COLLEGES OF PHYSICIANS & SURGEONS
(Identical letter sent to College in each province by Dr. Arif Bhimji)
Dr. ______, Registrar
Dear Dr. ______:
Over the past two years I have been researching the subject of routine infant circumcision. I have reviewed the medical, ethical, human rights, legal, and religious aspects of this practice. After studying the subject thoroughly, I find that I must now turn to the College for professional guidance in this matter. At issue is how I as a medical doctor can best serve the public in a manner consistent with the College's regulations and policies.
In 1996 the Canadian Paediatric Society reaffirmed an earlier statement recommending that "circumcision of newborns should not be routinely performed." In March 1999, the American Academy of Pediatrics made a similar recommendation. No national medical organization in the world currently advocates neonatal circumcision as a routine measure. Clearly there is now a high level of consensus in the medical community that neonatal circumcision is not medically necessary.
Canadian ethicists such as Dr. Margaret Somerville (Founding Director of the McGill Centre for Medicine, Ethics and Law) and Dr. Eike-Henner Kluge (Chair, Department of Philosophy, University of Victoria, and a former Director of Ethics and Legal Affairs at the Canadian Medical Association) have questioned the ethics of this practice.
With respect to consent for non-therapeutic procedures I have reviewed medico-legal cases such as Re "Eve", Supreme Court of Canada, 31 D.L.R. (4th) 1, reversing 15 D.L.R. (3d) 283. In this landmark case, Justice La Forest found:
Since, barring emergency situations, a surgical procedure without consent ordinarily constitutes battery, it would be obvious that the onus of proving the need for the procedure is on those who seek to have it performed. And that burden, though a civil one, must be commensurate with the seriousness of the measure proposed. In conducting these procedures, it is obvious that a court must proceed with extreme caution....It would appear that parents do not have an unfettered right to provide consent on behalf of their children. It is also evident that the responsibility of the physician is greater to the child, who is their patient, than to the parents.
To address the issue of medical procedures and religious beliefs, I referred to Re S.E.M.; M. and M. v. Director Of Child Welfare and Children's Guardian, CCH DRS 1987 P21-799,  1 W.W.R. 327, 74 A.R. 23, 4 R.F.L. (3d) 363, 32 D.L.R.(4th) 394. The presiding Justice ruled:
...that with regard to s. 7 of the Charter, the Act did not deprive the child S of the right to life: it protected that right. Assuming that the parents had a right under the same Charter provision to be free from state intervention, there had to be a balancing of protected but competing rights. The child's right to life took precedence over any competing right of the parents. The right to freedom of religion guaranteed by s. 2 of the Charter was not without qualification, despite its fundamental nature.These two cases, along with the current wording of Section 268 of the Criminal Code and the rulings provided in many similar cases, go to the heart of the issue on which I am requesting the College's guidance.
On the basis of my studies, I have concluded that there are no longer any reasonable medical grounds for performing routine newborn circumcision. It is also apparent that the practice raises ethical and human rights issues, as identified by prominent Canadian academics. The legal implications of the landmark court cases are obvious. It is also not unreasonable to suggest that Section 268, which prohibits non-therapeutic interference with female genitalia, could be applied by extension to routine infant circumcision. Section 15 of the Charter requires any law to benefit both sexes equally.
In light of the current state of medical knowledge, I request the College's guidance in determining the proper course of action for a physician to take in this matter. I believe that this can best be achieved by framing the potential issues as questions to which the College can then respond.
I feel that as a member of the medical profession, I have an obligation to provide the very best of care to the public, while adhering to the highest ethical standards. I trust that in order to guide my fellow physicians and myself, the College will provide detailed responses to the questions I have raised.
Please contact me at the address and telephone number provided should you require further information about my request.
[ B.C.| Alta.| Sask.| Man.| Ont.| Que.| N.B.| P.E.I.| N.S.| Nfld.]
On January 13, 2000, Dr. Bhimji received a photocopy of a
letter dated November 1, 1999 from the College to Professor Ron MacDonald.
PRINCE EDWARD ISLAND
January 18, 2000
letter of November 9, 1999 to Professor Ron MacDonald.]