THE CIRCUMCISION REFERENCE LIBRARY

Circumcision of Children

E DITOR —We are all adult men who believe that we have been harmed by circumcision carried out in childhood by doctors in Britain. We are concerned about the ethics of this surgery on children and that it is commonly carried out when it is not essential. We have read the BMA's ethical guidelines which give no guidance to practitioners who are faced with a boy who has been referred for circumcision.1 The possible future wishes of the patient should be considered.

Although it was shown 28 years ago that preputial development continues to the age of 17 and that only three of 1968 boys needed surgery,2 many British doctors still seem to be ignorant of this research.3 The European charter for children in hospital states that every child must be protected from unnecessary medical treatment. The United Nations Convention on the Rights of the Child states that children have rights to self determination, dignity, respect, integrity, and non-interference and the right to make informed personal decisions. Unnecessary circumcision of boys violates these rights.

A non-retractile foreskin in a boy can be managed conservatively.4,5 Circumcision should therefore rarely be necessary. It would be helpful if paediatric urologists could produce guidelines to advise doctors how foreskin problems can be managed. Preferably, circumcisions should not be done until the patient is adult or at least old enough to understand what is intended; then he has a right to a full, illustrated explanation of the nature of the operation and the reasons for it in advance, with the opportunity to ask questions, and help in coming to terms with the alteration of his anatomy afterwards. If the patient is not satisfied with the explanations his views should be taken into consideration.

It cannot be ethical for a doctor to amputate normal tissue from a normal child. In the case of disease, circumcision should be used only when there is evidence that conservative treatment is unlikely to be effective or that is it has failed. Avoiding surgery may be cheaper for purchasers of health care. Doctors should approach the child's foreskin with a combination of good ethics, a recognition of the rights of children. and advice based on evidence.

JOHN P WARREN, F DAVID SMITH, JOHN D DALTON, GRAHAM R EDWARDS, MARC PODEN, ROBERT PRISTON, PHILIP G COOKSTON, JOSEPH ELLIOT, J S PHILLIPS, JAMES WILLIAMS, MATTHEW MALLINSON-READ, IAN MORRIS, JOHN BOWRING, ROB WARBURTON, JAMES BLAZERY, TONY PETERS, JOHN MOORE. JOHN STEVENS

Norm UK

PO Box 71

Stone

Staffordshire ST15 03T