GP MAGAZINE, 27 June 1997, Page 44.

[CIRP Note: GP Magazine is distributed to General Practitioners within
the United Kingdom. The GMC is the General Medical Council, the
medical regulatory body of the United Kingdom.]


                                  LETTERS

CIRCUMCISION: IS THE GMC WRONG?

I note with interest that Lotte Newman has enthusiastically
endorsed the new GMC guidelines on circumcision (GP, June 6).

I have two main concerns:-

*   It may be impossible to obtain valid consent for the
     circumcision of healthy infants.


*   The right to religious freedom cannot override the need for
     protection of the rights and freedoms of others.


There is no doubt that parents have a power to give proxy consent
to removal of an incompetent child's foreskin, or any other
tissue, where strictly necessary for therapeutic reasons.
However, where the removal of tissue is not necessary for the
treatment or diagnosis of disease, a parent only has the legal
power of consent to a procedure which causes negligible risk and
minimal burden (1).

Male circumcision causes at least a 2 per cent risk of
significant complications(2), removes specialised tissue(3) and may
be later regretted by the subject(4).  It therefore meets neither
the requirement for negligible risk nor that for minimal burden.

How could the GMC could escape the conclusion that it is
impossible for doctors to obtain valid consent for the non-
therapeutic circumcision of healthy infants?

The GMC claim that the requirements of the UN Convention on the
Rights of the Child must be balanced against the requirements for
religious freedom.  The European Convention of Human Rights,
Article 9(2) states however:-

     Freedom to manifest one's religion or beliefs shall be
     subject only to such limitations as are prescribed by
     law and are necessary in a democratic society in the
     interests of public safety, for the protection of
     public order, health or morals, or for the protection
     of the rights and freedom of others.

Since doctors cannot obtain valid consent for the circumcision of
healthy unconsenting male children, and the practice is an
infringement of the right to bodily integrity, it appears contrary to
national and international law.

It is difficult to see how the GMC could fail to recognise the
circumcision of such children as serious professional misconduct for
which doctors should have their registrations revoked.

Dr John Dalton
Frizington, Cumbria

References:

1.   Human Tissue: Ethical and Legal Issues, Paragraph 7.8,
     Nuffield Council on Bioethics, 1995.

2.   N Williams and L Kapila. Complications of circumcision.
     Brit J Surg 1993;80:1231- 1236.

3.   Taylor JR, Lockwood and Taylor AJ. The prepuce:
     specialised mucosa of the penis and its loss to
     circumcision. Brit J Urol 1996;77:291-295.

4.   Warren JP et al. Circumcision of children. BMJ Letters
     1996;312:377.