Religion should not be a roadblock to child safeguarding in healthcare

Posted: Tue, 2 Jan 2024 12:38

A new paper highlights barriers to reforming guidance on non-therapeutic circumcision. The author, Dr Antony Lempert, explains why religion is one of the biggest barriers of all.

NSS speaks out at pro-genital autonomy event

Posted: Wed, 10 May 2023 11:48

The National Secular Society has called for an end to all forms of non-consensual religious genital cutting at the Worldwide Day of Genital Autonomy.

In a speech on Sunday, NSS campaigns officer Dr Alejandro Sanchez urged the government to "ensure that no one is subjected to unnecessary medical or surgical treatment during childhood", as recommended by the UN Committee on the Rights of the Child.

The "bodily integrity, autonomy and self-determination" of children must be protected, he added.

The Worldwide Day of Genital Autonomy (WWDOGA) is held in Cologne each year to commemorate the verdict of a local court in 2012, which held that non-therapeutic circumcision of boys constituted grievous bodily harm and was illegal under German law.

The court ruled that the "fundamental right of the child to bodily integrity outweighed the fundamental rights of the parents". Waiting until the child was capable of making their own decision about circumcision did not compromise the religious freedom of parents, it added.

Then-chancellor Angela Merkel said the decision to protect the bodily integrity of children risked Germany becoming "a laughing stock". The German parliament subsequently brought in new legislation to legalise circumcision.

Other groups represented at this year's WWDOGA included Terre de Femmes, an anti female genital mutilation organisation, and 15 Square, a support group for men affected by circumcision.

Religious genital cutting in the UK

Female genital mutilation (FGM) is illegal in the United Kingdom under the FGM Act 2003. This includes FGM performed for religious reasons. Non-therapeutic circumcision, by contrast, continues to enjoy a presumed exemption to the law against wounding.

Three baby boys, Celian Noumbiwe, Angelo Ofori-Mintah, and Goodluck Caubergs, have bled to death post-circumcision in recent years. Eleven were admitted to Birmingham Children's Hospital in just one year with life threatening haemorrhage, shock or sepsis following circumcision.

An NSS investigation last year revealed circumcisions were leaving children with deformed penises and babies requiring emergency blood transfusions.

In 2015, an English judge held that male circumcision is "more invasive" than some forms of FGM. The practice constituted "significant harm" under the Children Act 1989, he said. But, because it had a "basis in religion" and "health benefits", it fell within "reasonable parenting".

The NHS does not recommend non-therapeutic circumcision of boys and lists "permanent reduction in sensation in the head of the penis, particularly during sex" as a complication.

NSS: 'Religious genital cutting flies in the face of medical ethics and child rights'

Dr Sanchez said: "Subjecting a non-consenting child to a painful, dangerous and irreversible procedure to satisfy the religious wishes of parents flies in the face of medical ethics and child rights.

"The medical establishment and the government must now act, as they have done with FGM, to protect boys from medically unnecessary religious and cultural genital cutting."

Boys face serious complications from circumcision, complaints show

Posted: Thu, 19 Jan 2023 13:25

Dozens of children are suffering life-threatening, painful and permanent complications from religious circumcisions performed by doctors, the National Secular Society can reveal.

The General Medical Council (GMC), which regulates doctors in the UK, dealt with 39 complaints relating to 30 doctors regarding circumcisions between 2012 and 2022, according to information seen by the NSS in a Freedom of Information disclosure.

The complaints include incidents in which children's penises were left deformed and babies required blood transfusions.

Many of the circumcisions on babies and children are thought to have been performed for religious and cultural reasons only and were not medically necessary.

Babies and children suffer pain, bleeding and deformity

Many complaints to the GMC referred to circumcisions which led to excessive bleeding, sometimes requiring hospitalisation and blood transfusions.

One doctor's "substandard" circumcision resulted in "urinary complications" and "physical deformity" to the child's penis. Another complaint said a botched circumcision required a child to undergo further surgery. In another, a baby needed "specialist intervention" to repair his penis.

In one case a doctor reportedly used "inappropriate restraint techniques", including "using non clinical staff to restrain child patients". The Royal College of Nursing has told the NSS restrictive physical interventions should not be used in non-therapeutic circumstances that are either not an emergency or urgent.

Some complaints referred to patients suffering "excessive pain" or a lack of adequate pain relief.

Other complaints involved doctors using unsterile equipment, and several said patients suffered infections after being circumcised.

One baby reportedly suffered bad burns from a heater or lamp in the room during the procedure.

Some complaints referred to multiple circumcisions performed by the same doctor. The allegations against one doctor related to eight children.

