Is infant male circumcision an abuse of the rights of the child? No

Kirsten Patrick has fulfilled her duty to defend an indefensible practice about as well as anyone could with the scant and dubious evidence that supports the position that she has been assigned to defend.¹ Her claims, however, should be carefully examined. Space permits examining only a few of her claims.

1. Patrick states: “If competently performed, circumcision carries little risk.” This conditional statement contains a condition that is not often met. The operation frequently is assigned to the most junior operator available and is frequently botched.[2] Complications include hemorrhage, infection, and mutilation.² Death may occur from bleeding^2,3 or infection.^2,4 Mutilations may require gender reassignment.[2,5] How much risk does one need to reject a non-therapeutic operation?
2. Patrick states: “The medicalisation of male infant circumcision in some countries in the 1940s and 1950s followed from a widespread belief that it reduced the incidence of urinary tract infections.”¹ This is erroneous. Male neonatal circumcision was not thought to reduce urinary tract infection (UTI) until the publication of Wiswell’s curious report in 1986.⁶
3. Patrick states: “Male circumcision in a relatively high risk population gives protection from HIV that is equivalent to what a vaccine of moderate efficacy would have achieved. This absurd statement actually was first made by Bertrand Auvert in his hyperbolic advocacy of male circumcision. Others point out that these claims of the efficacy of circumcision in preventing HIV infection are wildly overstated.^7,8
4. Patrick states: “No robust research exists examining the long term psychological effects of male infant circumcision.” Patrick cannot see the forest because she is focusing on the trees. In reality the evidence of psychological harm is under her nose in the voluminous and argumentative medical literature. Men injured by circumcision and who have lost a body part have a need to grieve that loss.[9] The failure to grieve the loss puts men in denial. They seek to justify their loss. Circumcised men who are doctors use the medical literature to justify their loss.¹⁰ This results in a voluminous, confused, and chaotic literature as other doctors refute the fantasy claims of circumcised doctors.¹¹ These head-to-head counterclaims by Hinchley and Patrick are a microcosm of that ceaseless emotion-driven debate and a symptom of the inherent psychological injury of male neonatal circumcision.
5. Patrick states: “Male circumcision is not illegal anywhere in the world.” In actuality male circumcision is illegal in Finland as a result of a court decision.¹² Also South Africa’s new Children’s Act makes the circumcision of boys under 16 unlawful except for medical or religious reasons.

Patrick’s dubious case relies on myths, hyperbolic claims, and falsehoods for support. She represents the fanciful language and arguments of wounded circumcised male doctors in her report. Her paper actually is a powerful statement against medically unnecessary non-therapeutic neonatal male circumcision.

George Hill

Vice-President for Bioethics and Medical Science

Doctors Opposing Circumcision

Web: http://www.doctorsopposingcircumcision.org

References

1. Patrick K. Is infant circumcision an abuse of the rights of the child? No. BMJ 2007;335:1181.
2. Williams N, Kapila L. Complications of circumcision. Brit J Surg 1993;80:1231-6.
3. Newell TEC. Judgement of inquiry into the death of McWillis, Ryleigh Roman Bryan. Burnaby, B.C.: British Columbia Coroner's Service, Monday, 19 January 2004. Available at http://www.doctorsopposingcircumcision.org/pdf/BCcoroner_2004.pdf
4. Paediatric Death Review Committee: Office of the Chief Coroner of Ontario. Circumcision: a minor procedure? Paediatr Child Health 2007;12(4):311-2 Available at http://www.doctorsopposingcircumcision.org/pdf/Cairn_2007.pdf
5. Gearhart JP, Rock JA. Total ablation of the penis after circumcision with electrocautery: a method of management and long-term followup. J Urol 1989;142(3):799-801.
6. Wiswell TE. Circumcision and urinary tract infections. Pediatrics 1986;77:267-8.
7. Van Howe RS, Svoboda JS, Hodges FM. HIV infection and circumcision: cutting through the hyperbole. J R Soc Health 2005;125(6):259-65.
8. Garenne M. Male circumcision and HIV control in Africa. PLoS Med 2006;3(1):e78. Available at http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1...
9. Maguire P, Parks CM. Coping with loss: surgery and loss of body parts. BMJ 1998;316(7137):1086–8. Available at http://www.bmj.com/cgi/content/full/316/7137/1086
10. Goldman R. The psychological impact of circumcision. BJU Int 1999;83(Suppl. 1): 93–103. Available at http://www.blackwell-synergy.com/doi/abs/10.1046/j.1464-410x.1999.0830s1...
11. Hill, George. The case against circumcision. J Mens Health Gend 2007;4(3):318-23.Available at http://www.doctorsopposingcircumcision.org/pdf/Hill_2007.pdf
12. Court rules circumcision of four-year-old boy illegal. Helsingin Sanomat, Helsinki, Monday, August 7, 2006. Available at http://www.hs.fi/english/article/Court+rules+circumcision+of+four-year-o....

Competing interests:
None declared