ALBERTA REPORT, Alberta, Canada, November 17, 1997.
Pages 34-35.


A medical ethicist challenges parents' right to authorize circumcision

Earlier this year, the New England Journal of Medicine published a study about a pain suppressing cream designed for new-born boys who are about to be circumcised. The study angered anti-circumcisionists; they think trying to lessen babies pain is laudable, but they are unhappy because the study involved a control group of infants who had their foreskins removed the usual way, without anesthesia. Margaret Somerville, founder of Montreal's McGill Center for Medicine, Ethics and Law, says that the study was unethical and that circumcision is a form of "criminal assault." She and a growing group of angry "victims" think that circumcision is a human-rights issue, not a medical one.

For centuries doctors performed circumcisions without anesthesia assuming that babies could handle the pain if they even noticed it. These days, most doctors agree that babies can feel pain for circumcisions done without anesthesia. Most circumcisions are still done that way, however, because the risks of anesthetizing a newborn are considered not worth the price of momentary pain.

But circumcision itself, Dr. Somerville suggested in a letter to the Journal, is not worth that pain, particularly since babies cannot give their consent to the procedure. "Was it ethical," she asked, for [the authors] to include a group of infants circumcised without anesthesia?" The letter inspired a wave of media interest in Dr. Somerville's views, and she has since been quoted as saying that circumcision "is technically a criminal assault" under the Criminal Code definition which covers any medically unjustified "intentional wounding." Only Muslims and Jews, she thinks, should be exempt from prosecution for having their babies's foreskins removed.

Dr. Somerville--who does not favor criminal prosecution "at this time"--says that the onus is on parents to show that circumcision provides medical benefits. That issue has been the subject of three decades of furious scientific debate, and no consensus has emerged. A 1996 study by the Canadian Paediatric Society (CPS) concluded that "the overall so evenly balanced that it does not support recommending circumcision as a routine procedure." Circumcision reduces the incidence of urinary tract infections twelvefold, but only 1% or 2% ever get such infections, and under 2% of infection patients suffer complications.

Dr. Doug McMillan, chairman of the CPS Fetus and Newborn Committee, says that although the report did not support routine circumcision, he believed the decision is best left with parents. "There are other things that parents authorize that can have bad consequences," note the University of Calgary medical professor, citing pierced ears as an example. "But we have to believe that the majority of parents make the best choice they can. Our role is to give them information to make that choice.

Parents who inquire will not find clear answers in the medical literature. Studies have indicated that the organisms which cause sexually transmitted diseases (including AIDS) can be trapped and incubated under the foreskin, but anti-circumcisionists counter that proper hygiene eliminates this problem. Some doctors say circumcision lowers the incidence of penile cancer; others say it increases it. Some studies have even suggested that the pain of circumcision somehow inhibits mother-son bonding.

Marilyn Milos is founder of the National Organization of Circumcision Information Resource Centers (NOCIRC) which is based in San Anselmo, California. She says that on newborn males, the foreskin is connected to the tip of the penis by a thin membrane. "They literally have to tear the foreskin from the glans," often scarring the flesh in the process. She says, "It's like peeling an orange." This is so painful she claims, that it does permanent psychological damage. "Until I got in touch with my circumcision," one man told her recently, "I always wondered why I had this vague sense of terror."

Dr. McMillan admits that a 1995 study by Toronto researchers found that circumcised infants are more sensitive to the pain of vaccinations. But to connect that to psychological problems later in life "open to a lot of question," he says. Dr. Aaron Jesin, a Jewish physician from Toronto who performs both regular and ritual circumcisions, adds that the procedure is not as ghastly as its opponents say. "The whole thing takes 30 seconds or less," he says. "Some babies need pain medication and some don't and usually they calm down very quickly." Dr. Jesin also points out that 10% to 15% of males not circumcised at birth must undergo the procedure later in life for problems like phimosis (inability to retract the foreskin) and balano-posthitis (inflammation of the foreskin and glans).

Jews and Muslims believe that God commands them to circumcise their sons as symbol of the promise made to Abraham that he would become the "father of a multitude of nations." Circumcision became common in Christian society in the 1800s, says NOCIRC's Milos. Victorian doctors recommended circumcision as a way to prevent masturbation, which was associated with impotence, imbecility, insanity, blindness, consumption and other ailments.

Modern medical evidence in favour of circumcision emerged later, but opposition to the practice was low-key until the mid 1980s, says Ms. Milos. At that time, the gay community began to notice what other men had and didn't have. They began to acknowledge what had been done to them and they weren't afraid to talk about it. Now it's not just the gay community that's complaining."

Many of these men are upset because they feel cheated in their sex life. Foreskins contain bundles of nerve endings, rather like lips, which may contribute to sexual satisfaction. Ms. Milos contends that the surface of the glans on circumcised males thickens and is therefore less sensitive. Dr. McMillan observes that surveys have shown no difference in sexual satisfaction between circumcised and uncircumcised males, but Ms. Milos is unfazed. "It's preposterous to think that you won't have a loss of sensation," she asserts. Consequently she contends that circumcision is a sexual rights issue---"an assault on a child's sexuality and a violation of his right to an intact body."

Some men will do almost anything to get that "intact body" back. There are no statistics on exactly how many men have attempted foreskin restoration, either by stretching or surgery, but proponents insist it is increasingly common. For the do-it-yourselfer, The Joy of Uncircumcising! by California psychologist Jim Bigelow describes various methods involving different types of tape, weights and foam rubber cones.

Ms. Milos reports that there have been several lawsuits launched against doctors in the U.S. over botched circumcisions. She knows of no cases where a son is sueing his parents, but, she asserts, "it'll happen."

--Les Sillars

(File prepared 30 April 1998; revised 18 March 2000)

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