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Correspondent:

BRITISH COLUMBIA MEDICAL ASSOCIATION


 
March 10, 2000

Dr. Ian Courtice
President, B.C. Medical Association

Dear Dr. Courtice:

RE: INFANT MALE CIRCUMCISION

Infant male circumcision is becoming the focus of increasing public debate. For your information, I enclose copies of recent correspondence I have had on this subject with the College of Physicians and Surgeons of British Columbia. I also enclose a printout of a news item from the Radio Sweden Web site referring to a report on circumcision prepared for the Swedish National Board of Health. The report characterizes the circumcision of boys for non-medical reasons as a violation of the United Nations Convention on the Rights of the Child, and proposes a complete ban on the practice.

I understand the B.C. Medical Association (BCMA) offers recommendations about legislation and regulations affecting health care and the practice of medicine. Has the BCMA ever made any recommendations about legislation and regulations affecting infant male circumcision? If not, does the BCMA have any plans to study the issue?

Sincerely,
 
[signed]
 
D ennis H arrison
 

November 15, 2000

Dear Mr. H arrison:

Thank you for sending us all the information regarding infant circumcision that you have provided. We would strongly urge you to approach the Attorney General's office in order to seek the kind of societal changes that you are looking for as this is likely the most efficient way to achieve your goals.

Sincerely,
 
[signed]
 
Dr Glen Ward
Chair, Child & Youth Committee
Council on Health Protection
British Columbia Medical Association
 

November 23, 2000

Dr. Glen Ward
Chair, Child and Youth Committee
B.C. Medical Association

Dear Dr. Ward:

Thank you for your letter of November 15th, in which you suggest that the most efficient way to stop infant male circumcision might be to approach the Attorney General's office. In this regard, I would like to draw your attention to a new book called The Ethical Canary by Dr. Margaret Somerville, Director of the Centre for Medicine, Ethics and Law at McGill University. In a chapter devoted to circumcision, Dr. Somerville writes:

Some people believe that in order to make routine infant male circumcision undertaken for other than religious reasons illegal, we would need to change the law. This is not correct. The Criminal Code already prohibits assault, aggravated assault and sexual assault. An assault is any touching of another person that is more than what the law calls de minimis (a trifle) without that person's consent. (De minimis touchings include those involved in normal social interaction, unless the person touched has objected to them). Aggravated assault is assault that involves a wounding. Legally, a wounding is constituted by any breaking of the full thickness of the human skin. Consequently, all surgery, including infant male circumcision, could potentially fall within the definition of aggravated assault. Under our present interpretation of the Criminal Code, surgery does not do so, however, in two situations. Surgery is ethically and legally justified when it is necessary therapy undertaken by a competent physician with the informed consent of the patient or the patient's legal representative. And non-therapeutic surgery that is not contrary to public policy (for example, cosmetic surgery or donation of a paired organ for transplantation) is justified if undertaken with the fully informed consent of the competent adult undergoing it.
That is to say, under the Criminal Code infant male circumcision is already an aggravated assault because it involves wounding a non-consenting person without medical justification. Parents cannot legally consent to having their child wounded unless there is a medical justification for the wounding, which in the case of routine circumcision, there is not.

Dr. Somerville also writes:

A common error made by those who want to justify infant male circumcision on the basis of medical benefits is that they believe that as long as some such benefits are present, circumcision can be justified as therapeutic, in the sense of preventive healthcare. This is not correct. A medical benefits or "therapeutic" justification requires that overall the medical benefits sought outweigh the risks and harms of the procedure required to obtain them, that this procedure is the only reasonable way to obtain these benefits, and that these benefits are necessary to the well-being of the child. None of these conditions is fulfilled for routine infant male circumcision. If we view a child's foreskin as having a valid function, we are no more justified in amputating it than any other part of the child's body unless the operation is medically required treatment and the least harmful way to provide that treatment.
I enclose the following material that might be of interest to you:
  1. A paper by Dr. Arif Bhimji entitled Infant Male Circumcision: A Violation of the Canadian Charter of Rights and Freedoms, which was published recently in an electronic journal called Health Care Law.
     
  2. A recent article from the Globe and Mail entitled "The Ethics of Circumcision." This article contains excerpts from the previously cited book by Dr. Margaret Somerville.
     
  3. A collection of correspondence with the Attorney General of British Columbia.
In my letter dated March 10, 2000 to Dr. Ian Courtice, President of the BCMA, I asked whether the BCMA had ever made any recommendations with respect to infant male circumcision. If not, does the BCMA have any plans to study the issue? I would appreciate answers to these questions. It seems to me that in light of its mission to "advance the practice and science of medicine," the least the BCMA can do is to apprise its members of the fact that the lawfulness of infant male circumcision is a matter of doubt. A physician cannot legally intrude on a non-consenting child's body unless the intrusion is necessary to protect the child's physical or mental health. I don't think any reasonable person would argue that circumcision meets this condition, given the current state of medical knowledge.

I trust this information is of value. I look forward to your reply.

Sincerely,
 
[signed]
 
D ennis H arrison
 

August 14, 2001

Dr. Heidi Oetter
President, B.C. Medical Association

Dear Dr. Oetter:

The National Post reported on Saturday that the British Columbia Veterinary Medical Association has signed an animal welfare convention aimed at prohibiting cosmetic surgery on pet animals. The BCVMA believes that veterinarians have a moral obligation to respect all other living creatures, and that animals have a right to the bodies they were born with.

Meanwhile, thousands of baby boys in B.C. are being circumcised every year without medical justification. I'm curious about the apparent discrepancy between the ethical standards of the BCVMA on the one hand, and the ethical standards of the BCMA on the other.

Could you clarify if the BCMA believes it is ethical for a physician to alter the body of a human infant who has no medical need for surgery?

I would appreciate a response at your earliest convenience. Thank you for your time.

Sincerely,
 
[signed]
 
D ennis H arrison
 

August 21, 2001

Dear Mr. H arrison:

Thank you for your letter and I understand your concern regarding infant circumcision.

The BCMA does not have the authority to set policy or regulate such surgeries. Your concerns should be addressed to the College of Physicians and Surgeons of B.C. Their address is [address given].

Yours sincerely,
 
[signed]
 
Heidi Oetter, MD
President

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