JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, Vol 278, No 3, Page 202.
July 16, 1997.

LETTERS

To the Editor - Dr. Laumann and colleagues[1] conclude that data from
the National Health and Social Life Survey do not lend clear support
to either side in the circumcision debate.  However, by demonstrating
that circumcision does not reduce the risk of contracting STDs, the
authors may have knocked another prop out from under a medical
procedure that already depends on the frailest of support.  Moreover,
their finding that removal of the foreskin alters patterns of sexual
behavior over a lifetime casts further doubt on the appropriateness of
circumcising infants too young to give informed consent.

   Circumcision is an invasive procedure that is not essential to an
infant's welfare and virtually always can be deferred with little or
no risk.  The finding that circumcision has significant impact in
later life adds further credibility to the view that a decision
regarding circumcision should be postponed until a man can choose for
himself.  In 1995, the AAP Committee on Bioethics[2] stressed the
importance of involving children in decisions concerning their health
care.  The committee counseled physicians to view children as persons
in their own right, with interests distinct from those of their parents.

   Neonatal circumcision subjects male infants to an operation that
they may well reject if they were old enough to consider its
advantages and disadvantages.  A number of studies, such as that of
Taylor and colleagues,[3] have provided evidence that the foreskin is
a complex structure that performs important sensory functions.  The
summary ablation of this structure prior to the age of consent
infringes on one of the most basic human rights, namely, the right to
physical integrity.

   Although the courts have traditionally emphasized the importance of
the family, the rights of parents to govern their children are by no
means unrestricted.  In a society founded upon respect for the
individual, it is clearly in the interest of a child to participate
whenever possible, in decisions concerning his or her own body.

   Circumcision is an irreversible procedure that confers few, if any,
prophylactic benefits and appears to have long-term effects on sexual
behavior.  Hippocrates advised his followers to treat patients
conservatively.  Perhaps it is time that infant males born in America
were once again treated in accordance with a principle that has formed
a cornerstone for the practice of medicine since ancient times.

                                     Dennis Harrison
                                     Vancouver, British Columbia

1. Laumann, EO, Masi CM, Zuckerman EW. Circumcision in the United
   States: prevalence, prophylactic effects, and sexual practice. JAMA
   1997;277:1052-1057.

2. AAP Committee on Bioethics. Informed Consent, parental permission,
   and assent in pediatric practice. Pediatrics 1995;95:314-317.

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

Cite as:

Harrison D. Letter. JAMA 1997;278:202.

(Transcribed 16 July 1997)