I would like to express my concerns in regard to a medical study that was carried out not long ago at the University of Alberta. The study measured the pain responses of infants undergoing “routine” circumcision. News media around the world reported that the study was halted prematurely after some infants in the placebo group were traumatized to the point of danger.

It is my understanding that circumcision—of both male and female children—was introduced into the practice of medicine about a century ago for the express purpose of impairing normal sexual function. I understand further that insofar as it is a wounding of a child that is not done for a therapeutic purpose, infant circumcision may violate current provisions of the Criminal Code.

For your information, I enclose a copy of a letter I have written to Dr. Janice Lander, the head of the team that conducted the study.

Sincerely,
 
[signed]
 
D ennis H arrison

Dear Mr. H arrison:

Thank you for your letter of June 26, 1998, enclosing a copy of your correspondence to Dr. Janice Lander, Associate Dean, Faculty of Nursing, U of A, providing your comments concerning a study undertaken by the University of Alberta on the subject of pain responses of infants undergoing circumcision.

Routine newborn circumcisions, not medically indicated, were de-insured in the Province of Alberta in 1987. Alberta Health relies on the medical expertise of physicians to determine when a circumcision procedure is medically and required and appropriate. The Alberta Health Care Insurance Plan (AHCIP) covers the cost of medically necessary procedures.

The professional and ethical practice of medicine is governed by the College of Physicians and Surgeons of Alberta. The College is the professional body responsible for regulating physician practice. The Alberta Medical Association (AMA) is the professional association which provides policy direction to its members. I note you have chosen to copy the AMA regarding this issue.

Thank you for expressing your views.

Sincerely,
 
[signed]
 
Halvar C. Jonson
Minister

Dear Mr. Jonson:

Thank you for your letter of July 21, 1998, in response to my concerns regarding a circumcision pain study undertaken by the University of Alberta. You identify the College of Physicians and Surgeons of Alberta as the professional body responsible for regulating physician practice. I wrote to Dr. Larry Ohlhauser, Registrar of the College, on February 12, 1998, but have received no reply.

I enclose a copy of that letter for your information.

Sincerely,
 
[signed]
 
D ennis H arrison

Dear Minister:

I am writing to seek your assistance in obtaining satisfactory answers from the College of Physicians and Surgeons of Alberta. I feel that the College has not provided complete and candid responses to questions I have asked regarding a medical study carried out at the University of Alberta in 1997. The purpose of the study was to measure pain responses in infants undergoing circumcision.

I asked the College in a letter dated January 24, 2000 if it was ethical for physicians to circumcise non-consenting boys who had nothing wrong with their genitals. In his reply dated January 26, 2000, Dr. Larry Ohlhauser, Registrar of the College, said it was “only proper and logical” for parents to authorize circumcision of their children, regardless of whether or not the operation was medically required.

When I asked Dr. Ohlhauser if parents could, as a general rule, authorize medically unnecessary surgical interventions on their children, Dr. Ohlhauser for some reason called my inquiry “preposterous.” (Please refer to the letter from Dr. Ohlhauser dated February 15, 2000.) I asked for further clarification, but received no response.

The angry tone of Dr. Ohlhauser’s correspondence suggests that this issue should be explored more fully. It seems to me that as the body responsible for regulating medical practice in Alberta, the College of Physicians and Surgeons should be able to clarify the ethical principles governing the performance of non-therapeutic surgical interventions. I would very much appreciate it if you would request the College to respond to the following questions:

1. Is it ethical for a member of the College to operate on a non-consenting person, if the operation is not medically required?
2. Does the College believe that parents have the legal authority to consent to a surgical operation being performed on their child, if the operation is not medically required? If so, could the College please provide a reasoned argument or cite supporting Canadian case law.
3. Does the College consider male circumcision to be comparable to excision of the clitoral hood, an operation prohibited under the criminal law? If not, please explain why.

I believe these questions are important, as they touch on fundamental issues related to consent for procedures. I request that you write to the College in your capacity as Minister of Health and Wellness and ask them to provide candid and complete replies to the above questions.

I also seek your help in obtaining a full response to a letter I wrote on May 5th to Dr. Peter Venner, Chair of the College’s Research Ethics Review Committee. I asked Dr. Venner whether or not, in his opinion, the medical study undertaken at the University of Alberta in 1997 conformed to the principles embodied in certain human rights instruments. By way of reply, Dr. Venner said only that he had “nothing further” to add.

I would very much appreciate copies of any correspondence you might decide to send to the College.

I enclose copies of relevant correspondence between myself and the College, dated as follows:

• January 24, 2000 (to Dr. Ohlhauser)
• January 26, 2000 (reply from Dr. Ohlhauser)
• February 3, 2000 (to Dr. Ohlhauser)
• February 15, 2000 (reply from Dr. Ohlhauser)
• February 29, 2000 (to Dr. Ohlhauser—no reply)
• May 5, 2000 (to Dr. Venner)
• May 19, 2000 (reply from Dr. Venner)

Sincerely,
 
[signed]
 
D ennis H arrison

Dear Mr. H arrison:

Thank you for your letter of June 20, 2000 to the Honourable Halvar Jonson, former Minister of Health and Wellness, about the circumcision of male infants. I am pleased to respond.

I understand you are concerned about the ethics and legality of the practice of circumcision of newborns and have corresponded with the College of Physicians and Surgeons of Alberta (CPSA) and the chair of the Research and Ethics Review Committee of the CPSA in this regard. You indicated you are not satisfied with the answers you received from the CPSA and asked me to intervene by requesting the CPSA respond to a number of specific questions.

It would not be appropriate for me to personally intervene in this matter for several reasons. First, the Medical Profession Act establishes the CPSA as the governing authority of the medical profession in Alberta. This includes the right to self-government and to determine appropriate practice standards and professional conduct for physicians. Second, while the CPSA does not share your views, in my opinion the CPSA has already responded to the substance of your questions. The CPSA position is that a parent has the legal authority to consent to the circumcision of a newborn child and by implication, a physician who performs a circumcision with parental consent is not acting contrary to the ethics of the medical profession. Finally, the proposed questions raise issues respecting medical ethics and also complicated legal issues in the area of constitutional and criminal law. If you cannot resolve your differences with the CPSA, these issues would ultimately have to be resolved by the courts.

Thank your for taking the time to write.

Sincerely,
 
[signed]
 
Gary G. Mar, Q.C.
M.L.A. Calgary Nose Creek

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