MEDICAL POST, Volume 40, Issue 27,
Toronto, 6 July 2004.

B.C. college statement tightens its circumcision recommendations

By Lynn Haley

VANCOUVER – Opponents of circumcision are applauding a new policy statement issued by the B.C. College of Physicians and Surgeons.

Dr. Peter Seland, deputy registrar (ethics) of the college, said the new statement is intended to help physicians navigate this minefield.

The statement advises that circumcision may be carried out only when it is in the best interests of the child. It also says the procedure has no medical or prophylactic values and that doctors must advise parents of the associated risks including urinary tract infection, urinary retention, meatal stenosis and hemorrhage (as was seen in a recent B.C. case that resulted in the death of a one-month-old).

Doctors are under no obligation to circumcise the child at the request of parents, the statement says.

"There is a never-ending stream of concerns that we get at the college around this issue," said Dr. Seland. "There is nothing in terms of the intensity of the debate that separates this from abortion. People have very strong views about this issue.

"But when you cut through it all and examine it, it appears there is still a small portion of our society that might have been making the decision without being fully informed as to its implications, making decisions on such flimsy grounds as 'We want him to be like daddy.' So we really wanted a tool for physicians to look at, and think about where we're at, not just from a medical point of view."

The trump of course, Dr. Seland said, is the cultural and religious aspects of circumcision—unlike female genital mutilation which, Dr. Seland says, is off-the-wall.

"Since male circumcision is neutral medically, you can't really say that medical indications trump religious preferences," he noted. "The flames were fanned when that baby died in Penticton. It spurred us on to come out with this guideline."

Such a procedure at birth could conceivably have a traumatic effect in later years, said Dr. Seland.

"There is (also) the issue that a decision has been made by the parents to do this on weak grounds, and the result is the adult male is denied erogenous pleasure, though I don't know whether anybody will ever know that for certain," he said.

Dennis Harrison, a spokesman for the Canadian group Association for Genital Integrity, welcomes the changes in policy from the college. He says the focus on bioethics and human rights will help provide physicians with the tools they need to guide parents around the complex issues surrounding the procedure.

"This is very difficult for many parents, because there is often the conflict between the parents' rights and the child's right," said Harrison. "But in a country like Canada, the vast majority of circumcisions are not done for religious reasons. . . . It's true that parents are responsible for making decisions on behalf of their children, but there is no surgical operation a parent can consent to without medical need, and circumcision is not medically necessary. We applaud the college's guidelines, but we think they could have gone further."

The college's statement can be viewed at policymanual.

(File created 7 July 2004)