Academic journal article International Journal of Men's Health

An Examination of Legal and Ethical Issues Surrounding Male Circumcision: The Canadian Context

Academic journal article International Journal of Men's Health

An Examination of Legal and Ethical Issues Surrounding Male Circumcision: The Canadian Context

Article excerpt

Despite shifts in the discourses adopted and reinforced within the Canadian medical community and indeed the international community, routine neonatal male circumcision remains fairly normalized. Focusing on the Canadian context, this paper outlines the health-based and legal arguments against elective infant male circumcision. Part one provides an overview of routine neonatal male circumcision and deals with the crucial distinction between therapeutic and nontherapeutic intervention. It locates elective neonatal male circumcision within the nontherapeutic category. Part two outlines the theoretical underpinnings for medical consent in the Canadian context and discusses the legal requirements for "informed consent." The work of part three is to tease out issues of parental consent and whether parents should be entitled to substitute consent for nonmedically necessary, routine, neonatal circumcision.

Keywords: male circumcision, medical consent, Canadian medical community, parental consent

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On August 22, 2002, five-week-old Ryleigh McWilis died from complications resulting from of an elective circumcision. Two days after the procedure, his parents found his diaper soaked with blood and rushed him to a hospital in Penticton, British Columbia (Fournier, 2004). A Coroner's Report (2004) revealed that Ryleigh's lungs showed severe hemorrhage and areas of hyaline membrane disease, which can arise from asphyxia, shock, and acidosis.

It is interesting to note that, after almost three decades of explicit cautioning against routine circumcision of newborn male infants by the Canadian Paediatric Society (1975, 1996) and only weeks before Raleigh's death, the Canadian Medical Protective Association (CMPA) issued a statement (CMPA 2002) that there existed no unanimity within medical or legal communities about the justification for circumcising infant males. Six months before that, Saskatchewan's College of Physicians and Surgeons and the College of Physicians and Surgeons of Manitoba circulated memos to its members warning against routine circumcision of newborn boys (CPSS, 2002; CPSM, 2002). This was part of a broad-based educational strategy to raise professional and public awareness about the risks of routine circumcision. Shortly thereafter, the College of" Physicians and Surgeons of British Columbia began its own review of the procedure. It determined that infant male circumcision is ultimately a matter of parental choice (based on tradition, culture, religion, or personal preference) and that the procedure should be regarded as "cosmetic" (2002, p. 2). Even so, the College Council has not identified any need to place restrictions on the availability of elective infant male circumcision. However, it issued a notice that circumcision should be considered only after detailed discussion with the parents, explaining that neonatal circumcision is not a medical necessity, that currently the majority of boys are not circumcised, that a number of pediatric associations do not recommend the procedure, and that there are potential short- and long-term risks resulting from the procedure.

Despite shifts in the discourses adopted and reinforced by the Canadian medical community and the international medical community (American Academy of Pediatrics, 1999; Australian College of Paediatrics, 1996; British Medical Association 1996; Canadian Paediatric Society, 1996), routine neonatal male circumcision remains fairly normalized. Focusing on the Canadian context, this paper outlines the health-based and legal arguments against elective infant male circumcision. Part one provides an overview of routine neonatal male circumcision and deals with the crucial distinction between therapeutic and nontherapeutic intervention. It locates elective neonatal male circumcision within the nontherapeutic category. Part two outlines the theoretical underpinnings for medical consent in the Canadian context and discusses the legal requirements for "informed consent. …

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