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Canada
,→The most recent survey was done in 2006-7
[[File:Flag_of_Canada.svg|thumb|150px|Flag of Canada]]== Canada and circumcision == A report on non-therapeutic [[circumcision]] in Canada. ==History== The French-speaking people of Quebec and elsewhere generally do not favour circumcision. Male circumcision is not part of the native culture of indigenous Inuit, First Nations, and Métis populations (4.3% of the population). The Canadian Government established Residential Schools from about 1880 to assimilate the indigneous people into Euro-Canadian culture.<ref name="residential2021">{{REFweb |title=Residential Schools in Canada |url=https://www.thecanadianencyclopedia.ca/en/article/residential-schools |archived= |trans-title= |language= |last=Miller |first= |init=JR |author-link= |publisher=Canadian Encyclopedia |website= |date=2021-06-01 |accessdate=2022-10-26 |quote=}}</ref> The indigenous people who do circumcise today received [[circumcision]] as a cultural procedure from the English-speaking Canadians in the Residential Schools.<ref name="euringer2005">{{REFnews |title=BC Health Pays to Restore Man’s Foreskin |url=https://thetyee.ca/News/2006/07/25/Circumcision/ |last=Euringer |first=Amanda |init=A |publisher=The Tyee |date=2006-07-25 |accessdate=2022-08-21 }}</ref> [[Paul Tinari]], a Métis, attended a residential school near Montreal where he was [[circumcised]] at the age of eight by a Catholic priest and a Jewish [[mohel]]. Tinari states "thousands of young native and Métis boys were [[circumcised]] during their stays in the notorious residential school system."<ref name="euringer2005" /> The medicalized genital cutting of infants and children was first promoted in Canada during the mid to late 19th century by English-speakers after the fashion at the time of the [[United Kingdom]]. Doctors encouraged the genital cutting of both male and female children to prevent [[masturbation]] as well as various diseases like epilepsy and tuberculosis.<ref name="chhrp2018">{{REFdocument |title=International NGO Council on Genital Autonomy Supplementary Country Report Submission on Canada to the U.N. Committee on the Rights of the Child |url=http://chhrp.org/wp-content/uploads/2019/11/Canada-Supplementary-Report.pdf |contribution= |last=Antinuk |first=Kira |author-link=Kira Antinuk |publisher=[[Children's Health & Human Rights Partnership]] |format=PDF |date=2018-07-11 |accessdate=2020-06-23}}</ref>Pirie (1927), in a presentation to the Canadian Society for the Study of Diseases of Children, described [[circumcision]] as "very common".<ref name="pirie1927">{{Construction SiteREFjournal |last=Pirie |first=George R. |init=GR |author-link= |title=The story of circumcision |journal=Can Med Assoc J |date=1927-07 |volume=17 |issue=12 |pages=1540-2 |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC407762/pdf/canmedaj00234-0126.pdf |accessdate=2019-10-26}}</ref> [[Douglas Gairdner]]'s classic 1949 paper, ''The Fate of the Foreskin: A Study of Circumcision'',<ref name="gairdner1949">{{GairdnerDM 1949}}</ref> seems to have been ignored in Canada. Bruce Peter Reimer, later known as [[David Reimer]], was born in Winnipeg, Manitoba on 22 August 1965. His penis was destroyed in an accident during medically-unnecessary, non-therapeutic [[circumcision]] by Dr. [[Jean-Marie Huot]]. Patel (1966) reported his findings on neonatal [[circumcision]] in Kingston, Ontario, Canada. Patel reported a [[complication]] rate of 55 percent experienced in a series of 100 consecutive male infant circumcisions. He also reported on the incidence of circumcision at [http://www.kingstonhsc.ca/ Kingston General Hospital] in Kingston, Ontario. Patel reported an incidence of [[circumcision]] of 48 percent. This is for one hospital in Kingston, {{CAPTC|ON}} but has been widely and falsely cited as the rate for all Canada.<ref>{{REFjournal |last=Patel |first=Hawa |init=H |author-link= |title=The problem of routine infant circumcision |journal=Can Med Assoc J |date=1966 |volume=95 |issue= |pages=576-81 |url=http://www.cirp.org/library/procedure/patel/ |accessdate=2019-10-25}}</ref> Canada, like other English -speaking nations , formerly [[circumcised most ]] many of its boys, with circumcision rates in the sixty 40 to 70 percent rage range in the 1960s.<ref>{{REFjournal
|last=Wirth
|first=John L.
