Dutch medical alliance moves to change thinking on male circumcision
BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c2987 (Published 07 June 2010) Cite this as: BMJ 2010;340:c2987All rapid responses
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I welcome the policy response from the alliance of doctors in the
Netherlands concerning the circumcision of male children.
Over the last 14 years I have brought this matter to the attention of
all the appropriate authorities in Great Britain and Northern Ireland,
following my son's attempting suicide due to the lack of understanding of
the trauma which may follow this surgery and my own ignorance.
When I learnt of the harm caused by male circumcision I was
distraught that I had not known enough to protect my child and established
a charity in Nothern Ireland to prevent what had happened to him
happeniing to any other children.
It is very hard for parents to realise that they have harmed their
child but I have had to come to terms with the fact that I did not know
enough to protect him.
Hopefully now the GMC, BMA and the Uk Law Commission will protect
male children as they do female as otherwise they are guilty of gender
discrimination. My family may then be able to start to come to terms with
what has happened and live in a society where our pain is at least
recognised and were this practice is no longer acceptable.
Competing interests:
director of the National organisation Circumcision Information Resource Centre of Northern Ireland
Competing interests: No competing interests
I welcome the principled statement by the Dutch Medical Association
and their colleagues advocating an end to ritual circumcision. Without the
caveat of religious privilege, a debate about whether or not to surgically
interfere with the normal genitalia of little children would be largely
unnecessary.
There is no reason for gender discrimination when considering child
protection. Clinically unnecessary surgical excision of normal genital
skin violates a child's human right to an intact body and to be protected
from harm [1]
In 2007, Sorrells et al [2] demonstrated that circumcision ablates
the most sensitive parts of the male penis. There is a risk of further
harm [3] when the operation goes wrong. This is sad enough when the
circumcision was considered clinically necessary; it is tragic when the
operation was done for reasons of conforming to the parents’ religious or
cultural views.
Many children do not later share their parents' beliefs or even their
cultural values. The bodies of children must be protected from those who
would brand them when they are too young to either consent or object. This
protection must extend to their genitalia or it is no protection at all.
All intervention carries a degree of risk. This is why surgery should
only be contemplated where there is a potential for greater good than
harm, particularly on non-consenting infants to whom society owes a duty
of care and protection. This basic principle ordinarily guides our day to
day practice. Were it not for the demands of traditional religious
privilege it would not be up for discussion.
In January 2010, The SMF approached the doctors' regulatory body in
the UK, the General Medical Council (GMC), asking for them to reconsider
their stated non-position on Ritual male circumcision [4] and [5]. The
first principle of GMC guidance is 'Make the care of your patient your
first concern'. With regard to ritual non-therapeutic circumcision, we
were advised by the GMC that they had no immediate plans to amend their
current guidance.
It is time that both the GMC and the BMA followed the Dutch Medical
Association's excellent example of putting patient welfare ahead of the
varied chosen beliefs of their parents. Legislation should accompany this
to prevent all non-therapeutic surgery on non-consenting children. And
let's call it what it is: Non-therapeutic excision of the foreskin.
[1] UN Convention on the Rights of the Child 1989
http://www2.ohchr.org/english/law/crc.htm
[2] Morris L Sorrells et al, Fine-touch pressure thresholds in the
adult penis BJUI 2007; 99: 864-869.
(3) Williams N, Kapila L. Complications of circumcision. Brit J Surg
1993;80:1231-6.
[4] Circumcision of Male Children for Religious or cultural reasons
http://www.gmc-uk.org/guidance/ethical_guidance/personal_beliefs.asp
[5] Ritual Circumcision Letter to the GMC March 2010
http://www.secularmedicalforum.org.uk/index.php?subject=resources
Competing interests:
I co-ordinate the Secular Medical Forum (SMF) in the UK. http://www.secularmedicalforum.org.uk
We campaign for equality of care for all patients irrespective of their own or their doctors' own personal beliefs.
Competing interests: No competing interests
Putting children first
As a paediatrician I have seen many children with complications (early and late) secondary to 'routine' neonatal circumcision including circumcisions by medical practitioners of infants with hypospadias. Some have had to undergo painful procedures to treat complications. I have seen very few children who have had any problems related to their not being circumcised and none who have had to have circumcision as a therapeutic procedure.
In the absence of systematic surveillance and reporting procedures to follow-up infants who have been circumcised to see if there are or are not secondary problems, those who advocate circumcision as harmless or 'safe' are giving opinions without data.
It would be inconceivable for a new intervention to be adopted without careful study of outcome data including randomised controlled trials and an adverse event reporting process. Why a lesser level of evidence should be accepted for an old cultural practice being dressed up as a 'preventative health' measure is a mystery to me.
I congratulate the Dutch medical community on their stand. I look forward to a time when the rights and welfare of infants in Australia are also advocated for as unequivocally
Rod McClymont
Paediatrician
Bathurst,
Rural Australia
Competing interests:
None declared
Competing interests: No competing interests