LONDON: "GMC should come off the fence"

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

GERMAN CIRCUMCISION RULING

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)
Harlow
Essex

MANCHESTER: Midwife committed for trial after circumcision death - more unreported?

Men's Health Forum
April 19, 2012

Nurse charged as baby dies after circumcision

As a nurse is put on trial in Manchester, the debate about circumcision rages once again.
A trial date has been set for Grace Adeleye, 66, of Salford who has been charged with manslaughter after a baby boy died following a circumcision. At a Manchester Crown Court hearing on 18 April, her trial date was set for November 26. She is alleged to have caused the death of Goodluck Caubergs, from Oldham, by gross negligence two years ago.

The tragedy has inevitably shone the spotlight once again on circumcision with organisations such as NORM-UK and The Men's Network in Brighton condemning the practice.

The network's strategic director Glen Poole said: 'in the UK we are still subjecting an estimated 100 boys a day to non-consensual, medically unnecessary circumcision – with two-thirds of these procedures being carried out for non-religious reasons. While it is illegal to tattoo a boy either with or without his consent, parents do not need their son’s consent to have his foreskin painfully and unnecessarily removed without anaesthetic by non-medical practitioners.'

Circular argument
David Smith of NORM-UK, a charity offering support for men unhappy with circumcision, said: 'This is not the first case of a death following a circumcision.' He believes 'the true rate of deaths from this procedure is masked because of a circular argument.

'The circular argument goes: boys don't die because of circumcision, therefore in the case of a boy dying immediately after being circumcised there must be another cause, probably sudden infant death syndrome, and the preceding circumcision is coincidental. Thus the possibility of a causal relationship between the circumcision and the death is never recorded, and so this goes on being repeated and the connection is never made.'

What do you think about circumcision?

• Manchester Evening News: Salford nurse to go on trial
• 26 July 2012: conference held by Genital Autonomy, an advocacy organisation working with groups seeking an end to non-therapeutic genital surgery on children

Earlier story