|init=JL
|author-link=
|etal=no
|title=Current circumcision practices: Canada
|journal=Pediatrics
|location=
|DOI=
|accessdate=2019-10-25
}}</ref> The [[Canadian Paediatric Society]] took a position against non-therapeutic (CPS) issued its first statement on neonatal circumcision of boys in 1975, declaring it to have . The statement said "there is no [[medical indication]] for circumcision during the neonatal period." and to be The CPS called the amputation an "obsolete operation" and anticipated a "sharper decrease in the percentage of infants circumcised".<refname="cps1975">{{REFjournal
|last=Swyer
|firstinit=PRPW
|author-link=
|last2=Boston
|first2init2=RW |author2-link= |etal=yes |url=http://www.cirp.org/library/statements/cps1975/ |title=FN 75-01 Circumcision in the newborn period |journal=Canadian Paediatric Society News Bulletin Supplement |date=1975 |volume=88 |issue=2 |pages=1-2 |accessdate=2022-03-18}}</ref> [[Eleanor LeBourdais]] (1995) declared that male [[circumcision]] is "clearly can no longer be regarded as routine procedure."<ref name="lebourdais1995">{{REFjournal |last=LeBourdais |first=Eleanor |init= |author-link= |etal=no |title=Circumcision no longer a "routine" surgical procedure. |journal=Can Med Assoc J |location= |date=1995-06-01 |volume=152 |issue=11 |pages=1873-6 |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1337997/pdf/cmaj00071-0145.pdf |quote= |pubmedID=7773907 |pubmedCID=1337997 |DOI= |accessdate=2019-11-04}}</ref> Dr. [[Arif Bhimji]] (2000) applied international [[human rights]] law and the Canadian Charter of Rights and Freedoms to the practice of non-therapeutic child circumcision. He concluded:<blockquote>Circumcision of male infants is a clear violation of the rights guaranteed to all persons by the [https://www.canada.ca/en/canadian-heritage/services/how-rights-protected/guide-canadian-charter-rights-freedoms.html Canadian Charter of Rights and Freedoms]. Furthermore, the practice contravenes [[human rights]] legislation on provincial and international levels.<ref name="bhimji2000">{{REFjournal |last=Bhimji |first=Arif |init=A |author-link=Arif Bhimji |title=Infant Male Circumcision: A violation of the Canadian Charter of Rights and Freedoms. |journal=Health Law in Canada Journal (HLCJ) |date=2000-01 |volume=1 |issue= |pages=1-33 |url=http://www.cirp.org/library/legal/Canada/court1/ |accessdate=2019-11-07}}</ref></blockquote> == Research into pain of circumcision == Canada has been the the location of important research regarding the [[pain]] of circumcision. [[Janice Lander| Lander]] et al. (1997) conducted a comparison of neonatal non-therapeutic circumcision without anesthesia (current practice in 1997), ring block, dorsal penile nerve block, and a topical eutectic mixture of local anesthetics ([[EMLA]]) at the {{UNI|University of Alberta|UAlberta}}, Edmonton, AB.<ref name="lander1997">{{LanderJ etal 1997}}</ref> With no anaesthesia, the infants screamed continuously. Newborns in the untreated placebo group exhibited homogeneous responses that consisted of sustained elevation of heart rate and high pitched cry throughout the [[circumcision]] and following. Two newborns in the placebo group became ill following circumcision (choking and apnea). One experienced projectile vomiting.<ref name="lander1997" /> [[EMLA]] was the least effective pain control. Dorsal penile nerve block (DPNB) was more effective, and ring block was the most effective. The authors reported "[w]ithout exception, newborns in this study who did not receive an analgesic suffered great distress during and following the circumcision, and they were exposed to unnecessary risk (from choking or apnea)." The authors were so alarmed that they terminated the no anaesthesia arm of the study early.<ref name="lander1997" /> Taddio et al. (1997), working at the [https://www.sickkids.ca/ Hospital for Sick Children], Toronto, {{CAPTC|ON}}, concluded:{{Citation |Text=Although postsurgical central sensitisation (allodynia and hyperalgesia) can extend to sites of the body distal from the wound, suggesting a supraspinal effect, the long-term consequences of surgery done without anaesthesia are likely to include post-traumatic stress as well as pain. It is, therefore, possible that the greater vaccination response in the infants circumcised without anesthesia may represent an <u>infant analogue of a post-traumatic stress disorder</u> triggered by a traumatic and painful event and re-experienced under similar circumstances of pain during vaccination. |Author=Taddio et al. (1997) |ref=<ref name="taddio1997">{{TaddioA KatzJ IlersichAL KorenG 1997}}</ref>}} ==Reported incidence of non-therapeutic child circumcision== The reported incidence of child circumcision in Canada varies by province and has diminished over time. Newfoundland has always had a very low incidence of child circumcision while Alberta and Ontario have had a higher incidence of child circumcision. Johnston (1995) reported that the incidence of child circumcision in Canada had fallen from 60 percent a generation ago to an estimated 25 percent.<ref name="johnston1995">{{REFnews |title=Under the Knife |url=http://www.cirp.org/news/1995.09.11_TorontoStar/ |last=Johnston |first=David |coauthors= |publisher=Toronto Star |website= |date=1995-09-11 |accessdate=2019-10-26 |quote=}}</ref> The Montreal ''Gazette'' (2006) reported that the incidence of circumcision has fallen by 36 percent to 14 percent according to the Association for Genital Integrity, while [https://www.statcan.gc.ca/eng/start Statistics Canada] (2006) reported a high of 29.5 percent in P.E.I. and a low of 1.1 percent in Nova Scotia.