NATIONAL POST, Toronto, 30 August 2002.

The growing consensus against circumcision

Jackie Smith
National Post

Friday, August 30, 2002

Just 30 years ago, male circumcision was all the rage; as many as 90% of boys in the United States, 70% of those in Australia, 48% in Canada and 24% in the United Kingdom were circumcised (often without any anesthesia).

I remember the war that waged in my own mind when my son was born in the 1980s.

I had no religious reasons for choosing circumcision; I wasn't trying to guard against "unhealthy masturbation," as early proponents of circumcision were. I didn't care if he looked like dad, as some parents do. I wanted to know only one thing: What would be best for him -- medically.

If he wasn't circumcised, would I be responsible for increasing his chances of urinary tract infections and sexually transmitted disease, as some physicians had suggested? Would it mean he might need the operation later in life, when circumcision is more uncomfortable, not to mention unpleasant?

What if he had the operation and got an infection? What if the knife slipped? How would I live with myself?

More important, how would he live with himself?

It's the nature of parenting to always think, "What could I have done better?" So once I made a decision I worried over whether it was the right one. Like all parents, I tried to act in the best interests of my child.

When the Canadian Pediatric Society (CPS) reviewed the medical literature and came out against routine circumcision in 1996, I thought the matter was settled. The CPS looked at the effects of newborn circumcision on the rate of urinary tract infections, sexually transmitted diseases, cancer of the penis, penile problems, and decided the practice was inadvisable. This was in line with a recommendation made earlier by its Fetus and Newborn Committee and with 1971 and 1975 recommendations of the American Academy of Pediatrics.

Nevertheless, debates about the ethics of circumcision remain unresolved because of its connection to religion and culture -- because medical studies sometimes turn up different results, and because parents do think their kids should look like dad.

Still, I believe a consensus against circumcision is steadily emerging. In this new era of patient rights, circumcision has come to seem like an anachronism. Among doctors, there is a greater emphasis on informed decision-making, the limits on parents' rights to make decisions about their kids' health and the rights of children to be protected from parents who make wrong decisions. Even some adult men who were unnecessarily circumcised as children are asserting their rights to restitution. And since the balance of medical evidence suggests those who oppose circumcision have the facts on their side, doctors are increasingly refusing to perform circumcisions. Complications from bleeding, amputation, renal failure, sepsis and death are powerful incentives to stop.

With the death of an infant in B.C., possibly as a result of circumcision and currently under coroner's investigation, there will be more questions of circumcision's benefits and risks -- with a more pronounced focus on the latter.

Parents who opt for circumcision must, as a matter of both law and morals, make their decision based on the principle of respect for the rights and best interests of their child, according to the available information concerning risks and benefits. The death of the Kamloops baby may bring new awareness about the risks of circumcision (though the baby's death may ultimately turn out to have arisen from something far more complicated than a botched circumcision).

Indeed, the media coverage of the incident may speed circumcision for non-religious reasons into the dustbin of medical practice -- alongside many other once-popular procedures, such as the removal of the ovaries for hysteria, tonsillectomy for a sore throat, lobotomy for mental retardation, etc. In a few years, looking like dad or wanting to keep a boy "clean" may no longer be legally legitimate rationales for circumcision. It's about time they weren't. Parents who have had their kids circumcised can't be faulted for doing what they thought was right. But it is unethical to continue a practice that is no longer medically defensible and could harm our kids.

(File prepared 31 August 2002)