1231-6.
• Jason Proctor. Totally unexpected' death of baby probed.The Province, Vancouver, British Columbia, Thursday, 29 August 2002.
• Fleiss P, Hodges F, Van Howe RS. Immunological functions of the human prepuce.Sex Trans Inf 1998;74:364-367.
• Cold CJ, Taylor JR. The prepuce.BJU Int 1999;83 Suppl. 1:34-44.
• Coursey JW, Morey AF, McAninch JW, et al.Erectile function after anterior urethroplasty.J Urol 2001;166(6):2273-6.
• Fink KS, Carson CC, DeVellis RF. Adult Circumcision Outcomes Study: Effect on Erectile Function, Penile Sensitivity, Sexual Activity and Satisfaction.J Urol 2002;167(5):2113-2116.

Competing interests:   None declared