Consent for circumcision
Online posting: Sept. 12, 1996
Published in print: Jan. 1, 1997 (CMAJ 1996;156:17)
See response from: E. Etchells, G. Sharpe, P. Walsh
Re: Bioethics for clinicians: 1. Consent, by Dr. Edward Etchells and
associates, CMAJ 1996;155:177-80 [full text / résumé]
I read with interest the initial article in the series on
bioethics. Unfortunately, the issue of consent for one of the
most commonly performed operations in North America — the
circumcision of infant boys — remain unclear.
A report by the Committee on Bioethics of the American Academy of
Pediatrics casts doubt on whether a physician can ethically
perform circumcision on newborns.[1] Neither informed consent nor
patient assent apply because a newborn is not competent. Parental
permission is acceptable only in situations in which medical
intervention is clearly and immediately necessary. Nonessential
treatment that can be deferred without substantial risk should
delayed until the child's consent can be obtained.[1] Clearly,
neonatal circumcision is nonessential, and it is not recommended
by the Canadian Paediatric Society.[2]
Even if informed consent could be obtained, studies show that the
consent process for neonatal circumcision is nearly always
incomplete.[3,4]
Dr. Edward Etchells and associates state, "Under common law,
treating a patient without his or her consent constitutes
battery, whereas treating a patient on the basis of inadequately
informed consent constitutes negligence." Since a newborn cannot
give consent, does neonatal circumcision constitute battery? Does
the incomplete consent process in neonatal circumcision
constitute negligence?
Respect for a patient's autonomy must apply to the weakest among
us; otherwise, no one's autonomy can be assured.
Robert S. Van Howe, MD, FAAP
Marshfield Clinic
Lakeland Center
Minocqua, Wis.
vanhower@dgabby.mfldcl
in.edu
References
- Committee on Bioethics. Informed consent, parental
permission, and assent in pediatric practice. Pediatrics
1995;95:314-7.
- Fetus and Newborn Committee, Canadian Paediatric
Society. Neonatal circumcision revisited. CMAJ
1996;154:769-80.
- Christensen-Szalanski JJ, Boyce WT, Harrell H, Gardner
MM. Circumcision and informed consent. Is more information always
better? Med Care 1987;25:856-67.
- Ciesielski-Carlucci C, Milliken N, Cohen NH.
Determinants of decision making for circumcision. Cambridge Q
Healthc Ethics 1996;5:228-36.
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