Statements by Medical Authorities

Statements and policies on circumcision by medical authorities

On a world scale circumcision is a minority practice. It became common in the late Victorian period in Britain and the USA, then spread to other English-speaking countries – Australia, New Zealand and Canada. It never became established anywhere else, except in South Korea, as a consequence of the American occupation following the Korean War in 1953. Britain abandoned circumcision in the 1940s-50s, followed by New Zealand in the 1960s, Australia in the 1970s and Canada in the 1980s.

Since the 1970s medical authorities in all these countries have issued official statements and policies that recommend against circumcision of normal male infants and boys.

Australia

The most recent and authoritative statement was issued by the Royal Australasian College of Physicians in August 2009. This document states clearly:

The full outline statement follows

Great Britain

In its guidelines on circumcision, the British Medical Association takes a stronger and more critical line against unnecessary surgical interventions in children. It lays down the following principles of good practice:

• The welfare of child patients is paramount and doctors must act in the child’s best interests.
• Children who are able to express views about circumcision should be involved in the decision-making process.
• Consent for circumcision is valid only where the people (or person) giving consent have the authority to do so and understand the implications and risks.
• Both parents must give consent for non-therapeutic circumcision.
• Where people with parental responsibility for a child disagree about whether he should be circumcised, doctors should not circumcise the child without the leave of a court.

The BMA also advises that where a problem exists, circumcision should be the last resort, employed only after non-surgical treatments have been tried and failed:

"Unnecessarily invasive procedures should not be used where alternative, less invasive techniques, are equally efficient and available. It is important that doctors keep up to date and ensure that any decisions to undertake an invasive procedure are based on the best available evidence. Therefore, to circumcise for therapeutic reasons where medical research has shown other techniques to be at least as effective and less invasive would be unethical and inappropriate.

"Male circumcision in cases where there is a clear clinical need is not normally controversial. Nevertheless, normal anatomical and physiological characteristics of the infant foreskin have in the past been misinterpreted as being abnormal. The British Association of Paediatric Surgeons advises that there is rarely a clinical indication for circumcision. [Go to reference 5] Doctors should be aware of this and reassure parents accordingly."

On the question of consent, the BMA insists that in the case of children, both parents must give their consent, and that it must be in writing. Further, if the child is old enough to express an opinion, his wishes and preferences must be taken into account:

"The BMA and GMC have long recommended that consent should be sought from both parents. Although parents who have parental responsibility are usually allowed to take decisions for their children alone, non-therapeutic circumcision has been described by the courts as an “important and irreversible” decision that should not be taken against the wishes of a parent. [Go to reference 15] It follows that where a child has two parents with parental responsibility, doctors considering circumcising a child must satisfy themselves that both have given valid consent. If a child presents with only one parent, the doctor must make every effort to contact the other parent in order to seek consent."

Summary of consent issues

• Competent children may decide for themselves.
• The wishes that children express must be taken into account.
• If parents disagree, non-therapeutic circumcision must not be carried out without the leave of a court.
• Consent should be confirmed in writing.

Health benefits of circumcision doubted

In relation to circumcision as a prophylactic measure (to reduce the supposed risk of diseases that may be contracted in the future), the BMA warns that there are no agreed "health benefits" in circumcision of children and that doctors must warn parents that medical opinion is divided.

"There is significant disagreement about whether circumcision is overall a beneficial, neutral or harmful procedure. At present, the medical literature on the health, including sexual health, implications of circumcision is contradictory, and often subject to claims of bias in research. Doctors performing circumcisions must ensure that those giving consent are aware of the issues, including the risks associated with any surgical procedure: pain, bleeding, surgical mishap and complications of anaesthesia. All appropriate steps must be taken to minimise these risks. It may be appropriate to screen patients for conditions that would substantially increase the risks of circumcision, for example haemophilia.

"Doctors should ensure that any parents seeking circumcision for their son in the belief that it confers health benefits are fully informed of the lack of consensus amongst the profession over such benefits, and how great any potential benefits and harms are. The BMA considers that the evidence concerning health benefit from non-therapeutic circumcision is insufficient for this alone to be a justification for doing it."

The full text of the BMA statement is available here.

See also the guide to foreskin care and management by British Association of Paediatric Urologists

Other countries

Other countries where medical authorities have issued policies and guidelines on circumcision include Canada, the United States, Finland, Sweden and Denmark. As you might expect, it is the Scandinavian countries that are most critical of the practice and the United States that is most ambivalent, reflecting the extent to which circumcision has become embedded as a medical ritual there. Getting rid of an outdated medical procedure is easy; getting rid of an entrenched social custom is a different matter.

South Africa

Interestingly enough, the South African Medical Association does not consider the AIDS crisis a sufficient justification for routine circumcision of male infants or other normal male minors. In response to an inquiry from Nocirc of South Africa, the South African Medical Association stated that there was no justification for routine circumcision of infants or children. In letter to Nocirc SA, dated 4 February 2005, and signed by Professor Ed Coetzee, Chairperson of the SAMA Education, Science and Technology Committee, the Association states:

“After lengthy DISCUSSION on the matter, the Committee RESOLVED that it be conveyed to NOCIRC-SA that, from a medical point of view, there was no medical justification for routine circumcision in males and children.”

In this conclusion, SAMA joins medical authorities in Britain, Canada, the USA, Australia and New Zealand in agreeing that there is no medical case for routine circumcision. In fact, it goes slightly further than the Royal Australian College of Physician in 2002s, which stated that there is “no medical indication”; SAMA says there is “no medical justification”, an even stronger rejection.

Nocirc-South Africa website

Coming from a country with an extremely high incidence of HIV infection (and also a high incidence of male circumcision), this is a significant declaration. South Africa is also one of the very few countries to have passed legislation regulating and to some extent restricting circumcision of male minors.

Further information on the Africa page

Canada

 

Policies issued by the various provincial medical bodies and the Canadian Pediatric Society are available from CIRP.

The latest (September 2009) policy issued by the College of Physicians and Surgeons of British Columbia (September 2009) is available on this site.

United States, Finland, Sweden, Denmark

 

Further details on statements by medical authorities available from CIRP.

 

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