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Ritual (Religious) Circumcision

Advice from BAPS, BAUS & BAPU

Some BAUS members have contacted us with concerns about ritual (religious) circumcision performed in the community (i.e. outside the hospital setting). Their worries have been twofold. First, they have raised concerns about complications following the procedure and, second, they have asked how to respond if asked to perform the procedure in the community.

We have, therefore, taken advice from the British Association of Paediatric Surgeons (BAPS) on this matter.   They have provided a statement of information for members, written primarily by Robert Wheeler, Consultant Paediatric Surgeon, on behalf of BAPS; this statement has also been formally endorsed by BAUS and BAPU.

Statement on ritual (religious) circumcision

"From time to time, urologists and general surgeons who look after children may have to deal with the complications of a circumcision performed outside hospital, in the community.  Obviously, there is a duty to treat the complications appropriately.  However, beyond dealing with the surgical presentation, there is little that the individual surgeon can do to reduce the likelihood of “community circumcisions” causing harm, because few of the individuals who perform ritual circumcisions are registered medical practitioners.

"Whilst complaints about doctors can be directed to the General Medical Council (GMC), the GMC has no authority to take action against individuals who are not registered with the GMC performing circumcision in the community.  Circumcisionists who falsely claim to be registered with the GMC are few and far between, but they are committing a criminal offence by making such a claim.  Paradoxically, some GMC-registered doctors who have practised circumcision in the past have resorted to relinquishing their registration, in order to avoid scrutiny by the GMC when faced with complaints.  Providing a de-registered doctor scrupulously avoids giving the impression that he/she is still a registered medical practitioner, and as long as the boy’s parents/guardians provide consent to surgery, the principle of caveat emptor ('let the buyer beware') applies.

"Unqualified circumcisionists, just like de-registered doctors, are protected from allegations of battery by parental consent.  However, should the child be maimed or even die as a result of the procedure, recklessness on the part of the circumciser might be used as the basis for a criminal prosecution.

"Doctors who circumcise boys in hospital will continue to be scrutinised in the normal manner.  If their practice is criticised, they can defend themselves by showing that their practice is considered reasonable by their peers (in the form of an expert opinion) and that any expert opinion is viewed by a court as being able to withstand logical scrutiny."

"Registered medical practitioners wishing to perform circumcisions at home or outside the hospital setting
would find it very difficult nowadays to reconcile such a practice with the current GMC regulations".

"It remains to be seen whether an English court would consider ritual circumcision of a male infant as consistent with the child’s best interests.  The court would be likely to balance the technical and psychological harm that might arise as a result of the circumcision against the benefits of circumcision provided by the resulting acceptance into the faith community.  Doubtless, Parliament’s statutory prohibition of female circumcision would also be taken into account, as would the potential health benefits from circumcision and the 'finality' of circumcision in a child who cannot provide consent for the procedure."

Download the article by Robert Wheeler & Pat Malone on Male circumcision: risk versus benefit from Arch Dis Child 2013; 98(5): 321-2 (the entire May 2013 issue was devoted to male circumcision).

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