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BMA says non-therapeutic circumcision needs consent of both parents

London Debashis Singh

The BMA has published guidelines designed to offer doctors a safeguard and a model of good practice for male circumcision in babies and children.

The guidelines mainly relate to the ethics of non-therapeutic or "ritual" circumcision. This is carried out for religious reasons or to incorporate a child into a community or simply because some fathers express a preference for their sons to be like them.

The guidelines state that it is the responsibility of the parents to demonstrate that a non-therapeutic circumcision is in the child’s best interest. To achieve this, the BMA now advises that both parents must give consent before a "non-therapeutic" circumcision can be performed. If the parents disagree about whether a child should be circumcised, doctors should not proceed without the go ahead of a court.

The guidelines also list several factors that may help doctors to assess the child’s best interest in relation to a non-therapeutic circumcision. These include the patient’s physical and emotional needs, the risk of harm or suffering for the patient, and the views of both the child (if he is old enough to participate in the decision) and the parents. Implications of performing or not performing the procedure and religious and cultural factors should also be noted.

In some faiths circumcision is a defining feature. Jewish babies are circumcised shortly after birth. Muslim children are circumcised much later, often when they may be able to participate in decision making.

Dr M Shuja Shafi, chairman of the health and medical committee of the Muslim Council of Britain, gave a critical response to the publication: "The guidelines express a one sided view without due regard or consideration to code of conduct of faith communities—namely, Muslims and Jews.

"No other surgical procedure imposes written consent from both parents. In some exceptional circumstances it may be advisable to obtain consent of both parents. This document should be seen as draft proposals which needs to be firmed up in the light of wide consultation and discussion among the faith communities and their professionals."

The BMA guidelines also covers circumcision for medical purposes. It recommends that when a clear clinical need for circumcision exists, the procedure must be performed only by or under the supervision of doctors trained in children’s surgery and take place in premises suitable for surgical procedures.

Dr Michael Wilks, chairman of the BMA’s ethics committee, said: "We hope these guidelines help doctors in their discussions with patients who ask for their sons to be circumcised. It is extremely important for doctors to act in the best interest of the child when agreeing to circumcision procedure."

The British Jewish Board of Deputies declined to comment on the guidelines until its working group had met to discuss them.

The guidelines can be accessed at the BMA’s website: www.bma.org.uk.
 
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