Intended for healthcare professionals

Letters

Guidelines on circumcision

BMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7110.750 (Published 20 September 1997) Cite this as: BMJ 1997;315:750

Legal position is unclear

  1. John D Dalton, Research archivista
  1. a NORM UK, Stone, Staffordshire ST1 0SF

Editor—In the news item by Linda Beecham the chairman of the General Medical Council standards committee, Professor Sir Cyril Chantler, assures readers that male circumcision is legal.1 The position is not, however, as clear as he claims. There is no doubt that parents have the power to give proxy consent for removal of an incompetent child's foreskin or any other tissue when removal is strictly necessary for therapeutic reasons. When the removal of tissue is not necessary for treating or diagnosing disease a parent only has the legal power of consent to a procedure which causes negligible risk and minimal burden.2 Male circumcision causes at least a 2% risk of clinically important complications,3 removes specialised tissue,4 and may be later regretted by the patient.5 It therefore meets neither the requirement for negligible risk nor that for minimal burden.

It is difficult to see how the GMC could escape the conclusion that it is impossible for doctors to obtain valid consent for the non-therapeutic circumcision of healthy infants. The claim that parents would turn to people “who lacked the skills to perform the procedure competently” is superficially attractive, but the therapeutic context does not render ethical surgery which has no therapeutic intent and which is performed without the consent of the patient. No matter how great the benefits of a procedure it is bad medicine if it is performed without consent.

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No longer recommended routinely in North America

  1. R G Buick, Consultant paediatric surgeonb
  1. b Birmingham Children's Hospital, Birmingham B16 8ET

Editor—I am concerned that the General Medical Council's guidelines on circumcision, as described in the news article by Linda Beecham, do not address the efficacy of this procedure when it is not clinically indicated.1 Since there are clinical indications for circumcision few would argue that it should be outlawed, but circumcision is also widely practised for religious, social, and pseudomedical reasons. Doctors and parents need guidance on the clinical and psychological implications of circumcision performed for non-medical reasons. The GMC's guidelines do not give this type of guidance or indicate where it can be found.

In North America, where circumcision is common, this question has been addressed by many organisations. Most recently, the Canadian Paediatric Society addressed the issue of whether neonatal circumcision of newborn male infants should be recommended routinely.2 Its discussions and conclusions are relevant to the question of male circumcision for non-medical reasons. Although the authors indicated that the position was “evenly balanced,” they recommended that “circumcision of newborns should not be routinely performed.” This is the official position of the Canadian Paediatric Society, and it is in keeping with previous statements and statements by the American Academy of Pediatrics. I understand that the Royal College of Paediatrics and Child Health is considering the matter. Both doctors and patients should be aware of current recommendations in North America.

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