Success! Amazon withdraws infant circumcision training kits following NSS campaign

Posted: Wed, 20 Dec 2017 10:14

Amazon UK has confirmed it has withdrawn infant circumcision training kits from sale over child safety concerns following a National Secular Society request to do so.

The Society said Amazon risked normalising unnecessary and risky surgery by allowing a group called ESP to sell the kits on its site. In a letter Dr Antony Lempert, the chair of the NSS's Secular Medical Forum, asked Doug Gurr, the chief executive of Amazon UK, to remove the kits from sale permanently.

"Male circumcision in the UK is wholly unregulated and we fear that the sale of this product may encourage unqualified practitioners to carry out unnecessary surgery on infants in non-clinical conditions, resulting in serious harm," Dr Lempert wrote.

"Non-therapeutic circumcision is unethical and unnecessary and is putting infant boys at risk of death and serious injury. This practice could be encouraged by the morally negligent sale of infant circumcision training kits to the public."

It is unclear whether Amazon's decision, which has been reported in The Independent, is permanent. Similar kits remain on sale (in white and black) on its US site. An Amazon spokesperson told the NSS that these cannot be imported to the UK.

In the UK the kits were priced between £365.16 and £456.60. They included mock torsos with genitals, scissors and scalpels. One was advertised as including "the foreskin, glans penis, frenulum, meatus and coronal groove".

The sales pitch on the Amazon website, which came from a third party seller, said the kits were "made with soft, lifelike material, which is pliable, delicate, and realistic to the touch". They were sold in a variety of colours, and several associated accessories were also on sale separately.

The NSS questioned whether allowing the sale of such items was consistent with Amazon UK's Supply Chain Standards policy, which requires sellers to process the risks of the items they sell. It also voiced concern that the sales pitch for the kits suggested circumcision is done primarily for health reasons.

Dr Lempert also said the sellers had misrepresented the health benefits of circumcision. "No medical association in the world actively recommends routine infant male circumcision for health reasons," he wrote. "Any associated claims for medical benefit of surgical training equipment should be accurate."

The NSS, which campaigns for non-consensual, non-therapeutic circumcision to be outlawed, welcomed Amazon UK's decision to remove the kits from sale. Its chief executive Stephen Evans said: "No child should be subjected to unnecessary medical surgery. The morally negligent sale of infant circumcision training kits to the public normalises this form of abuse and risks encouraging it.

"A growing number of medics and lawyers are questioning forced genital cutting and recognising the need to safeguard boys from this unethical practice. Religious freedom is not an absolute right and certainly doesn't justify the amputation of healthy, functioning body parts from babies' bodies."

Although data is limited, infant circumcision has been linked to serious injuries and deaths. In 2009, the emergency department of Birmingham Children's Hospital admitted 105 boys for circumcision related injuries. In 2011 the same hospital admitted 11 baby boys aged 0-1 years old to their paediatric intensive care unit with life-threatening complications directly caused by circumcision.

In 2012 a nurse in Oldham was found guilty of manslaughter after killing a baby boy in a botched circumcision two years earlier.

The British Association of Paediatric Surgeons has said there is little if any reason to circumcise boys under five years old. In January 2015 the head of the family division of the High Court in England and Wales, Sir James Munby, said non-therapeutic infant male circumcision caused "significant harm" to boys.

This week, Manoj Shenoy, president of the British Association of Paediatric Urologists, told The Independent that the training kits "are not medically appropriate" and said he had concerns they could increase unregulated circumcision.

There is also a growing international medical consensus against ritual circumcision. In September a Belgian federal government committee ruled against the circumcision of infant boys for reasons other than medical necessity.

In 2010 the Royal Dutch Medical Society (KNMG) urged doctors to adopt "a strong policy of deterrence" on infant male circumcision, which it called "a violation of children's rights to autonomy and physical integrity". KNMG said any medical advantages of circumcision were significantly outnumbered by the risks and other disadvantages, such as the loss of up to 30% of erogenous tissue.

In 2013 an international group of physicians criticised the American Academy of Paediatrics for promoting infant male circumcision. The Council of Europe adopted a non-binding resolution advising member states not to allow the ritual circumcision of children unconditionally, at least for very young children. In a joint statement, the Nordic children's ombudsmen condemned non-therapeutic infant circumcision as violating fundamental medical-ethical principles.