<ref>{{REFnews |title=Rates of circumcision slashed in past 30 years. |url=http://www.cirp.org/news/2006-03-23montrealgazette/ |last= |first= |coauthors= |publisher=The Gazette |website= |date=2006-03-23 |accessdate=2019-10-26 |quote=}}</ref><ref>{{REFnews |title=Circumcisions continue to drop: Province has second-lowest rate in the country |url=http://www.cirp.org/news/halifaxdailynews2006-03-25/ |last=MacDonald |first=Andrea |coauthors= |publisher=Halifax Daily News |website= |date=2006-03-25 |accessdate=2019-10-26 |quote=}}</ref> == Position statements of medical societies == === Canadian Paediatric Society (CPS) ===The [[Canadian Paediatric Society]] (CPS) took a position against non-therapeutic circumcision of boys in 1975, declaring it to have "no [[medical indication]]" and to be an "obsolete operation".<ref name="cps1975" /> The CPS revisited circumcision in 1996 and recommended: {{Citation |Text=Circumcision should not be routinely performed. |ref=<ref name="chhrp2018"/><ref name="cps1996">{{REFjournal |last=Outerbridge |first=Eugene |init=E |author-link= |etal=no |title=Neonatal circumcision revisited |journal=Can Med Assoc J |location= |date=1996-03-15 |volume=154 |issue=6 |pages=769-80 |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1487803/pdf/cmaj00090-0027.pdf |quote= |pubmedID=8634956 |pubmedCID=1487803 |DOI= |accessdate=2019-10-26}}</ref> |Author=Canadian Paediatric Society (1996)}} The CPS again considered infant circumcision in 2015. The CPS stated: {{Citation |Text=While there may be a benefit for some boys in high-risk populations and circumstances where the procedure could be considered for disease reduction or treatment, the Canadian Paediatric Society does not recommend the routine circumcision of every newborn male. |ref=<ref name="cps2015">{{REFjournal |last=Sorokin |first=S. Todd |init=ST |author-link= |last2=Finlay |init2=JC
|author2-link=
|last3=Murdock Jeffries |first3init3=AAL
|author3-link=
|last4etal=Paréyes |first4title=CNewborn male circumcision |author4journal=Paediatr Child Health |location= |date=2015-link08 |volume=20 |issue=6 |pages=311-20 |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4578472/ |quote= |pubmedID=26435672 |pubmedCID=4578472 |DOI=10.1093/pch/20.6.311 |accessdate=2019-10-26}}</ref> |last5Author=ReesCanadian Paediatric Society (2015)}}This statement received criticism from [[Intact America]] and [[NOCIRC]] in a joint statement.<ref>{{REFdocument |first5title=EJoint statement in response to the Canadian Paediatric Society |author5url=https://intactamerica.org/joint-linkstatement-in-response-to-the-canadian-paediatric-society/ |contribution= |last6last=Segal |first6first=S |author6-linkpublisher=Intact America |last7format=Sinclair |first7date=JC2015-10-02 |author7accessdate=2024-06-09}}</ref> === College of Physicians and Surgeons of British Columbia (CPSBC) === The [https://www.cpsbc.ca/ College of Physicians and Surgeons of British Columbia] has issued three guidances for its members regarding non-linktherapeutic male circumcision of children. The most recent (2009) says in part: {{Citation |Text=You are not obliged to act upon a request to circumcise an infant, but you must discuss the medical evidence and the current thoughts in bioethics that dissuade you from performing this procedure. You must also inform the parents that they have the right to see another physician. |etalref=no<ref>{{REFdocument |title=FN 75 Circumcision in the newborn period(Infant Male)
|trans-title=
|language=
|url=http://www.cirp.org/library/statements/cpsbc2009/cpsbc-circ-stmt2009.pdf |contribution= |quote= |trans-quote= |quote-lang= |last= |first= |author-link= |publisher=College of Physicians and Surgeons of British Columbia |format=PDF |date=2009-09 |accessdate=2019-11-18}}</ref> |Author=College of Physicians and Surgeons of British Columbia}} === Canadian Urological Association (CUA) === The [[Canadian Urological Association]] (CUA) considered the matter of circumcision and issued a statement in February 2018. The CUA concluded: {{Citation |Text=Given the socioeconomic, educational status, and health demographics of our population, universal neonatal circumcision cannot be justified based on the current evidence available. |ref=<ref name="cua2018">{{REFjournal |last=Dave |first=Sumit |init=S |author-link= |etal=yes |title=Canadian Urological Association guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants (abridged version) |journal=Can Urol Assoc J |location= |date=2018-02 |volume=12 |issue=2 |pages=18-28 |url=https://cuaj.ca/index.php/journal/article/view/5034/3470 |quote= |pubmedID=29381455 |pubmedCID=5937397 |DOI=10.5489/cuaj.5034. Epub 2017 Dec 1 |accessdate=2019-10-26}}</ref> |author=[[Canadian Urological Association]]}} ==Non-availability of third-party payment== Canada has fourteen single-payer health insurance plans (HIPs) — one for each of the ten provinces and three territories and a 14th plan for government employees. The British Columbia HIP stopped paying for non-therapeutic [[circumcision]] in 1984. Ontario HIP stopped payment for non-therapeutic circumcision in July 1995; Saskatchewan stopped in 1996. One by one, all other HIPs have stopped paying for non-therapeutic circumcision. In 2006, Manitoba HIP was the last to stop, but only after the wrong boy was [[circumcised]] at [http://www.sbgh.mb.ca/ St. Boniface Hospital].