February 5, 2013
ETHICS CORNER: CIRCUMCISION
by Dr. Jeff Blackmer, Director of Ethics, CMA
What advice should a physician give to parents considering whether or not to have their baby circumcised?
For some parents, the decision is easy because of religious tenets or family tradition. For others, it involves a struggle to balance competing evidence. In Canada this evidence is evaluated and the medical standard is set by the Canadian Paediatric Society (CPS), which since 1996 has held that “circumcision of newborns should not be routinely performed.”
However, in August the American Academy of Pediatrics (AAP) updated its 1999 policy on circumcision and cited evidence showing that the procedure offers some potential benefits, including lower risk of urinary tract infection (UTI), penile cancer and sexually transmitted disease (STD) infection.
There are, of course, provisos. For instance, most UTIs occur in the first year of life and can be avoided with proper hygiene, and the lower STD rates appear applicable only to certain populations, such as gay men. As well, most of the studies that were consulted by the AAP did not involve North American men. So what should doctors do when parents seek their advice? I would point out that the AAP guidelines do not advocate circumcision as standard practice and state that the final decision should be left up to the parents, as is currently the case. The CPS is currently reviewing the evidence and expects to release an updated statement of its own. Until then, its current advice stands.
So, despite all the recent publicity related to the AAP, not much has changed. Some parents will always choose circumcision, some will always reject it, and some will decide based solely on the evidence. The role of physicians in this decision-making process is simply to remain up to date on the evidence and do all they can to help parents make an informed decision.