And in 2016 the Danish Medical Association said circumcision should only be performed with "informed consent".

Children's right to physical integrity and protection from physical injury is protected by the International Treaty on the Rights of the Child.

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Belgian federal committee rules against ritual circumcision

Posted: Wed, 27 Sep 2017 17:16

A Belgian federal government committee has ruled against the circumcision of infant boys for reasons other than medical necessity.

The Committee for Bio-Ethics ruled that bodily integrity was more important than religious faith.

"As circumcision is irreversible and therefore a radical operation, we find the physical integrity of the child takes precedence over the belief system of the parents," said Marie-Geneviève Pinsar, the committee's chair.

The committee was responding to a question posed by a group of doctors from Brussels in 2014. It said it took three years to make its decision because of the question's religious and cultural importance. Estimates in Belgium suggest 15% of men are circumcised.

The decision will not be binding in law, but it adds to the growing weight of medical opinion against unnecessary male circumcision. In 2010 the Royal Dutch Medical Society (KNMG) advised doctors to discourage parents from having their sons circumcised, urging "a strong policy of deterrence".

It said "non-therapeutic circumcision of male minors is a violation of children's rights to autonomy and physical integrity" and added that the procedure can cause complications including bleeding, infection, urethral stricture and panic attacks.

KNMG said any medical advantages of circumcision were significantly outnumbered by the risks and other disadvantages, such as the loss of up to 30% of erogenous tissue.

In 2013 an international group of physicians criticised the American Academy of Paediatrics for promoting infant male circumcision. The Council of Europe adopted a non-binding resolution advising member states not to allow the ritual circumcision of children unconditionally, at least for very young children. The Scandinavian children's ombudsmen issued a joint statement saying children should be allowed to choose for themselves.

And in 2016 the Danish Medical Association said circumcision should only be performed with "informed consent".

Children's right to physical integrity and protection from physical injury is protected by the International Treaty on the Rights of the Child.

The National Secular Society is committed to ending non-consensual surgery on children when it is performed for religious rather than medical reasons. Antony Lempert, of its Secular Medical Forum, commented:

"The decision by the Belgian government's ethics committee is a welcome addition to the growing international consensus that the surgical assignation of a child's genitals with the religious or cultural preferences of their parents violates medical ethics, even when the child is a boy born into a Jewish or Muslim community.

"That these religious communities feel strongly about the practice of ritual male genital cutting is undeniably the main reason why many have shied away from tackling this practice. Babies can neither resist nor complain yet many adult men are now describing their horror at what was done to them in the name of someone else's beliefs and some have spoken of the lifelong complications. Many within the religious communities themselves are also turning away from the practice in order to protect their children from what is now known to cause significant and irreversible harm.

"Child safeguarding procedures have been developed precisely because parents and cultures cannot and do not always protect the children in their care from harm. To deny a child the most basic of protection from permanent bodily modification especially on the most sensitive and private part of his body is undeniably a violation of his rights.

"UK law should be applied consistently. Repeatedly, UK judges have ruled to protect children from similar and arguably less severe practices on the grounds that the child cannot be assumed to have a belief system and must be guaranteed bodily integrity until they are old enough to make informed decisions about their own body. In the SMF we have long argued that the application of the same principles should result in an immediate end to the cutting of any child's healthy genitals for religious or cultural reasons."

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Doctor faces private prosecution for circumcising baby boy without the mother’s consent

Posted: Wed, 24 May 2017 12:10

A doctor is facing a private prosecution for assault after he circumcised a boy without the mother's consent.

Dr Balvinder Mehat circumcised the child while the boy was under the care of his father, in July 2013.

The procedure was performed on the baby, whose parents are separated, while he was with his father for the day. He was returned to his mother later that day and she said "he was obviously in pain".

Following the circumcision she said he was "screaming and crying."

"He has been mutilated and suffered permanent damage."

She is now using legal aid to bring about a private prosecution against the doctor who carried out the procedure. Police decided that there was not enough evidence to prosecute.