<ref>{{REFnews |title=Circumcision mix-up |url=http://www.cirp.org/news/canadacom11-18-05/ |last= |first= |publisher=Canada.com |accessdate=2019-10-26}}</ref> <ref name="skeldon2008">{{REFdocument |title=The Medicalization and Resultant Decline of Circumcision in Canada |url=https://prism.ucalgary.ca/bitstream/handle/1880/47498/2008_HMD_Skeldon.pdf?sequence=1 |contribution= |last=Skeldon |first=Sean |publisher=University of Calgary |format=PDF |date=2008-03 |accessdate=2022-06-24}}</ref> [[Third-party payment]] for non-therapeutic circumcision is not presently available anywhere in Canada.<ref name="skeldon2008"/> <ref name="jamesloewen2019">[[James Loewen]] (2019). Personal communication.</ref> Parents who wish to have a son [[circumcised]] must pay out-of-pocket for the costs of the circumcision.<ref name="rediger-muller2013">{{REFjournal |last=Rediger |first=Chris |init=C |author-link= |last2=Muller |first2=Andries J. |init2=AJ |author2-link= |etal=no |title=Parents' rationale for male circumcision |journal=CPS News Bull SupplCan Fam Physician
|location=
|date=19752013-02 |volume=859 |issue=2 |pages=e110-115 |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3576965/ |quote= |pubmedID=23418252 |pubmedCID=3576965 |DOI= |accessdate=2019-10-26}}</ref> ==Reasons for circumcision== Brown & Brown (1987) and Rediger & Muller (2013), working in Saskatoon, found "newborn male circumcision rates continue to be heavily influenced by the circumcision status of the child's father."<ref name="brown-brown1987">{{REFjournal |last=Brown |first=Mark S. |init=MS |author-link= |last2=Brown |first2=Cheryl A. |init2=CA |author2-link= |etal=no |title=Circumcision Decision: Prominence of Social Concerns |journal=Pediatrics |location= |date=1987-08 |volume=80
|issue=2
|pages=1215-219 |url=https://pediatrics.aappublications.org/content/80/2/215? |quote= |pubmedID=3615091 |pubmedCID= |DOI= |accessdate=2019-11-10}}</ref><ref name="rediger-muller2013"/> With the decline in the incidence of [[circumcision]] in Canada that started decades ago, there are fewer and fewer [[circumcised]] fathers, so one would expect the incidence of circumcision in Canada to continue to decline. ==Canadian circumcision deaths== Various deaths caused by circumcision have been reported in Canada, one in British Columbia and two in Ontario. There may be others because [[death]] by circumcision may not be properly reported. * Chino Burrell: 7-months-old, [[Fatalities| death by circumcision]], [https://www.sickkids.ca/ Hospital for Sick Children], Toronto, Ontario, Canada, June 9, 1974.* {{REFweb |url=http://www.circumstitions.com/death-exsang.html |title=Ryleigh McWillis - death from blood loss |last=Newell |first=T.E.C. |author-link= |publisher=British Columbia Coroner's Service |website= |date=2002-08-22 |accessdate=2019-10-26 |format= |quote=}}* {{REFjournal |last=Cairns |init=J |author-link= |etal=yes |title=Circumcision: A minor procedure? |journal=Paediatr Child Health |location= |date=2007-04 |volume=12 |issue=4 |pages=311-2 |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2528673/ |quote= |pubmedID=19030377 |pubmedCID=2528673 |DOI= |accessdate=2019-10-27}}* {{REFnews |title=Ontario newborn bleeds to death after family doctor persuades parents to get him circumcised |url=https://nationalpost.com/health/ontario-newborn-bleeds-to-death-after-family-doctor-persuades-parents-to-get-him-circumcised |last=Blackwell |first=Tom |coauthors= |publisher=National Post |website= |date=2015-10-25 |accessdate=219-11-16 |quote=}} See also: [[Fatalities]]. ==Non-therapeutic circumcision and Canadian law== Non-therapeutic [[circumcision]] of children is a practice that is of uncertain lawfulness in Canada. The ''Charter of Rights and Freedoms'' (1982), [https://www.canada.ca/en/canadian-heritage/services/how-rights-protected/guide-canadian-charter-rights-freedoms.html#a2e Section 7] provides every Canadian with the right to security of the person.<ref name="chhrp2018" /> In addition, Canada is a state-party to the United Nations ''[https://www.ohchr.org/EN/ProfessionalInterest/Pages/CCPR.aspx Covenant on Civil and Political Rights]'' (1966) and the ''[https://www.ohchr.org/en/professionalinterest/pages/crc.aspx Convention on the Rights of the Child]'' (1989), both of which provide various [[human rights]] to children, which are violated by non-therapeutic child circumcision. [[Margaret A. Somerville]], then Director of the [https://www.mcgill.ca/study/2010-2011/faculties/law/information/law_centre_for_medicine_ethics_and_law McGill Centre for Medicine, Ethics and Law], wrote to Pierre Blais in 1993, then Minister for Justice and Attorney-General, to propose that "male circumcision would not be totally banned. Rather circumcision of those persons unable to consent for themselves (which would, of course, include all infants) would not be allowed under the Criminal Code as it presently stands." However, no action was taken.