The GMC provided the names of two doctors subject to the complaints who had been struck off after botching circumcisions.

In 2013 a baby was admitted to hospital after being circumcised by Sam Neriman at his "dedicated Circumcision Clinic" in London. A fitness to practise panel found Neriman failed to stop the baby's bleeding effectively before discharging him.

In 2015 Muhamad Siddiqui was struck off following complaints made about four circumcisions he performed on infants as part of his "Mobile Children's Circumcision Service". His repeated failings included performing the procedure in unhygienic conditions and without proper health checks or emergency medical equipment.

In one case, he failed to recognise a baby was having a seizure resulting from a local anaesthetic and therefore did not act immediately to ensure an ambulance was called.

In another, he did not check whether the local anaesthetic was working when the baby screamed during the procedure, and continued to cut his foreskin regardless.

Siddiqui is facing prosecution on 39 charges, including actual bodily harm.

A previous NSS Freedom of Information request revealed eleven boys had been admitted to one hospital in 2011 alone with life threatening haemorrhage or sepsis following circumcision.

The NSS's findings echo concerns raised in 2014 by NHS paediatric surgeon Shiban Ahmed. He claimed some circumcisions in the UK were "barbaric and amateurish" and had resulted in "children [being] maimed for life".

Although proponents of circumcision claim the procedure is safe, the Medical Protection Society, an insurance company for doctors, states it carries "considerable risks and complications".

Many circumcisions 'medically unnecessary'

The GMC does not collect data on which circumcisions are performed for medical reasons, and which are performed for religious or cultural reasons only, with no medical need.

But several of the complaints specify the circumcisions were "religious" or performed at home. Circumcisions would only be performed at home if they were requested for religious or cultural reasons.

Furthermore, the NSS said it is likely many, if not most, of the circumcisions performed on babies and young children were carried out for religious and cultural reasons, rather than out of medical necessity. This is because there is only one medical condition, pathological phimosis, that categorically requires circumcision. This condition is "unusual before five years of age" according to circumcision guidance from the Royal College of Surgeons of England.

Ritual circumcisions on boys are most common among Jewish, Muslim and some African Christian communities, where they are often considered a religious obligation.

Complaints filed with the GMC only relate to circumcisions performed by qualified doctors. Many religious and cultural circumcisions in the UK are performed by people without medical qualifications and so are neither regulated nor recorded.

All forms of ritual genital cutting on girls are prohibited in the UK by anti-FGM (female genital mutilation) laws. But religious and cultural circumcision on male babies and children is permitted, including by non-doctors.

In 2015 the High Court ruled that nontherapeutic male circumcision, no matter how competently performed, constitutes "significant harm". The High Court further concluded that to claim male circumcision is less invasive or harmful than some forms of FGM would be "irrational".

In a 2018 YouGov survey, 62% of people in the UK said they would support a law prohibiting the circumcision of children for non-medical reasons.

NSS: 'Protect boys from religious genital cutting'

NSS campaigns officer Dr Alejandro Sanchez said: "These complaints lay bare the dangers of medically unnecessary circumcision in babies and children. It is a myth that circumcision is simple and safe.

"Subjecting a non-consenting child to a painful, dangerous and irreversible procedure to satisfy the religious wishes of parents flies in the face of medical ethics and child rights.

"These findings are almost certainly the tip of the iceberg. They are only the complaints brought against medically trained professionals. The harms caused by non-medically trained individuals, who under the law can also carry out circumcision, hardly bear thinking about.

"The medical establishment and the government must now act, as they have done with FGM, to protect boys from medically unnecessary religious and cultural genital cutting."

Read The Mirror's coverage of these findings

Image by StockSnap from Pixabay

Our health system is failing to protect children from ritual circumcision

Posted: Wed, 2 Nov 2022 09:23

While UK medical bodies tie themselves in knots on ritual male infant circumcision, untold numbers of boys are being subjected to a painful, risky and irreversible procedure, says Dr Alejandro Sanchez.

In 2008, the Chief Medical Officer for Scotland wrote to health executives informing them that ritual circumcision was to be provided on the NHS. "[I]n the interest of the wellbeing of the child", he wrote, the procedure would be carried out under general anaesthetic by a paediatric surgeon in one of four specialist paediatric centres.

Hospital guidelines added "doctors agree that a surgical circumcision should always be carried out under a general anaesthetic. This is safer and less painful for your child".

In September, the NSS sought clarification from the Chief Medical Officer: what were the implications of these rigorous strictures for religious circumcisions performed outside of the NHS? The CMO would not be drawn.

