Thursday, July 5, 2012

LONDON: "GMC should come off the fence"

Letter to The Times (not published)
July 4, 2012


By John Warren
Doctors throughout Europe, where there is no tradition of infant male circumcision in medical practice, have been faced in recent years by an increasing demand for this service, due to the immigration of families from other parts of the world where male circumcision has been a cultural norm.   There is confusion over how to respond to this demand, both among the medical and also the legal professions.   The ruling in Germany, reported in The Times on 28 June, illustrates this problem.   In this case a state court ruled that circumcision on non-medical grounds of a child amounted to grievous bodily harm.   In The Netherlands, the Royal Dutch Medical Association has issued a report stating that non-therapeutic circumcision of underage boys amounts to a violation of a child’s physical integrity, and so contravenes Article 8 of the European Convention of Human Rights and Article 11 of the Dutch constitution.   In Norway, the Centre Party has proposed an outright ban on non-therapeutic male circumcision of under-age boys, provoking a heated debate.

Here in the UK , there has so far been little debate, despite the fact that large numbers of boys are being circumcised for non-therapeutic reasons, some within the NHS,  some in private clinics, and some by non-medically qualified operators.   It is impossible to determine accurately how many.   However, the medical literature shows a complication rate of anywhere between 2 and 20%.   These do not include late problems discovered by adult men who were circumcised as infants, and our records at NORM-UK include many examples of both physical and psychological problems that appear to result from this operation.

Earlier this month (June) the Westminster coroner gave a verdict of accidental death in the case of a one month old baby boy who died of haemorrhage from his wound two days after circumcision.
The General Medical Council does not have a position on the issue of non-therapeutic male circumcision of children.   It states: We do not have general authority to determine public policy on issues that arise within medical practice – these are matters for society as a whole to determine, through the parliamentary process.

There are four principles of medical ethics: autonomy, beneficence, non-maleficence and justice.   Clearly a child’s autonomy is breached by a non-therapeutic procedure permanently altering his anatomy.   Regarding beneficence, no medical organisation in the world recommends routine infant circumcision for health reasons.   Non-maleficence refers to not doing harm;  the possibility of complications mentioned above shows that there is considerable potential for harm from this procedure.  Justice asks the question ‘is it fair?’   Would you do the same to a girl?   Would you do the same to an adult male without his consent, that is tie him down and forcibly remove his foreskin, possibly without anaesthesia?

In my view the UK needs a debate involving doctors, lawyers, ethicists, politicians, representatives of religions and the wider public on the subject of non-therapeutic circumcision of underage boys.   And the General Medical Council should consider coming off the fence and  consider carefully whether its lack of position on this topic is consistent with its role:  to protect, promote and maintain the health and safety of the public by ensuring proper standards in the practice of medicine.
  Dr John Warren
(Chairman NORM-UK)

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