<ref>{{REFweb |url=http://www.cirp.org/library/statementslegal/Canada/Somerville-Blais/ |title=Letter to Pierre Blais, Minister of Justice |last=Somerville |first=Margaret |author-link=Margaret A. Somerville |publisher= |website= |date=1993-01-28 |accessdate=2019-11-04 |format= |quote=}}</ref> Several decisions of the [https://www.scc-csc.ca/home-accueil/index-eng.aspx Supreme Court of Canada] call consent for non-therapeutic circumcision of a child into question, but no case so far has ruled on the matter of circumcision. [[Suzanne Bouclin]] (2005) has examined the issues and concluded:<blockquote>Where a parent or substitute decision maker has deemed that it is in the child’s best interest to undergo a treatment, there may be some conflict between that privilege and the fundamental right to security of the person protected under Section 7 of the Charter. Because the State’s power to intervene is broad and can be permanent, parental decision making has been protected under the Charter. Nevertheless, the Court has determined that parents’ rights are not absolute and that the State will intervene when necessity is demonstrated. Section 7 of the Charter provides everyone with a certain degree of autonomy in decisions concerning their private lives, including those concerning medical treatment. The protection of the security of the person is so fundamental that medical treatment administered without a patient’s [[informed consent]] may amount to battery. In the context of circumcision, if a medical practitioner performs routine neonatal circumcision without an infant’s parental consent, that practitioner may be liable for criminal assault as well as for damages for any harm that resulted from her or his negligence ([[Margaret A. Somerville|Somerville]], 2000). Given that a portion of the medical community has agreed that infant male circumcision is nontherapeutic and that it may be in and of itself be a harmful practice, it is arguable that when performed on neonates for nontherapeutic reasons, it amounts to a violation of the child’s [https://www.justice.gc.ca/eng/csj-sjc/rfc-dlc/ccrf-ccdl/check/art7.html Section 7] rights. As stated at the [[Declaration of the First International Symposium on Circumcision (1989)| Declaration of the First International Symposium on Circumcision]], “parents and/or guardians do not have the right to consent to the surgical removal or modification of their children’s normal genitalia.” The Declaration adds that the only person who may consent to medically unnecessary procedures upon herself or himself is that individual, having reached a stage in life where she or he can consent and only upon being fully informed about the risks and benefits of the procedure. Note, however, that the Declaration is not a binding legal instrument. '''…'''Public awareness is increasing, as evidenced by the numerous parents, health practitioners, children’s rights activists, ethicists, lawyers, and concerned citizens who have voiced their opinion. Insofar as male circumcision is the removal of healthy erogenous flesh without medical purpose and without the consent of the child and given that it is a painful procedure, neonatal circumcision is unnecessary and may well violate a child’s bodily integrity.<ref name="bouclin2005">{{REFjournal |last=Bouclin |first=Suzanne |init=S |author-link=Suzanne Bouclin |etal=no |title=An examination of legal and ethical issues surrounding male circumcision: the Canadian context |journal=Int J Mens Health |location= |date=2005 |volume=4 |issue=3 |pages=205-23 |url=http://www.cirp.org/library/legal/Canada/cps1975bouclin2005/
|quote=
|pubmedID=
|pubmedCID=
|DOI=
|accessdate=2019-10-2527}}</ref></blockquote> ===Canadian Medical Association Code of Ethics and Professionalism=== The CMA code has two statements relevant to the non-therapeutic circumcision of male infants: * Never participate in or support practices that violate basic [[human rights]].* Never participate in or condone the practice of torture or any form of cruel, inhuman, or degrading procedure.<ref name="cma2018">{{REFdocument |title=CMA Code of Ethics and Professionalism |url=https://policybase.cma.ca/en/viewer?file=%2fdocuments%2fPolicyPDF%2fPD19-03.pdf#phrase=false |contribution= |last= |first= |publisher=Canadian Medical Association |format= |date=2018 |accessdate=2021-07-08}}</ref> It therefore appears that non-therapeutic circumcision of boys is unethical in Canada. ===Lawsuit=== The ''New York Post'' (2019) reported that a Canadian woman of African ancestry took her nine-day-old son to the [https://www.vemcregina.com/ Victoria East Medical Clinic] in Regina, SK to be [[circumcised]]. In the course of the circumcision, the tip of his penis was allegedly cut off. An ambulance was called but the [http://www.rqhealth.ca/facilities/regina-general-hospital Regina General Hospital] was unable to reattach the severed part. The family has retained [https://ca.linkedin.com/in/kolade-oladokun-llb-llm-bl-827886114 Kolade Oladokun] who has filed a lawsuit.<ref>{{REFnews |title= Canadian woman sues after tip of son’s penis cut off in circumcision |url=https://nypost.com/2019/08/19/canadian-woman-sues-after-tip-of-sons-penis-cut-off-in-circumcision/ |last=Steinbuch |first=Yaron |coauthors= |publisher=New York Post |website= |date=2019-08-19 |accessdate=2020-06-16 |quote=}}</ref> ==Canada and circumcision in the 21st century== Jackie Smith (2002) discussed the growing consensus against non-therapeutic child circumcision, which she called an "anachronism".<ref name="smith2002">{{REFnews |title=The growing consensus against circumcision |url=http://www.cirp.org/news/nationalpost08-30-02a/ |last=Smith |first=Jackie |coauthors= |publisher=National Post |website= |date=2002-08-30 |accessdate=2019-10-27 |quote=}}</ref> ===Third-party payment is not available=== At the beginning of the 21st Century, only the Manitoba Health Insurance Plan (HIP) still paid for non-therapeutic circumcision, however Manitoba HIP ended payment in 2006.