Intended for healthcare professionals

Rapid response to:

News Roundup [abridged Versions Appear In The Paper Journal]

BMA says non-therapeutic circumcision needs consent of both parents

BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7393.782/e (Published 12 April 2003) Cite this as: BMJ 2003;326:782

Rapid Response:

Medical doctors must respect the human rights of their patients

EDITOR--Gatrad et al. are unhappy because the Medical Ethics Committee of the British Medical Association suggests the written consent of both parents for a child circumcision.1 This requirement was not invented by the Medical Ethics Committee. It is a requirement laid down in a court of law as a protection for the child2 and is not under the control of the British Medical Association. The Medical Ethics Committee would be remiss in its duty if it did not inform doctors of this legal requirement. The requirement for the signature of both parents protects doctors from being caught between warring parents and it protects children from unnecessary non-therapeutic circumcision when parents disagree.

Gatrad and colleagues also dislike the requirement for written consent.1 However, written consent is necessary to protect the doctor. A male circumcision, like other surgical procedures, would be assault on a patient without a valid written informed consent, which protects a doctor from lawsuit in most cases. The Medical Ethics Committee has acted properly in advising a written consent as a record of the consent should litigation occur.3 Persons who are injured while a minor have a right to institute litigation to recover damages when they reach the age of majority. Doctors must retain the written consent in their files as protection against a possible lawsuit decades after the surgical operation on the infant. Even a signed written consent, however, may offer little protection.4,5 Parental decisions must be made in a child’s best interest,5,6 so the existence of parental power to consent to an unnecessary non-therapeutic assault on a child, which results in the permanent excision of healthy functional erogenous tissue remains questionable. The lawfulness of the circumcision of male children under the Human Rights Act 1998 has not been resolved.7

Gatrad and associates claim to endorse the view of the Medical Ethics Committee that "…the welfare of infant and child patients is paramount," but then they improperly elevate the “interest of families” above the best interest of the child-patient, because they want the National Health Service to cover the cost of religious circumcisions.1 The Medical Ethics Committee acted properly by excluding this topic from their discussion of the ethics and law of male circumcision.3 This proposal would divert taxpayer funded medical resources to serve the personal religious views of the parents. Moreover, the NHS is a public body that must comply with human rights law, so it must honour the human rights of patients.8

The circumcision of male children violates the four principles of medical ethics – beneficence, non-maleficence, autonomy, and justice.9 Moreover, studies demonstrate that male circumcision impairs or degrades the function of the penis in several ways.4,5,9 Degrading treatment is an offence against Article Three of the European Convention on Human Rights.10 Children born into Muslim or Jewish homes have the same human rights as children born into other homes. Medical doctors must respect the human rights of their patients.3 Doctors who refuse to perform non-therapeutic circumcision of male children are on solid ground.

George Hill

Executive Secretary

Doctors Opposing Circumcision

Suite 42

2442 NW Market Street

Seattle, Washington 98107

USA

Web: http://www.doctorsopposingcircumcision.org/

References:

  1. Gatrad AR, Shafi S, Sheikh A. The law and ethics of male circumcision. BMJ 2003; rapid response: 2 May.
  2. Re J [2000] 1 FCR 307.
  3. Medical Ethics Committee. The law and ethics of male circumcision: Guidance for doctors. London: BMA, 2003.
  4. Gregory J Boyle, J Steven Svoboda, Christopher P Price, J Neville Turner. Circumcision of Healthy Boys: Criminal Assault? 7 J Law Med 301 (2000).
  5. J. Steven Svoboda, Robert S. Van Howe, James G. Dwyer, Informed Consent for Neonatal Circumcision: An Ethical and Legal Conundrum. 17 J Contemporary Health Law Policy 61 (2000).
  6. American Academy of Pediatrics Committee on Bioethics. Informed consent, parental permission, and assent in pediatric practice. Pediatrics 1995;95(2):314-317.
  7. Peter W Edge. Male circumcision after the human rights act 1998. 5 J Civil Liberties 320 (2000).
  8. Hewsen B. Why the human rights act matters to doctors. BMJ 2000;321:780-781.
  9. Hill G. Can anyone authorize the non-therapeutic permanent alteration of a child’s body? Am J Bioeth 2003;3(2): in press.
  10. Council of Europe. Convention for the Protection of Human Rights and Fundamental Freedoms. Rome, 4.XI.1950.

Competing interests:  
None declared

Competing interests: No competing interests

22 May 2003
George Hill
Executive Secretary
Doctors Opposing Circumcision, Suite 42, 2442 NW Market Street, Seattle, Washington 98107, USA