Male circumcision debate has made progress

Abstract

Gillam's assessment that the debate on non-therapeutic circumcision of boys has ‘gone round in circles’1 is too pessimistic. It is true that the statements of the Australian Paediatric Association in 1971 and the College of Paediatrics in 1983 were unequivocal in their rejection of circumcision and advised doctors actively to discourage the practice, but they were only brief, unsupported statements of opinion. The current (2010) policy of the RACP may contain reservations, but it is a far more detailed document that surveys the medical literature and reaches the evidence-based conclusion that there is no medical basis for routine circumcision in Australia. This conclusion has been endorsed by subsequent reviews of the literature.2 Unlike the old statements, moreover, the current policy pays due attention to bioethical and human rights issues and observes that the value of the foreskin and the likely future wishes of the boy are factors to be taken into account. It is in these areas – bioethics and human rights – that developments have been most dramatic. Forty years ago, scarcely anybody questioned the ethics of NTC, but since the passage of the UN Convention on the Rights of the Child (1989), there has been an upsurge of ethical analysis and the emergence of many contending viewpoints. Critics of circumcision stress the human rights of boys, draw parallels between circumcision and other forms of genital cutting (especially female genital mutilation)3 and question the propriety of doctors circumcising minors for cultural or religious reasons. Highlights since 2010 include a special issue of the Journal of Medical Ethics (July 2013), increased questioning of circumcision from Jewish4 and Muslim5 thinkers, and serious legal challenges to the practice. A report from the Tasmania Law Reform Institute (2012) concluded that the harms of non-therapeutic circumcision are great enough to warrant regulation and partial prohibition, while a senior British judge has stated that circumcision amounts to ‘significant harm’ and is more damaging than mild forms of FGM.6 On the other side of the fence, defenders of religious and culturally motivated circumcision stress tradition, parental rights and religious freedom. In view of these developments, it would seem that future debates about circumcision are likely to be less about the medical benefits than its ethical and legal status. As Gillam remarks, these arguments are sure to be with us for a long time yet.