<ref name="skeldon2008" /> No insurance coverage of non-therapeutic circumcision is currently available. ===The incidence of circumcision varies widely by region=== Saskatchewan had an incidence of circumcision in 2000 and 2001 of 27.6 percent. The Saskatchewan College of Physicians and Surgeons said in 2002 that was much too high and should be reduced substantially. The Registrar, Dr. Dennis Kimble, said, "they [doctors] aren't required to carry out a procedure simply because parents want it done."<ref>{{REFnews |title=Sask. college wants circumcision rates reduced |url=http://www.cirp.org/news/medicalpost03-18-02/ |last=Driver |first=Deana |coauthors= |publisher=Medical Post |website= |date=2002-03-19 |accessdate=2021-07-22 |quote=}}</ref> ===The most recent survey was done in 2006-7=== The [https://www.canada.ca/en/public-health.html Public Health Agency of Canada] carried out a survey of mothers' birth experiences in 2006-7. Item 38 was male infant non-therapeutic circumcision. (See pages 224-5.)<blockquote>Among women with a male baby, 31.9% (95% CI: 30.3–33.6) reported circumcising their baby. There was marked regional variation in circumcision. In the 10 jurisdictions in which at least five circumcisions were reported, the proportion of women who reported having their male baby circumcised ranged from 44.3% (95% CI: 39.2–49.4) in Alberta and 43.7% (95% CI: 40.6–46.8) in Ontario to 9.7%† (95% CI: 5.2–14.2) in the Northwest Territories and 6.8%† (95% CI: 3.6–10.0) in Nova Scotia.<ref>{{REFdocument |title=What Mothers Say: The Canadian Maternity Experiences Survey |url=https://www.canada.ca/content/dam/phac-aspc/migration/phac-aspc/rhs-ssg/pdf/survey-eng.pdf |contribution= |last= |first= |publisher=Public Health Agency of Canada |format=PDF |date=2009 |accessdate=2019-10-27}}</ref></blockquote> In all provinces and territories, only a minority of boys are being [[circumcised]]. Sheldon (2008) reported an incidence of 13.9 percent.<ref name="skeldon2008"/> The incidence of circumcision in Labrador and Newfoundland is reported to be close to zero.<ref>{{REFweb |url=https://momlovesbest.com/choosing-circumcision |title=Circumcision: Pros and Cons |last=Goodwin |first=Caitlin |author-link= |publisher= |website=MomLovesBest |date=2019-05-06 |accessdate=2021-07-10 |format= |quote=Labrador and Newfoundland have close to zero}}</ref> The incidence of circumcision in Canada is believed to be one-half or less than that of the [[United States]]. The above referenced survey (2006-7) provides the most recent available statistics on the incidence of non-therapeutic child circumcision in Canada. ===Factors pushing the incidence of non-therapeutic circumcision down=== It is likely that the incidence of circumcision has further declined since the survey was taken for the following reasons: * The long-term trend in the incidence of [[circumcision]] in Canada is down. * The health insurance plans (HIPs) do not support non-therapeutic circumcision.<ref name="skeldon2008" /> * The ratio of [[intact]] fathers to [[circumcised]] fathers is changing toward more [[intact]] fathers and fewer [[circumcised ]]fathers. Boys who were born after the decline in circumcision started and who are [[intact]] are now reaching the age at which they start families and become fathers. [[Intact]] men usually do not want any son to be [[circumcised]] (See [[Adamant father syndrome]]), so they will usually not have a son [[circumcised]].<ref name="rediger-muller2013" /> This will cause a further decline in the incidence of [[circumcision]]. * The large numbers of [[intact]] boys growing up healthy and happy is further eroding support for non-therapeutic [[circumcision]]. * The survey (2006) found that the incidence of circumcision on Prince Edward Island was 38 percent. A recent report (2019) indicated that non-therapeutic circumcision of boys is no longer available on P.E.I. because no practitioner will perform the non-therapeutic [[amputation]] of part of a boy's [[penis]].<ref>{{REFnews |title=Mom 'enraged' she can't find doctor to perform circumcision on P.E.I. |url=https://www.cbc.ca/news/canada/prince-edward-island/p-e-i-no-doctors-circumcision-1.5187284 |last=Williams |first=Nicole |coauthors= |publisher=CBC News |website= |date=2019-06-24 |accessdate=2019-10-27 |quote=}}</ref> * Most hospitals do not provide non-therapeutic circumcision, however [https://www.wrh.on.ca/ Windsor Regional Hospital] is an exception to the general rule. Windsor Regional Hospital still promotes medically-unnecessary, non-therapeutic [[circumcision]] to parents of normal, healthy male infants in apparent violation of the infants' [https://www.justice.gc.ca/eng/csj-sjc/rfc-dlc/ccrf-ccdl/check/art7.html Section 7 rights]. The hospital is reported to circumcise 51 percent of boys born in the hospital. This is far higher than the incidence of non-therapeutic circumcision elsewhere in Ontario and Canada.<ref>{{REFnews |title=Circumcisions spark debate |url=http://www.cirp.org/news/windsorstar03-19-05/ |last=Williamson |first=Doug |coauthors= |publisher=Windsor Star |website= |date=2005-03-19 |accessdate=2021-07-22 |quote=Dr. Tony Hammer, a Windsor family doctor, said his colleagues may be performing the medically unnecessary procedure simply to make a buck. <b>…</b> There is a financial incentive for physicians, and I wonder if they are fully informing their patients of a lack of medical need.