The mother's lawyer, Saimo Chahal QC, said: "This mother did not consent to her son undergoing the circumcision procedure, which could constitute a criminal offence. While some people with religious beliefs see circumcision as normal, there are others who see it as an unnecessary assault which can be physically and psychologically harmful."

Men Do Complain, a group which campaigns against male genital mutilation, say that "non-therapeutic genital cutting has significant physical and psychological consequences and has no proven benefits."

In 2015 Sir James Munby, a senior judge, and President of the Family division of the High Court noted that some forms of type IV FGM were "much less invasive than male circumcision". He said "any form" of FGM constitutes "significant harm", including Type IV FGM and that the same "must therefore be true of male circumcision."

He noted that these similar procedures were treated differently by the law and said it was a "curiosity" that the law "is "still prepared to tolerate non-therapeutic male circumcision performed for religious or even for purely cultural or conventional reasons, while no longer being willing to tolerate FGM in any of its forms."

Type IV FGM includes "all other harmful procedures to the female genitalia for non-medical purposes, for example: pricking, piercing, incising, scraping and cauterization".

In 2012 a German court convicted a doctor under existing German law for assault when he performed non-therapeutic circumcision on a healthy boy. The conviction prompted anger from Muslims and Jews throughout the world. Within a few months, the German Chancellor, Angela Merkel, pushed through new legislation to exempt male circumcision from such legal safeguards and child protection mechanisms.

In 2013 the Parliamentary Assembly of the Council of Europe passed a recommendation challenging "medically unjustified violations of children's physical integrity". It called on the Council to take account of "children's right to physical integrity" and "their right to participate in any decision concerning them".

Meanwhile the first federal female genital mutilation case is being prosecuted in the United States, with defence lawyers planning to argue that FGM is a religious rite.

There has never been a successful prosecution for the FGM in the UK.

“Growing recognition” that circumcision of children is wrong, as Danish doctors call for it to end

Posted: Fri, 9 Dec 2016 15:47

The Danish Medical Association has made a "symbolic" statement calling for an end to male circumcision, arguing that the procedure should only ever be performed with "informed consent".

The Association said that male circumcision involves "pain" and the "risk of complications" and that it was "ethically unacceptable" to perform the operation "without the informed consent of the person undergoing the procedure."

"It is most consistent with the individual's right to self-determination that parents not be allowed to make this decision."

Circumcision should be an "informed personal choice" left to the individual to decide for themselves when they come of age, the Association said.

Though deeply critical of the practice, the Association has stopped short of calling for an outright ban, saying that it would be "difficult to predict the consequences" of a complete prohibition.

Lisa Moller, President of the Medical Association's Ethics Committee, said that the areas "is ethically, culturally and religiously complex, and we worry whether a legal ban might result in unauthorised circumcisions."

Instead, the new policy position says that the "process towards the elimination of circumcision of boys" should be undertaken in dialogue with the religious minorities that practice it.

The statement was welcomed by Doctor Antony Lempert of the National Secular Society's Secular Medical Forum.

"The Danish Medical Association has added its weight to the growing recognition that 'it is wrong to deny an individual the right to choose whether or not they want to be circumcised.' This unequivocal position statement, welcomed by the SMF, recognises that the surgical infliction of parents' religious or cultural beliefs on a normal child's healthy body represents a life-long burden to be borne by the owner of the body.

"It is encouraging that Denmark has joined the growing number of countries willing to challenge harmful religious privilege and practice. The SMF supports the choice not to call for a ban. There is no need to ban an activity that would already be illegal were existing laws against violent assault on vulnerable people implemented.

"The principles of child safeguarding are that children should be protected from serious avoidable harm inflicted on them until such time as they have matured sufficiently to protect themselves and to make their own decisions about what is best for them. That these principles still need to be stated in defence of a child's right to protection from assault is a reflection of the enduring power wielded by adults with religious beliefs.

"The assumption that the child belongs or will later choose to belong to their parents' belief system or culture is increasingly exposed as wishful thinking.

"In the name of tolerance, cultural relativism and widespread misinformation, necessary challenge to traditional practices has been ducked mainly for fear of offending religious adults or communities. But these communities are not homogenous and many within them would welcome support for increased child protection."