In the face of inconvenient questions regarding ritual circumcision, such intellectual and ethical contortion is all too common. UK medical bodies maintain that children subjected to ritual circumcision in clinical settings must be 'protected' by strict safeguards. Those circumcised in the community, however, are on their own.

We should, of course, be gravely concerned that ritual male circumcision is permitted on medical premises at all. The practice is non-consensual; not medically indicated; constitutes 'significant harm' under the Children Act 1989 and is deferrable until the age of consent.

The notion that Female Genital Mutilation (FGM) would be permissible if carried out in an operating theatre is, naturally, repellent. Medicalised ritual circumcision deserves equal disapprobation and contempt.

The physical harm of ritual circumcision is now incontrovertible: eleven boys were admitted to Birmingham Children's Hospital in just one year with life threatening haemorrhage, shock or sepsis post-circumcision. Three baby boys, Celian Noumbiwe, Angelo Ofori-Mintah, and Goodluck Caubergs, have bled to death post-circumcision in recent years. And the evidence of psychological impacts is also growing.

British Medical Association (BMA)

Nonetheless, UK medical bodies have set out their stalls on circumcision. The British Medical Association's 2019 guidance advises that circumcision can be used to treat medical conditions such as pathological phimosis (overly tight foreskin) but only when less invasive measures such as steroid creams or stretching would prove ineffective. To act otherwise would be "unethical and inappropriate." This, by itself, would be sound clinical and ethical advice.

The BMA, however, provides one caveat: an otherwise "unethical and inappropriate" circumcision may proceed if there are "relevant social and cultural interests". Thus, the circumcision is somehow morally transformed by the coincidence of the parents' religion.

Such doublethink is beneath the BMA and represents a dereliction of duty. All children, including those born to Jewish or Muslim parents, deserve equal protection from ritual circumcision. If, upon reaching the age of consent, that child still wishes to undergo the procedure, that remains their prerogative.

Care Quality Commission (CQC)

Let us turn now to the mental gymnastics of the Care Quality Commission, the organisation tasked with inspecting healthcare facilities in England. Their recommendations are, superficially, robust: "we would expect providers to ensure that the provision of non-therapeutic male infant circumcision services is safe and appropriate."

But when pressed in a Freedom of Information request, the CQC was unable to confirm if ritual circumcision without general anaesthetic was "safe". Likewise, it was silent on the safety of physically pinning down children undergoing circumcision.

Both these practices were described in a dossier submitted to the CQC by whistle-blower paediatric surgeon Mr Shiban Ahmed. The state of UK circumcision practice was "barbaric and amateurish", he said, adding that "the NHS is allowing babies to be maimed". How the CQC responded, if at all, remains unclear.

General Medical Council (GMC)

Perhaps the General Medical Council, the professional regulator of doctors, might have the moral courage to speak up? After all, it has a statutory obligation under the Medical Act 1983 to "protect, promote and maintain the health, safety and well-being of the public".

Would that it were. "You should usually provide" procedures for "mainly religious or cultural reasons", states their 2013 'Personal beliefs and medical practice' guidance. A seemingly more pressing concern was relayed to Dr Antony Lempert, head of the Secular Medical Forum: "You have no idea how offended the chief rabbi would be if we were to change our guidance."

Where does this leave the state of circumcision in the UK? It must be carried out under general anaesthetic by a paediatric surgeon, except where it need not be. It can only be carried out where conservative measures have failed, except where they haven't. It can only be carried out when it is safe, except we don't know what safe means. And the status quo must be upheld lest we offend religious authorities.

This tortuous entanglement is morally unsustainable. It is this gordian knot, not the foreskin, that should be cut.

Image by PublicDomainPictures from Pixabay

Experts: “Serious weaknesses” in medical guidance on circumcision

Posted: Mon, 25 Jul 2022 10:51

Experts have criticised "serious weaknesses" in medical guidance which permits religious and cultural circumcision on boys.

Professionals in academic, legal and medical fields have called for the UK's largest doctors' union to change their "permissive" stance on non-therapeutic male circumcision on infants and children, in a journal article published this month.

The British Medical Association (BMA) released guidance on non-therapeutic male circumcision of children in 2019 to aid physicians in deciding whether to perform the procedure. The BMA has long claimed to be "neutral" on the ethics of non-therapeutic circumcision on male children. However, the article describes how this claim is inaccurate since the BMA guidance, premised on an "incoherent and impracticable analysis of the child's best interests", is permissive of the practice.

The article said the guidance is a "missed" opportunity to "accurately reflect current ethical, legal, safeguarding, or medical concerns" regarding infant circumcision.

The authors said they are "not aware" of any other non-therapeutic invasive procedures on children involving "significant harm" that the BMA treats as "ethically neutral".

