EDITOR- In the news item by Linda Beecham the chairman of the General Medical Council standards committee, Professor Sir Cyril Chantler, assures readers that male circumcision is legal¹. The position is not, however, as clear as he claims. There is no doubt that parents have the power to give proxy consent for removal of an incompetent child's foreskin or any other tissue when removal is strictly necessary for therapeutic reasons. When the removal of tissue is not necessary for treating or diagnosing disease a parent only has the legal power of consent to a procedure which causes negligible risk and minimal burden ². Male circumcision causes at least a 2% risk of clinically important complications³, removes specialised tissue⁴, and may be later regretted by the patient⁵. It therefore meets neither the requirement for negligible risk nor that for minimal burden.

It is difficult to see how 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 claim that parents would turn to people "who lacked the skills to perform the procedure competently" is superficially attractive, but the therapeutic context does not render ethical surgery which has no therapeutic intent and which is performed without the consent of the patient. No matter how great the benefits of the procedure it is bad medicine if it is performed without consent.

John D Dalton, Research Archivist
NORM UK,
Stone, Staffs. ST15 0SF