THE FORUM, Fargo, ND, 18 December 2002.

Circumcision debate to open in Fargo

By Steven P. Wagner

The Forum - 18 Dec. 02

A Cass County jury could be the nation's first to decide what hospitals must tell parents before circumcising boys.

To make their decision easier, Zenas Baer wants to show jurors taped footage of a doctor removing the foreskin from a baby boy's penis.

"This is the practice I think is absolutely barbaric," Baer said while preparing for a pre-trial hearing today.

"What parent would consent to do it? I don't know of many who would after receiving that information," he said.

The hearing will shape several legal issues for a landmark trial, likely the nation's first of its kind, slated to start 3 Feb.

Three years ago, Anita and James Flatt of Hawley, Minn., filed a lawsuit on behalf of their son, now 5, against Dr. Sunita Kantak, MeritCare Medical Center and the state of North Dakota, claiming they weren't sufficiently informed about the procedure.

If they had known more about circumcision, they would have chosen to forgo it, Baer said.

"Medical doctors don't tell the patient, or the parents, complete information about the procedure," he said.

"The medical community is perpetuating these results in 50% of the population … without the benefit of a medical diagnosis. There is no medical reason to do it on a routine basis."

The hospital contends Anita Flatt was given information about circumcision and gave doctors consent to perform the procedure.

"All parents that have sons born at MeritCare are given information on circumcision," said hospital spokeswoman Carrie Johnson.

"This information educates parents about circumcision and allows them to make an informed choice that factors in their own personal beliefs and preferences," she said.

Angela Lord, a MeritCare lawyer, deferred all questions to the hospital.

In court papers, the hospital claims it doesn't routinely recommend circumcision and the Flatts requested it be done on their son.

Previously, the Flatts' claim about the legality of North Dakota's law was dismissed by a judge.

The Flatts' son was born early 6 March 1997. That evening, a nurse asked Flatt to sign a consent form for circumcision but didn't describe the benefits or risks of the procedure, according to the lawsuit.

At the time, she was medicated for pain. The next day, Kantak spoke briefly with her but didn't discuss the benefits, risks or potential complications and James Flatt was never consulted.

The hospital, though, says Anita Flatt made the decision for her son before Kantak circumcised him.

"She asked to have her son circumcised," Johnson said.

Flatt understood the procedure and didn't raise any questions to hospital staff, she said.

Male circumcision is both a medical procedure and a 4,000-year-old religious practice sacred to Muslims and Jews.

Circumcising newborns causes virtually no medical harm, but offers practically no benefit, either, according to a study published January 2000 in the journal Pediatrics.

Circumcision is thought to prevent urinary tract infections and penile cancer. But the researchers found that for every complication from circumcision, only six urinary tract infections are prevented. And for every two complications, only one case of penile cancer is prevented.

"There is no medical reason to do it on a routine basis," Baer argues. He plans to call national experts to support his client's claim.

The foreskin has more nerves per square inch than any part of the male body, he said.

If someone believes a child can be affected in utero, then circumcision must also influence boys because their first penal experience is a painful one, Baer said.

"Whenever you have a painfully traumatic event, it's imprinted in the brain," he said.

Another issue Baer plans to point out is a doctor's duty to act in the baby's best interest.

A baby can't consent to the procedure, and circumcision isn't in a baby's best interest, he said.

According to one estimate, 60% of male infants are circumcised in the US. Baer estimates 80% to 90% of baby boys in North Dakota are circumcised.

Worldwide, about 85% of men are uncircumcised, Baer said. The majority of circumcised men live in the US, he said.

"We are the hotbed for genital mutilation of baby boys," Baer said.

Nine months before the Flatts filed the suit, the American Academy of Pediatrics issued a policy statement saying the benefits of circumcision weren't significant enough to recommend it as a routine procedure.

Based on cultural, religious and ethnic traditions, however, the academy said parents should be given complete information about the potential benefits so they can make an informed choice.

In 1996, a federal judge threw out a similar lawsuit Baer filed in US District Court, and the Eighth Circuit Court of Appeals upheld the dismissal.

The district case differs from the federal case because it asks for financial damages for the procedure performed on the boy, where the federal lawsuit only wanted a ruling against the state law.

Since her son's birth, Flatt has begun working as a lawyer for Baer in his Hawley office. Her husband was killed in a pickup accident last year.

East Central District Judge Cynthia Rothe-Seeger will preside over the case after Judge Georgia Dawson stepped down from the case. Dawson's husband sits on the hospital's board of directors.

At today's hearing, Baer hopes Rothe-Seeger allows lawyers to question potential jurors individually about views and family history on circumcision.

"This is not an easy issue to talk about," Baer said. "Most people don't talk about the condition of their penis. It is a taboo subject. As long as it's kept taboo, we won't get beyond the barbarism."

(File revised 21 December 2002)