}}</ref> * The [https://www.cpso.on.ca/ College of Physicians and Surgeons of Ontario] (2010) issued a special order to prohibit paediatrician [[Daniel Marshall]], who operated the Circumcision Centre in Hamilton, {{CAPTC|ON}} from examining or being alone with youths. DeMaria et al. (2013) surveyed physicians in southwest Ontario who still perform circumcisions. They concluded from their survey: {{Citation |Text=Our survey findings indicate that most physicians performing neonatal circumcisions in our community have received informal and unstructured training. This lack of formal instruction may explain the complications and unsatisfactory results witnessed in our pediatric urology practice. Many practitioners are not aware of the contraindications to neonatal circumcision and most non-surgeons perform the procedure without being able to handle common post-surgical complications. |ref=<ref name="demaria2013">{{REFjournal |last=De Maria |first= |init=J |author-link= |last2=Abdulla |first2= |init2=A |author2-link= |last3=Pemberton |first3= |init3=J |author3-link= |last4=Roees |first4= |init4=A |author4-link= |last5=Braga |first5= |init5=LH |author5-link= |etal=no |title=Are Physicians Performing Neonatal Circumcisions Well Trained? |journal=Can Urol Assoc J |location= |date=2013 |volume=7 |issue=7-8 |article= |page=260-4 |pages= |url=https://cuaj.ca/index.php/journal/article/view/200 |pubmedID=24032062 |pubmedCID= |DOI=https://doi.org/10.5489/cuaj.200 |accessdate=2021-06-24}}</ref> |Author=DeMaria et al. (2013)}} The CBC (2018) reported that Pakistani [https://www.ratemds.com/doctor-ratings/78555/Dr-Ejaz-Ahmad-Winnipeg-MB.html/ Dr. Ejaz Ahmad], who practiced medicine on Portage Avenue in Winnipeg, had been suspended from the practice of medicine for five months by the [https://cpsm.mb.ca/ College of Physicians and Surgeons of Manitoba], after he performed 18 circumcisions from June 2016 to July 2017 on pediatric patients and two boys almost bled to death.<ref name="glowaki2018">{{REFnews |title=2 boys almost bled to death in botched circumcisions by Manitoba doctor |url=https://www.cbc.ca/news/canada/manitoba/winnipeg-doctor-suspended-botched-circumcisions-1.4953561 |last=Glowaki |first=Laura |init= |author-link= |last2= |init2= |author2-link= |publisher=CBC News |website= |date=2018-12-20 |season= |accessdate=2022-07-05 |format= |quote=}}</ref> The CBC reported: <blockquote>Among the complications, two boys were rushed to hospital with potentially life-threatening bleeds, one after a portion of his [[penis]] was amputated and the other with arterial bleeding. Other boys experienced complications like swelling, pain, embedded gauze from improper wound care, possible infections and disfigurement. At least one boy's [[penis]] was left so deformed he required a revision surgery.<ref name="glowaki2018" /></blockquote> The circumcisions performed by Dr. Ahmad were performed for cultural reasons, not medical reasons, so they were not insured by Manitoba Health. The CBC reported: <blockquote>Along with malpractice, the college found Ahmad displayed several "multi-dimensional" professional shortcomings. He neglected to warn parents about the risks of their surgeries, failed to create records and when families went to other doctors for help, he told them not to disclose who had carried out the surgeries. In one instance, Ahmad told a doctor and nurses in an emergency room the procedure had been performed by a "traditional man" and not, in fact, himself.<ref name="glowaki2018" /></blockquote> The [https://www.gov.mb.ca/health/ Manitoba Department of Health] issued a ''Patient Safety Learning Advisory'' in February 2018 regarding an incident in which a newly [[circumcised]] infant boy experienced [[bleeding]] after his non-therapeutic [[circumcision]]. A blood pressure cuff suitable for infants was not available so a proper diagnosis was not made. The boy was discharged home, however [[bleeding]] continued and the boy was returned to the emergency department but was then transferred to a tertiary care facility. The boy suffered multiple complications.<ref>{{REFweb |title=Patient Safety Learning Advisory |url=https://www.gov.mb.ca/health/patientsafety/docs/psla61.pdf |archived= |trans-title= |language= |last= |first= |author-link= |publisher=Manitoba Health, Seniors and Active Living |website= |date=2018-02 |accessdate=2022-07-04 |format=PDF |quote=The infant required transfer to a tertiary care site by the neonatal transport team due to multiple complications.}}</ref> Infant boys have very little blood in their tiny bodies so the ability to withstand [[bleeding]] is very limited. Typically, exsanguination and hypovolemic shock occurs. Manitoba Services (2022) reported Winnipeg attorney [https://www.bestlawyers.com/lawyers/martin-j-pollock/76357 Martin Pollock] filed a Statement of Claim on 22 June 2022 in the Court of Queen's Bench on behalf of the Muslim mother of a five-year-old boy who was circumcised in Portage la Prairie in 2017. The suit names [https://www.gov.mb.ca/health/ Manitoba Health] and three health care workers as defendants. The mother "alleges in the lawsuit that the injuries suffered by her son were caused or contributed to by the negligence of the two doctors, the nurse and the health region named in the suit, which led to 'severe and permanent injuries.'"