I am writing to ask your professional opinion on the human rights aspects of
a medical study carried out at the University of Alberta in Edmonton, Alberta, Canada. The purpose of the study was to measure pain responses in male infants undergoing circumcision.
Circumcision is not required for an infant's mental or physical health. The Canadian Paediatric Society advises that this procedure 'should not be routinely performed'. By the researchers' own account, circumcision of male newborns is not medically required.
There is no doubt, therefore, that the study in question involved performing non-essential surgery on non-consenting persons. All of the subjects suffered pain; some were traumatized to the point of danger. The study was halted prematurely after one of the subjects vomited, went into shock and stopped breathing for more than 25 seconds.
The researchers freely admitted that they had inflicted unnecessary pain and suffering on healthy children, but justified their actions on the ground that they were merely doing what the children's parents wanted. At the present time about 20 percent of male infants in Canada are being circumcised (the comparable figure for the USA is 60 percent).
Amnesty International (AI) is committed to upholding the right of every person to physical integrity. The London Declaration, adopted by AI on 21 May 1995, calls for the abolition of 'cruel, inhuman or degrading treatment or punishment' and urges professional associations 'to investigate and act upon all reports of human rights abuses by health professionals'. The AI Health Professionals Network Online says it 'regularly issues appeals for action' on cases involving 'infliction of human rights violations with the assistance of medical personnel'.
In your view, did the medical study in question constitute a violation of human rights? If not, please explain why.
I enclose the following material:
- the abstract of the study published in the Journal of the American Medical Association;
- a compilation of correspondence related to the study, including letters from the Office of the Attorney General of Alberta, the Alberta Minister of Health, the Chair of the Research Ethics Board that approved the study, Health Canada, and the Chief Crown Prosecutor in Edmonton;
- a copy of the final report submitted by the researchers to Health Canada;
- a copy of a letter dated 10 November 1997 from Dr Margaret Somerville to Dr Robin Walker. Dr Somerville is a Fellow of the Royal Society and the founding director of McGill University's Centre for Medicine, Ethics and Law. At the time the letter was written, Dr Walker was a member of the Fetus and Newborn Committee of the Canadian Paediatric Society.
Note the following statement on page 2 of Dr Somerville's letter:
The present law would prohibit circumcision of a child unless the persons consenting to this and the physicians carrying it out can show that it is justified.
It should also be noted that the study was supported by a grant in the amount of $135,966 from the government of Canada, as per
a
letter dated 8 May 1998 from Mr Ian Potter, Assistant Deputy Minister, Health Promotion and Programs, Health Canada. (Item #7 in blue binder).
Thank you for considering this matter. I look forward to your reply.
Sincerely,
[signed]
D ennis H arrison
September 25, 2000
Dear Mr H arrison,
Thank you for your letter to James Welsh dated 30 August 2000.
AI has no comment to make on medical research which falls within the realms of the customary practice of medicine unless
- it is malevolent in intent
- it causes severe pain or suffering
- it is contrary to international human rights standards, and
- it is not being dealt with by the responsible authorities.
The abuses which AI has documented in the medical sphere have been egregious abuses such as the involvement of doctors in the torture of prisoners, assistance in carrying out the death penalty, deliberate denial of medical care where this could threaten life or otherwise constitute cruel, inhuman or degrading treatment. It has not involved other incidents or procedures of contested ethical validity, medical malpractice (even where this has involved pain), poor professional standards or otherwise deficient and unprofessional conduct.
AI has no knowledge of any decision by an authoritative international human rights tribunal which would suggest that neonatal circumcision of male infants constitutes a human rights violation in international law.
By contrast, the Committee charged with monitoring the Convention on the Elimination of Discrimination Against Women has issued several general recommendations relating to female genital mutilation (FGM). For example, General Recommendation 14 (1990) calls on states parties to take appropriate and effective measures with a view to eradicating the practice, including introducing appropriate health care and education strategies and including information about measures taken to eliminate FGM in their reports to the Committee. The UN Beijing Declaration and Platform for Action, resulting from the Fourth World Conference on Women in 1995, contains a clear condemnation of FGM as a form of violence against women and reaffirms the responsibility of states to take action to curb such violence.
The scope of Amnesty International's work—the organization's mandate—is determined by its members. To this point, AI's membership has determined that the organization will work against FGM but not take a position on the issue of male circumcision.
Yours sincerely
[signed]
Claudio Cordone
Director
Research and Mandate Program
October 4, 2000
Dear Mr Cordone
Thank you for your letter of 25 September 2000, in response to my questions concerning a medical study carried out at the University of Alberta.
The study involved performing non-essential surgery on non-consenting persons. All of the subjects suffered pain; some were traumatized to the point of danger. The study was halted prematurely after one of the subjects vomited, went into shock and stopped breathing for more than 25 seconds.
I draw the following conclusions from your letter:
- The study in question was not contrary to international human rights standards and did not fall within the scope of AI's work.
- The study in question would have been contrary to international human rights standards, and would have fallen within the scope of AI's work, if the subjects had been female rather than male.
I would be grateful if you could either confirm that my analysis is correct or explain where I have gone wrong.
Sincerely,
[signed]
D ennis H arrison
February 25, 2003
Mr. Alex Neve
Secretary General
Amnesty International Canada
(English-Speaking Section)
Dear Mr. Neve:
I wrote to you about three years ago in connection with a medical study undertaken at the University of Alberta for the purpose of measuring pain responses in male infants undergoing circumcision. I expected that Amnesty International would be interested in reviewing the human rights aspects of this study, since circumcision is not a medically required procedure for male infants, and Amnesty has taken a stand against medically unnecessary operations on girls.
You replied that the issues I had raised were "outside the mandate of Amnesty International."
Last night I heard you on the CBC radio program "As It Happens" defending the rights of notorious Holocaust denier Ernst Zundel, who voluntarily left Canada for the United States in 2001, and is now seeking re-entry to this country as a refugee.
I would appreciate it if you could clarify why Amnesty International's mandate includes upholding the refugee rights of an Ernst Zundel, but at the time I last wrote to you, did not include speaking up for the rights of children to physical integrity.
Male circumcision is not a trivial operation. I enclose a copy of a news report describing the death of a B.C. infant from circumcision complications last August. Physicians' organizations all agree that infant male circumcision is not medically justified.
In the opinion of Amnesty International, does the performance of irreversible, medically unnecessary surgery on children raise human rights issues? Please note that unlike Mr. Zundel, infants are completely incapable of making their own decisions, and are totally dependent on others to protect their rights.
Thank you for taking the time to consider this matter. I look forward to your reply.
Sincerely,
[signed]
D ennis H arrison