Dr Lempert added that in response to campaign work by the Secular Medical Forum, the British Medical Association was considering an update to its position on male circumcision, last revised in 2006.

Forced cutting of young boys’ genitals violates the most fundamental medical ethics

Posted: Mon, 24 Oct 2016 15:39

Too often those who carry out forced cutting of young boys' genitals escape with gentle admonishment, rather than punishment commensurate with the severity of their actions, writes Dr Antony Lempert of the Secular Medical Forum.

In 2013, Dr Hassan Abdulla, a psychiatrist, was convicted of performing illegal surgery on children. Ordinarily this would set major alarm bells ringing but the devil is in the detail. The reason this surgery was illegal was that he had failed to register with the Care Quality Commission, the (CQC), in doing so. The CQC was therefore unable to regulate the conditions under which he operated on children. Once alerted to his practice, the CQC inspected Dr Abdulla's private surgical premises and found that the facilities were substandard and potentially dangerous. In particular, infection control practices were inadequate, equipment was out of date and support staff were not appropriately trained.

In 2014, the Medical Practitioners' Tribunal Service (MPTS) imposed restrictions on his practice. In September this year, already two years later, it was felt that Dr Abdulla had not fully reflected on his misconduct and had not demonstrated sufficient insight; subject to his appeal he has now been suspended from the medical register for 9 months.

Yet this tells only half the story. For years, Dr Abdulla not only admitted but advertised that he operated on the normal genitals of dozens of healthy children. It is common knowledge that the children's parents paid Dr Abdulla to perform the irreversible, surgical assignation of their children's healthy genitals with the parents' own religious or cultural values and beliefs. The right of each of those children to an open future unrestricted by forced genital cutting at an early life was not apparently considered as part of the verdict in this case either by the magistrates court or by the MPTS.

The irony is that if Dr Abdulla should wish to continue to perform unregulated genital surgery on children without any interference from regulatory bodies as he states he does, he might consider de-registering as a medical practitioner. Non-medics are not required to register either with the CQC or with anyone else before they take a knife, scissors or specially-designed surgical instruments for clamping, tearing and removing the highly functional, sensitive foreskin from young boys and babies. It is only after the event, when some babies have died or have been seriously injured that action is occasionally taken. Contrast the response to the deaths four years ago of 28 day old Goodluck Caubergs in Oldham with the death under similar circumstances of 28 day old Joseph Ofori-Mintah in London. Both babies died of haemorrhage from their cut penises within 48 hours of unnecessary surgery performed in the community at the request of their parents. The Nigerian midwife who cut Goodluck was convicted of manslaughter whilst the rabbi who cut Joseph was told by the coroner that it was "a tragic unforeseen accident".

The fact that so many otherwise reasonable people consider it hardly a problem that (male) children's healthy genitals are fair game to any person with a knife, qualified or not, stands testament to the fallacy of common practice. Because something such as non-therapeutic circumcision, has been practised for generations, perhaps with the weight of biblical endorsement, does not mean that it is safe or reasonable to continue to do so. Non-therapeutic forced male genital cutting results in serious physical, sexual and emotional harm to many people. As babies their future views, beliefs and wishes cannot be known, however much their parents may wish them to conform to their own beliefs. Some of these babies don't make it to adulthood, others do so but with significant and enduring harm.

Dr Abdulla might have done better to stick to the branch of medicine in which he is trained: as a psychiatrist. Instead, he has demonstrated an inability to understand the most fundamental medical ethic of 'First do no harm'. In these circumstances, a short-term suspension from the medical register seems like a gentle admonishment rather than punishment commensurate with the severity of his actions.

Dr Antony Lempert is chair of the Secular Medical Forum. The views expressed in our blogs are those of the author and may not represent the views of the NSS.

Secular medics welcome religious circumcision ruling

Posted: Fri, 22 Apr 2016 10:37

A High Court judge has ruled against a devout Muslim who wanted his children circumcised, finding that the boys should be able to make the choice themselves in a judgement welcomed by the Secular Medical Forum.

Dr Antony Lempert of the SMF described the ruling as a small but "welcome" step "towards safeguarding children from forced genital cutting."

