Re: Infant male circumcision

On November 27, 1997, you made the following comments to the press in regard to Bill 30, the Health Information Protection Act: “It fails to protect patient rights. It legalizes invasion of privacy. And it violates trust between a doctor and patient.”

Unfortunately, it seems to me that a disregard for patient rights is a failing that is not unique to institutions of Government. The right of infant males to their physical integrity is being violated every day by Alberta physicians who perform non-therapeutic infant circumcision.

Could you kindly comment on the performance by Alberta practitioners of an outmoded procedure which is not recommended by the Canadian Paediatric Society and which appears, insofar as it ablates normal erogenous tissue from the genitals of a healthy child, to contravene Section 45 of the Criminal Code of Canada.

I enclose copies of some correspondence I have had relating to a circumcision pain study carried out recently at the University of Alberta.

Sincerely,
 
[signed]
 
D ennis H arrison

Enclosures

Dear Mr. H arrison:

Re: Infant Circumcision

On behalf of the President, Dr. W. W. (Bill) Anderson, thank you for your recent letter and information package about infant circumcision. I appreciate that you took the time to bring this matter to our attention.

You ask if the Alberta Medical Association can comment on the performance of the procedure by Alberta practitioners. At present, this service is still available in the province upon request of parents. We acknowledge that there is disagreement over this procedure being offered. (I would also remind you that for some Albertans, circumcision is required to fulfil religious edicts). However, so long as the procedure is available here, I am confident Alberta physicians will stay abreast of all related clinical developments.

Yours truly,
 
[signed]
 
Ronald A. Kustra, BA, ABC
Assistant Executive Director
(Public Affairs)

Dear Mr. Kustra:

Thank you for your letter of March 3rd.

You raise the question of circumcision as a religious duty. However, religion has nothing to do with the vast majority of infant circumcisions performed either in Alberta or in any other province. The fulfilment of religious edicts is probably best left to those who have expertise in such matters. Physicians are licensed to practise medicine.

You express confidence that Alberta physicians will keep abreast of all related clinical developments. However, I think it’s important to bear in mind that neonatal circumcision is a non-therapeutic surgical intervention. Recent events related to the practice of forced sterilization have demonstrated that when it comes to non-therapeutic surgical interventions, the developments which Alberta physicians need to keep abreast of relate more to law, ethics, and human rights, than to clinical technique.

I enclose a copy of an article entitled “Female circumcision: When medical ethics confronts cultural values” published in the Canadian Medical Association Journal 1993. You may find the article of interest because the legal and ethical issues raised by female circumcision are identical to those raised by infant male circumcision. The author is Dr. Eike-Henner Kluge, Chair of the Department of Philosophy at the University of Victoria, advisor on Ethical Issues in Health Care to the B.C. Ministry of Health, and former Director of Ethics and Legal Affairs at the Canadian Medical Association.

Sincerely,
 
[signed]
 
D ennis H arrison

Copy to: Dr W. W. Anderson

I would like to express my concerns about the practice of infant male circumcision, with specific reference to a medical study undertaken recently by the University of Alberta. The purpose of the study was to measure pain responses in infants undergoing circumcision.

For your information, I enclose copies of letters I have written on this subject to Mr. Ian Potter, Assistant Deputy Minister, Health Promotion and Programs, and Dr. Larry Ohlhauser, President of the Alberta College of Physicians and Surgeons. I also enclose other material that may be of interest to you.

I have provided copies of all relevant correspondence to Mr. Steven Svoboda, Director of Attorneys for the Rights of the Child (ARC). ARC is a newly formed, non-profit, international network of attorneys dedicated to raising public awareness of the rights of male children to physical integrity and self-determination. As part of its work, this organization is investigating ways of making legal remedies available to circumcised males.

Canadian legal experts such as Dr. Margaret Somerville, Founding Director of McGill University’s Centre for Medicine, Ethics and Law, have expressed the view that “routine” infant circumcision contravenes current provisions of the Criminal Code.

Sincerely,
 
[signed]
 
D ennis H arrison

Enclosures:

1. Comparison of Ring Block, Dorsal Penile Nerve Block, and Topical Anesthesia for Neonatal Circumcision
2. NewsNet5 report: Anesthesia Complications Killed Baby
3. The prepuce: specialized mucosa of the penis and its loss to circumcision
4. Immunological functions of the human prepuce
5. Circumcision in the physicians’ own words

Dr. David Bond, President
Alberta Medical Association

Dear Dr. Bond:

I would like to ask questions in regard to a medical study carried out a couple of years ago at the University of Alberta. I have received no response to two letters I wrote on this subject to Dr. Larry Ohlhauser, Registrar of the College of Physicians and Surgeons of Alberta.

The purpose of the medical study was to measure pain responses in male infants undergoing routine circumcision. In a report prepared for Health Canada, the researchers state: “...infants suffered immensely during and following the circumcision...one infant became unstable and stopped breathing for several periods of time after the circumcision was completed; others had choking episodes.” Further on the researchers state that in their view, “circumcision is not medically necessary.”

It seems to me that this study raises important questions in connection with physicians’ duties toward children. Was it ethical and legal for physicians to subject children to a surgical procedure that—in the physicians’ own words—caused great suffering and was not medically necessary? Why did this happen, and what is being done about it?

For your information, I enclose a copy of a letter I have received from Mr. Bob Rechner, provincial Children’s Advocate. Mr. Rechner suggested that I write to you.

Sincerely,
 
[signed]
 
D ennis H arrison

Dear Mr. H arrison:

The Alberta Medical Association does not have a policy statement regarding circumcision which, as you are aware, is a medical procedure insured by the government health care plans. I note that in quoting from the study, you enclose the cover page which concludes: “This study should convince physicians to use anesthesia for neonatal circumcision...”

Sincerely,
 
[signed]
 
David W. Bond, MD
President

Dear Dr. Bond:

Thank you for your letter of December 17th. You describe circumcision as “a medical procedure insured by the government health care plans.” However, the government health care plans insure only those services deemed medically necessary. Routine neonatal circumcision has not been deemed medically necessary in Alberta since 1987; the procedure was dropped from the insured services list in that year. As of this writing, all provinces have de-insured neonatal circumcision except Manitoba.

You have not provided a direct answer to the questions I raised in my letter of November 23rd, though you appear to suggest that neonatal circumcision presents no ethical or legal difficulties as long as anaesthesia is used. However, if neonatal circumcision is invasive enough to require the use of anaesthesia, is it ethical for a physician to undertake this procedure for non-medical reasons? Moreover, is it ethical for a physician to permanently alter the anatomy of a person incapable of consenting for himself, if this is not medically necessary?

I have had an extensive correspondence in relation to the medical study conducted by Dr. Janice Lander et al. at the University of Alberta. Many medical professionals seem to display surprising knowledge-gaps, as regards both the anatomy of the human penis and the ethical principles governing the practice of medicine.

The correspondence is available online at www.courtchallenge.com/letters/lander.html.

Sincerely,
 
[signed]
 
D ennis H arrison

Dear Mr. H arrison:

On behalf of the President, Dr. David Bond, I wish to advise you that we have no further response to your letter.

Yours truly,
 
[signed]
 
Ronald A. Kustra, BA, ABC
Assistant Executive Director
(Public Affairs)

Top of page