The article raised a number of specific concerns with the BMA guidance, including:

• The guidance has the effect of tilting parents' personal, religious and cultural preferences for circumcising their child against the child's best interests.

• The BMA says it is committed to non-discrimination in terms of sex. But the guidance "undermines this commitment by affording differential protection to children on the basis of sex" because it does not apply the same protections afforded to girls from genital cutting (female genital mutilation, or FGM) to boys.

• The BMA advocates for "increased acceptance into a family or society" as a "strong social or cultural benefit" of circumcision, despite rightly rejecting this argument for female genital cutting.

• The guidance states without any supportive evidence that male infant circumcision "does not require medical expertise". The article explains how this "contradicts the BMA's own exposition of the numerous clinical, anesthetic and hygiene standards required of a doctor carrying out the procedure." This may mean the BMA is "tacitly accepting that the minimal standards of care for non-doctor circumcisers should be lower than the standards of care for doctors". It called this guidance "disturbing".

• The BMA says it "cannot envisage a situation where it is ethically acceptable to circumcise a child…who refuses", but does not offer the same ethical judgment on circumcision on neonates who are "even more vulnerable" than children who can speak.

• The BMA is "inconsistent" in that while it warns that parents "can exert great influence on their child's view of a procedure", it remains silent on the "much more extreme danger" to neonates and very young children who parents want to circumcise.

The article warned that the BMA's guidance would, if applied to female genital cutting, yield the conclusion that cutting healthy tissue from a non-consenting child's vulva "could permissibly be performed if the parents request it for cultural or religious reasons".

It concluded that a "consistent application of widely-accepted medical ethics, safeguarding, legal and human rights principles should result in equal protection for all children from all forms of non-therapeutic genital cutting practices to which they cannot consent".

Secular Medical Forum chair: BMA guidance 'inconsistent and confusing'

Dr Antony Lempert, chair of the National Secular Society's Secular Medical Forum and one of the report's authors, said: "The BMA has produced guidance that is inconsistent, confusing and at times, incoherent, reflecting the deeper, unresolved moral and legal tensions surrounding child genital cutting more generally.

"Childhood ritual male circumcision is an anomaly. There is no other case where the law and medical guidance would countenance such an invasive, painful and often unsafe procedure on a non-consenting minor.

"Instead of circumventing good medical practice so as not to offend religious sensibilities, ethical and legal consistency would strengthen arguments against all ritual genital cutting practices. Ultimately, this would protect boys and girls since advocates of female genital cutting are increasingly emboldened by inconsistent guidance permissive of ritual male cutting."

Image by Tú Nguyễn from Pixabay

Religious and cultural genital cutting challenged at NSS event

Posted: Fri, 17 Jun 2022 12:21

Experts made the case for protecting all children from religious and cultural genital cutting at a recent National Secular Society online event.

On Wednesday 8^th June, representatives from the International NGO Council on Genital Autonomy (INGOCGA) led an online discussion on their new report, supported by the NSS, which calls on the United Nations to take greater steps to eliminate all forms of non-consensual, non-therapeutic genital cutting.

Every year, millions of children are forcibly subjected to permanent and painful cutting of their genitals for religious or cultural reasons.

While increasing numbers of countries give girls legal protection from all forms of non-therapeutic genital cutting (female genital mutilation), not a single country affords similar protections to boys.

Secular Medical Forum chair Dr Antony Lempert and Canadian government medical adjudication consultant Kira Antinuk explained why forced genital cutting is a violation of children's fundamental rights, including freedom of religion or belief, and dispelled some of the myths surrounding FGM and male circumcision. They also shared ideas on what needs to happen to ensure all children, whatever their sex or cultural background, are given equal rights to make decisions about their bodies for themselves.

You can watch the video of the discussion here.

Speaker biographies

Dr Antony Lempert, Secular Medical Forum (Chair)
Dr Antony Lempert is a partner in a rural GP practice on the Welsh/English border. Since 2008 he has coordinated and chaired the SMF which works to protect patients from the harm caused by the imposition on them of other people's personal beliefs. Dr Lempert is a British Medical Association representative, and chairs the Shropshire division of the BMA.

Kira Antinuk, RN BScN MN
Kira Antinuk lives on Vancouver Island in Canada, where she works as a Medical Adjudication Consultant for the federal government. She also serves as the Executive Director of the Children's Health & Human Rights Partnership, a non-profit organisation of professionals in the fields of medicine, ethics, and law who are committed to ending non-therapeutic genital surgery on children in Canada.

Special thanks to Richard Duncker, of Men Do Complain, for editing the video. Please support his work at Men Do Complain and his Vimeo channel.

Image: esudroff, Pixabay.