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Correspondent:

CANADIAN PAEDIATRIC SOCIETY


 
February 17, 1999

Dear Dr. Jardine:

I am writing to express my concerns over the laissez-faire attitude being taken by the Canadian Pædiatric Society (CPS) towards neonatal circumcision.

According to the CPS clinical practice guideline,[1] neonatal circumcision confers no net medical benefit. If this assessment is correct, then any physician who performs a routine infant circumcision is profiting from a surgical intervention that is without medical value to the child patient.

As the Chair of the Bioethics Committee, can you explain how such behaviour on the part of physicians can be reconciled with the ethical principles governing pædiatric practice?

Sincerely,
 
[signed]
 
D ennis H arrison

Reference:
 
1. Fetus and Newborn Committee, Canadian Pædiatric Society. Neonatal Circumcision Revisited. CMAJ 1996;154(6):769-780.

Copies to:
 
Dr. Emmett Francœur, President, Canadian Pædiatric Society
Dr. Eike-Henner Kluge, Chair, Department of Philosophy, University of Victoria
Dr. Douglas McMillan, Chair, Fetus and Newborn Committee, Canadian Pædiatric Society
Dr. Eugene Outerbridge, Principal author, Neonatal Circumcision Revisited
Dr. Peter Singer, Director, University of Toronto Joint Centre for Bioethics
Dr. David F. Smith, Vice President, Canadian Pædiatric Society
Dr. Margaret Somerville, Founding Director, McGill Centre for Medicine, Ethics and Law
Dr. Robin Walker, Chief, Division of Neonatology, Children's Hospital of Eastern Ontario
Dr. John Watts, Past President, Canadian Pædiatric Society
Dr. John R. Williams, Director of Ethics, Canadian Medical Association
 

July 14, 1999

Dear Dr. Jardine:

I wrote you last February 17th to inquire whether neonatal circumcision could be reconciled with the ethical principles governing pædiatric practice. So far I have received no response.

I am sure you will be replying in due course. In the meantime, I am sending you a copy of an article that appeared recently in the British Journal of Urology. This article, entitled "The prepuce," discusses the anatomical covering of the glans penis and clitoris. The findings include the following:

  • "The prepuce is an integral, normal part of the external genitalia..." (p. 31)
     
  • "The clitoral prepuce develops similarly to that in the male." (p. 36)
     
  • "The prepuce is primary erogenous tissue necessary for normal sexual function." (p. 41)
     
  • "The prepuce is a specialized, specific erogenous tissue in both males and females." (p. 41)

I would appreciate answers to the following questions:

  1. In the opinion of the Bioethics Committee, is it ethical for a physician to remove a girl's prepuce without medical indication? Please explain.
     
  2. In the opinion of the Bioethics Committee, is it ethical for a physician to remove a boy's prepuce without medical indication? Please explain.

I look forward to your response.

Sincerely,
 
[signed]
 
D ennis H arrison

enclosure

Copies to:

  1. Dr. Douglas D. McMillan, Chair, Fetus and Newborn Committee, Canadian Paediatric Society
     
  2. Dr. John R. Williams, Director of Ethics, Canadian Medical Association

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