Religious requirements "should not be allowed to override a person's most fundamental right to grow up with an intact body and to make their own choices about permanent bodily modifications," he said.

"It is a procedure that permanently removes healthy, erogenous and functional tissue from the most intimate part of a person's body without that person's consent and for no medical reason.

"That it should take a parental disagreement in court for a child to be protected from forced genital cutting remains a serious concern from a child safeguarding perspective."

The judge said that the boys' mother was "resolutely opposed" to having the children circumcised and ruled that "There is no guarantee that these boys will wish to continue to observe the Muslim faith with the devotion demonstrated by their father, although that may very well be their choice."

She added: "They are still very young and there is no way of anticipating at this stage how the different influences in their respective parental homes will shape and guide their development over the coming years."

James Chegwidden, who acted as junior counsel for the mother in the case, said that while he could not comment on the specifics of the case, the ruling was "an encouraging step towards the legal protection every child deserves."

He said that the decision was "a reminder that, together with the freedom to practise a religion or philosophy for oneself, comes the necessary obligation not to impose that religion or philosophy on others."

But he warned that the case revealed "just how limited our current legal protection of our children is."

"Bodily autonomy is a right of every child – it cannot be reduced or ignored simply because both its parents happen to be religious. For a right so fundamental as bodily autonomy for a child to depend totally on the whim of an adult is simply unacceptable.

"The court has still yet to classify infant circumcision as 'significant harm', despite the significant evidence that male genital cutting is at least as invasive as some forms of FGM."

The father, an Algerian-born Muslim who has lived in England for fifteen years, is now separated from the boys' mother, whom he had met ten years ago and subsequently lived with. He entered the UK using false travel documents but was subsequently given a British passport.

The couple separated after the mother, from Devon, and the two boys had to flee their home when he violently attacked her in 2012. He was described as "an increasingly controlling and violent individual who sought to impose restrictions on how she lived her life." He had previously "threatened many times that he will abduct the children to Algeria" and was "violent, threatening and controlling towards the mother."

Mrs Justice Roberts said that the father was a "devout Muslim" committed to ensuring that as part of his son's "dual heritage" they "grow up as Muslims observing all the tenets and practices" of Islam.

The children are currently aged six and four, and the judge said that she had reached a "clear conclusion" about the "irreversible procedure" and that the children should have the right to choose for themselves.

"I am simply deferring that decision to the point where each of the boys themselves will make their individual choices once they have the maturity and insight to appreciate the consequences and longer-term effects of the decisions which they reach," the judge said.

"There are risks, albeit small, associated with the surgery, regardless of the expertise with which the operation is performed.

"There must be clear benefits which outweigh these risks which point towards circumcision at this point in time being in their best interests before I can sanction it as an appropriate course at this stage of their young lives."

The judge's warning about the risks of circumcision came as a medical tribunal heard the case of Dr Muhammad Chaudhary, a doctor accused of bungling a circumcision on a two month old baby, who then allegedly tried to bribe the child's family into dropping a claim against him.

He reportedly told the Muslim family that "Litigation in Muslim culture is not usually a route to adopt especially in ritual matters" in an attempt to stop action being taken against him.

Dr Chaudhary failed to repair the damage he had caused during four further surgeries. After he failed to fix the damage he had caused in the initial operation, he advised the family to "treat him [their son] like the Quran and be gentle."

The child was finally referred to a specialist surgeon, the Mirror reported, and had to endure three additional operations in a hospital.

Doctor Lempert said these cases occurred with "nauseating regularity."

"There are practically no restrictions on who can perform forced genital cutting on young (male) children in the UK. The procedure is almost wholly unregulated in the UK. The reality is that we simply don't know the extent of harm caused to young children by ritual circumcision. We do know that many such children turn up in A&E and some need treatment in paediatric Intensive Care Units as a direct result of non-therapeutic circumcision.

"Dr Chaudhary is being investigated because he is a doctor who is alleged to have behaved dishonestly. Ironically, should Dr Chaudhary be removed from the medical register, he would no longer be required to satisfy even the limited requirements of the GMC in this matter and would be free to continue cutting young boys' genitals."