The most recent and authoritative statement was issued by the Royal Australasian College of Physicians in October 2010. This document states clearly:

“After reviewing the currently available evidence, the RACP believes that the frequency of diseases modifiable by circumcision, the level of protection offered by circumcision and the complication rates of circumcision do not warrant routine infant circumcision in Australia and New Zealand.”

The policy also points out that routine circumcision is under strong attack from bioethics and human rights advocates, “because it is recognised that the foreskin has a functional role, the operation is non-therapeutic and the infant is unable to consent.”

Summing up the pros and cons, the statement continues: “The decision to circumcise or not to circumcise involves weighing up potential harms and potential benefits. The potential benefits include connectedness for particular socio-cultural groups and decreased risk of some diseases. The potential harms include contravention of individual rights, loss of choice, loss of function, procedural and psychological complications.”

That being the case, it would appear that the potential harms outweigh the potential benefits, meaning that the circumcision decision is one that can properly be made only by the person who must bear the consequences. The new statement leaves this issue open, but does point out that leaving the circumcision decision to be made by the boy when he is old enough to understand the issues and make an informed choice has the merit of respecting individual autonomy and preserving all the options:

“The option of leaving circumcision until later, when the boy is old enough to make a decision for himself does need to be raised with parents and considered. This option has recently been recommended by the Royal Dutch Medical Association. The ethical merit of this option is that it seeks to respect the child’s physical integrity, and capacity for autonomy by leaving the options open for him to make his own autonomous choice in the future.”

The policy concludes by noting that its recommendation not to cut is consistent with policies on circumcision released by the British Medical Association, the Canada Pediatric Society, the American Academy of Pediatrics, the Royal College of Surgeons of England and the Royal Dutch Medical Association.

The full statement may be downloaded from the RACP website as a PDF: use search function.

NOTE: RACP tends to reorganise its website rather frequently and changes the address of documents. If you can't find what you are looking for, go to their main page and usethe search function:  https://www.racp.edu.au

Doctors reject call for more circumcision: New RACP policy defends rights of child

Australian and New Zealand doctors have decisively rejected a proposal that near-universal circumcision of baby boys be introduced as a strategy against heterosexually transmitted HIV infection. The call, published in the Medical Journal of Australia, came from a small group of well-known circumcision enthusiasts who based their suggestion on evidence from three clinical trials in Africa that circumcision of adult men can reduce the risk of a male’s acquiring HIV during unprotected sexual intercourse with an infected female partner.

But this suggestion has been firmly knocked back by the Royal Australasian College of Physicians, which points out that Australia is not Africa, that infants and children are not at risk of sexually transmitted diseases, and that more circumcision would do nothing to reduce or contain the risk of HIV infection in the Australian and New Zealand context. They also point out that the recommendation by the World Health Organisation, that circumcision be offered as an option for AIDS control in areas of high HIV prevalence, applied to sexually active adult men, not to infants or children, and was not intended to apply to the developed world.

Dr Gervase Chaney, President of the Paediatric and Child Health Division of the RACP, said that he and his colleagues did not agree with the new proposal. Speaking on the ABC’s “World Today” program on 20 September, Dr Chaney said: “We believe that the evidence currently would not support that in Australia. It might be supported in other countries, particularly in Africa where there are much higher rates of HIV transmitted heterosexually. But at this stage that is not something that we would support; we disagree with that group.”

Also commenting was the President of the Australian Medical Association, Dr Andrew Pesce, who said that he found it “difficult to believe that a foreskin, evolved over billions of years of human evolution, needed to be chopped off as soon as the baby was born.”

“What we are talking about”, Dr Pesce continued, “is that otherwise healthy boys have an operation because of a feeling that it’s good for them in the future, even though there is nothing wrong now. That requires a lot of rigorous data collection, a really good understanding of what the potential benefits over the lifetime of the operation are, and balancing them up against the immediate surgical risks of a procedure which can have a low but a measurable complication rate of bleeding, infection, scarring things like that.”

The RACP’s new policy on routine circumcision of male infants and boys, released a fortnight later, states firmly that it does not recommend circumcision as a “routine” or medically unnecessary procedure: “After reviewing the currently available evidence, the RACP believes that the frequency of diseases modifiable by circumcision, the level of protection offered by circumcision and the complication rates of circumcision do not warrant routine infant circumcision in Australia and New Zealand.”

The policy also points out that routine circumcision is under strong attack from bioethics and human rights advocates, “because it is recognised that the foreskin has a functional role, the operation is non-therapeutic and the infant is unable to consent.”

Summing up the pros and cons, the statement continues: “The decision to circumcise or not to circumcise involves weighing up potential harms and potential benefits. The potential benefits include connectedness for particular socio-cultural groups and decreased risk of some diseases. The potential harms include contravention of individual rights, loss of choice, loss of function, procedural and psychological complications.”

That being the case, it would appear that the potential harms outweigh the potential benefits, meaning that the circumcision decision is one that can properly be made only by the person who must bear the consequences. The new statement leaves this issue open, but does point out that leaving the circumcision decision to be made by the boy when he is old enough to understand the issues and make an informed choice has the merit of respecting individual autonomy and preserving all the options:

“The option of leaving circumcision until later, when the boy is old enough to make a decision for himself does need to be raised with parents and considered. This option has recently been recommended by the Royal Dutch Medical Association. The ethical merit of this option is that it seeks to respect the child’s physical integrity, and capacity for autonomy by leaving the options open for him to make his own autonomous choice in the future.”

That would surely also be the attitude of all parents who genuinely respected the body and mind of their children.

The policy concludes by noting that its recommendation not to cut is consistent with policies on circumcision released by the British Medical Association, the Canada Pediatric Society, the American Academy of Pediatrics, the Royal College of Surgeons of England and the Royal Dutch Medical Association.