COLLEGES OF PHYSICIANS & SURGEONS

An identical letter was sent to the College in each province by a local resident.
 

I am writing to express my concerns about the College's policy on male circumcision, or more precisely, the lack of such a policy. New medical evidence suggests that circumcision of healthy male infants is both unnecessary and harmful. I feel that in keeping with its role as guardian of the public interest in matters related to the practice of medicine, the College of Physicians & Surgeons of (province) has a duty to formulate a policy on male circumcision based on recent medical evidence.

No national medical organization in the world today has the opinion that infant male circumcision is medically indicated. The Canadian Paediatric Society concluded in 1996, after an exhaustive review of the literature, that the benefits of neonatal circumcision do not outweigh the harms. The American Academy of Pediatrics arrived at a similar conclusion earlier this year. If infant male circumcision does not confer a clear medical benefit, then what justification exists for performing this surgery?

I am troubled by the medical profession's past record on circumcision. In postulating that erotic sensation was the cause of disease, physicians not only got the science wrong—their misguided attempts to impair normal sexual function also made them a party to what today would be viewed as serious human rights violations. As recently as 1935, a physician wrote:

I suggest that all male children should be circumcised. This is 'against nature', but that is exactly the reason why it should be done. Nature intends that the adolescent male shall copulate as often and as promiscuously as possible, and to that end covers the sensitive glans so that it shall be ever ready to receive stimuli. Civilization, on the contrary, requires chastity, and the glans of the circumcised rapidly assumes a leathery texture less sensitive than skin. Thus the adolescent has his attention drawn to his penis much less often. I am convinced that masturbation is much less common in the circumcised. With these considerations in view it does not seem apt to argue that 'God knows best how to make little boys'.    —R.W. Cockshut. Circumcision. British Medical Journal, vol. 2 (19 October 1935), p. 764.

The anti-sexual overtones in the above passage are obvious, as are the parallels with female genital mutilation. Can the College provide assurance that when performed today, circumcision of newborn boys is not a human rights violation?

Under Canadian law, the onus is on physicians and parents to show that a child will derive a clear benefit from a proposed surgical intervention. A landmark court case, Re "Eve," illustrates this principle. (Please refer to Appendix 1.) Given the current state of medical knowledge, I believe it would be impossible for anybody to show that a child would derive a clear benefit from circumcision, except in rare cases where the child suffered from a disease or disorder that did not respond to less invasive forms of treatment. Further, there seems little doubt that amputating portions of a child's genitals without medical need infringes on the child's most basic human rights, including the right to physical integrity guaranteed under Section 7 of the Charter of Rights and Freedoms.

To assist me in understanding the College's position on circumcision, I would appreciate answers to the following questions:

1. Does the College have an official policy on male circumcision? If not, please explain why.
    
2. Does the College plan to introduce a policy on male circumcision? If so, what is the target date for instituting this policy?
    
3. Does the College agree with the Canadian Paediatric Society's recommendation that neonatal circumcision should not be routinely performed?
    
4. Can the College provide assurance that it is ethical for physicians to excise normal tissue from non-consenting persons for non-therapeutic purposes?
    
5. Can the College provide assurance that a physician who circumcises a child without clear medical indication is respecting that child's right to physical integrity as guaranteed under the Charter of Rights and Freedoms?
    
6. Does the College believe that parents have the legal authority to consent to invasive, non-therapeutic surgical interventions being performed on their children? If so, please explain.
    
7. Does the College consider male and female circumcision to be comparable practices? If not, please explain.
    
8. Is the College concerned that interference with children's genitals for non-medical reasons might constitute child abuse? If not, please explain.
    
9. Does the College consider that physicians who circumcise non-consenting persons for non-medical reasons are engaging in professional misconduct?
    
10. Is the College prepared to institute a policy prohibiting its members from engaging in non-therapeutic circumcision of children? If not, please explain.

Given the College's statutory obligation to protect the general public, I believe the College must take steps to address the issue of infant male circumcision. As a member of the general public, I would appreciate a specific response to each of the questions I have raised.

Yours sincerely,

[signed]

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