Health: Circumcision guidelines fail to answer ethics question

New guidance on the circumcision of baby boys is being issued today. But as Jeremy Laurance, Health Editor, reports, the ethical question of whether the operation should be carried out at all has been ducked.

It has been called the unkindest cut. Male circumcision of new- born infants on demand by parents rouses strong passions. Now doctors warn that when the children grow up they may sue their parents and doctors for assault.

Today, the General Medical Council, the doctor's disciplinary body, is sending new guidance on the practice to all 180,000 doctors in the UK. It was forced to act after complaints about standards of care and letters questioning the ethics of the practice. The guidance says doctors performing the operation must be skilled in it, keep up to date with developments and discuss the issue carefully with the parents.

However, it does not answer the ethical question of whether it is right to perform the operation for religious or cosmetic reasons. An estimated one in five men in the UK is circumcised. Critics argue that where there is no medical justification for the procedure it amounts to an assault.

Professor Sir Cyril Chantler, chairman of the GMC's standards committee, told the council last May that male circumcision was legal and the question of whether it was ethical had to be decided by society, not doctors. If doctors did not do it, parents would be driven to back-street clinics.

The council, which has consulted on the matter since last year, said some "strong views" had been expressed by religious organisations, professional and patient groups and children's organisations. Many had recognised the difficulty of balancing the rights of the child with the rights of individuals to practise their religion. However, experts writing in the British Medical Journal question the legality of the procedure. Raymond Buick, paediatric surgeon at Birmingham Children's hospital, wrote: "Doctors and parents need guidance on the implications of circumcision ... The GMC's guidelines do not give this type of guidance." Mr Buick told The Independent: "There are concerns that when these children grow up ... they may ask why it was done."

John Dalton, a research archivist in Staffordshire, said parents only had the legal power to consent to a non-medically necessary procedure on a child if it carried a negligible risk. Circumcision carried a 2 per cent risk of "clinically important" complications. "It is bad medicine if it is performed without consent," he said in the BMJ.