<ref>{{REFnews |title=Baby who bled for hours after circumcision was sent home from ER twice, suffered brain damage: lawsuit |url=https://manitobaservices.com/news/baby-who-bled-for-hours-after-circumcision-was-sent-home-from-er-twice-suffered-brain-damage-lawsuit/ |last=Manny |first= |init= |author-link= |last2= |init2= |author2-link= |publisher=Manitoba Services |website= |date=2022-07-03 |season= |accessdate=2022-07-05 |format= |quote=The child, now five years old, lives with motor impairment, irreversible brain damage, impaired vision and speech, and developmental delay. He “will continue to suffer the effects of his disabilities for the balance of his lifetime,” the suit says.}}</ref> As of 2022, [[third-party payment]] for non-therapeutic [[circumcision]] has not been available anywhere in Canada since 2006.<ref name="skeldon2008" /> Moreover, non-therapeutic circumcision is not done in most hospitals,<ref name="jamesloewen2019" /> so parents who want to have a boy [[circumcised]] must take the boy to the surgery of a practitioner who specializes in non-therapeutic male circumcision, and furthermore must pay out of pocket. For example, the cost of circumcision of a newborn boy in New Brunswick is C$425 ranging up to C$1500 for a teenager or adult.<ref>{{REFweb |url=https://gentleproceduresnb.ca/circumcision/cost-how-much/ |title=Circumcision Pricing & Insurance Coverage |publisher=Gentle Procedures Clinic |accessdate=2019-11-06}}</ref> The prevalence of circumcision is higher among older males, but lower among younger males. As older, mostly [[circumcised]] males die and are replaced in the population by younger, mostly [[intact]] males, the overall prevalence of [[circumcised]] men in Canada is gradually declining. [[Intact]] males usually do not want any son to be [[circumcised]],<ref name="brown-brown1987" /> <ref name="rediger-muller2013" /> so the demand for [[circumcision]] in Canada is declining. Mayan et al. (2021) carried out a massive empirical study of the male population of the province of Ontario, Canada (569,950 males), of whom 203,588 (35.7%) were [[circumcised]] between 1991 and 2017. The study concluded that circumcision status is not related to risk of [[HIV]] infection.<ref name="mayan2021">{{REFjournal |last=Mayan |first=Madhur |init= |author-link= |last2=Hamilton |first2=Robert J. |init2= |author2-link= |last3=Juurlink |first3=David N. |init3= |author3-link= |last4=Austin |first4=Peter C. |init4= |author4-link= |last5=Jarvi |first5=Keith A. |init5= |author5-link= |etal=no |title=Circumcision and Risk of HIV Among Males From Ontario, Canada |journal=J Urol |location= |date=2021-09-23 |volume= |issue= |article= |page= |pages= |url=https://www.auajournals.org/doi/pdf/10.1097/JU.0000000000002234 |quote=We found that circumcision was not independently associated with the risk of acquiring [[HIV]] among men from Ontario, Canada. |pubmedID=34551593 |pubmedCID= |DOI=10.1097/JU.0000000000002234 |accessdate=2021-10-02
}}</ref>
Schröder et al. (2021) reviewed the experience of the [https://www.sickkids.ca Hospital for Sick Children] in Toronto with regard to circumcision-related emergency admissions between 2000 and 2013. They found that 19 previously healthy neonates had emergency admissions for circumcision complications. The records of patients who had died were searched to identify those who had been [[circumcised]].
Four of the boys had post-circumcision [[bleeding]]. Four of the boys had [[glans]] amputations. Two previously healthy boys died.<ref name="shroder2021">{{REFjournal
|last=Schröder
|first=Annette
|init=
|author-link=
|last2=Farhat
|first2=Walid A.
|init2=
|author2-link=
|last3=Chiasson
|first3=David
|init3=
|author3-link=
|last4=Wilson
|first4=Gregory J.
|init4=
|author4-link=
|last5=Koyle
|first5=Martin A.
|init5=
|author5-link=
|etal=no
|title=Serious and Fatal Complications after Neonatal Circumcision
|trans-title=
|language=
|journal=Eur Urol
|location=
|date=2021-12-12
|volume=29
|issue=
|article=
|page=
|pages=S2405-4569(21)00316-3
|url=https://www.eu-focus.europeanurology.com/article/S2405-4569(21)00316-3/fulltext
|archived=
|quote=
|pubmedID=34973956
|pubmedCID=
|DOI=10.1016/j.euf.2021.12.005
|accessdate=2022-01-15
}}</ref> Based on the data provided, the estimated [[death]] rate is one dead boy for every 84,000 circumcisions.
Non-circumcision or [[genital integrity]] is the norm in all parts of Canada.
==Video==
[[Christopher Guest]], {{MD}}, {{FRCPC}}, of Barrie, {{CAPTC|ON}}, discusses circumcision in Canada:
<youtube>7-vbutOy4X8</youtube>
A news report on circumcision in Canada.
<youtube>Yf06OSHcZc8</youtube>
{{SEEALSO}}
* [[Canadian Children's Rights Council]]
* [[Circumcision]]
* [[Circumcision maps]]
* [[Children’s Health & Human Rights Partnership]]
* [[Circumcision: The Whole Story]]
* [[Child Circumcision: Rites or Rights?]]
* [[College_of_Physicians_and_Surgeons_of_Ontario]]
* [[Foreskin]]
* [[Trauma]]
* [[2020 USA & Canada Circumcision Crisis Protests]]
{{LINKS}}
* {{REFweb
|url=http://can-fap.net/
|title=Canadian Foreskin Awareness Project
|last=Callender
|first=Glen
|author-link=Glen Callender
|publisher=
|website=
|date=
|accessdate=2019-12-16
}}
{{ABBR}}
{{REF}}
[[Category:Circumcision]]
[[Category:Male circumcision]]
[[Category:Canada]]
[[Category:Lawsuit]]
[[Category:Statistics]]
[[Category:History]]
[[de:Kanada]]