Difference between revisions of "United Kingdom"

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[[File:Flag of the United Kingdom.svg|thumb|150px|Flag of the United Kingdom]]
 
The '''United Kingdom (UK)''' was the scene of early efforts to promote male circumcision. It influenced the adoption of male [[circumcision]] in other English-speaking nations. Later it was the scene of efforts to reduce and eliminate the practice.
 
The '''United Kingdom (UK)''' was the scene of early efforts to promote male circumcision. It influenced the adoption of male [[circumcision]] in other English-speaking nations. Later it was the scene of efforts to reduce and eliminate the practice.
  
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While Jews living in the UK practiced [[Jewish circumcision| ritual circumcision]] of boys on the eighth day of life in accordance with the [[Abrahamic covenant]], the practice was nearly unknown among gentiles.  
+
While Jews residing in the UK practiced [[Jewish circumcision| ritual circumcision]] of boys on the eighth day of life in accordance with the [[Abrahamic covenant]], the practice was nearly unknown among gentiles.  
  
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French physician Claude-François Lallemand (1790-1854) recommended circumcision as a treatment for spermatorrhea (excessive, involuntary ejaculation), which was then believed to be a disease. Lallemand influenced English physicians such as William Acton.<ref>{{REFjournal
+
==Introduction of circumcision as a medical practice==
 +
 
 +
French physician [[Claude François Lallemand]] (1790 – 1854) recommended [[circumcision]] as a treatment for ''spermatorrhea'' (excessive, involuntary ejaculation), which was then believed to be a disease. Lallemand influenced later English physicians such as [[William Acton]].<ref name="darby2005">{{REFjournal
 
  |last=Darby
 
  |last=Darby
 
  |first=Robert
 
  |first=Robert
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  |init=
+
  |init=R
 
  |author-link=Robert Darby
 
  |author-link=Robert Darby
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|etal=no
 
 
  |title=Pathologizing Male Sexuality: Lallemand, Spermatorrhea, and the Rise of Circumcision
 
  |title=Pathologizing Male Sexuality: Lallemand, Spermatorrhea, and the Rise of Circumcision
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|trans-title=
 
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|language=
 
 
  |journal= J Hist Med Allied Sci
 
  |journal= J Hist Med Allied Sci
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|location=
 
 
  |date=2005-07
 
  |date=2005-07
 
  |volume=60
 
  |volume=60
 
  |issue=3
 
  |issue=3
 +
|pages=283-319
 +
|url=https://books.google.de/books?id=kn-nYdTpGx4C&pg=PA117&redir_esc=y#v=onepage&q&f=false
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|pubmedID=15917258
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|DOI=10.1093/jhmas/jri042
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|accessdate=2021-09-04
 +
}}</ref>
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 +
[[Edward H. Dixon]] (1845) from New York, [[United States| USA]], advocated circumcision to prevent [[masturbation]].<ref name="Dixon1845">{{Dixon1845}}</ref>
 +
 +
Sir [[Jonathan Hutchinson]] (1828 – 1913) was an English surgeon, dermatologist, ophthalmologist, pathologist and venereologist.<ref>{{REFweb
 +
|url=https://litfl.com/jonathan-hutchinson/
 +
|archived=
 +
|title=Jonathan Hutchinson
 +
|trans-title=
 +
|language=
 +
|last=Zhang
 +
|first=Gary
 +
|author-link=
 +
|last2=Cadogan
 +
|init2=
 +
|first2=Mike
 +
|author2-link=
 +
|publisher=Life in the Fast Lane
 +
|website=
 +
|date=2020
 +
|accessdate=2021-09-04
 +
|format=
 +
|quote=
 +
}}</ref> Darby describes Hutchinson as a puritanical and gloomy Quaker who disapproved of masturbation on moral grounds.<ref name="darby2017>{{REFweb
 +
|url=https://www.historyofcircumcision.com/templates/pages/the_crotchets_of_sir_jonathan_hutchinson.html
 +
|archived=
 +
|title=The crotchets of Sir Jonathan Hutchinson
 +
|trans-title=
 +
|language=
 +
|last=Darby
 +
|first=Robert
 +
|author-link=Robert Darby
 +
|publisher=
 +
|website=The History of Circumcision
 +
|date=
 +
|accessdate=2021-09-04
 +
|format=
 +
|quote=
 +
}}</ref> Sir Jonathan advocated circumcision to prevent syphilis.<ref name="hutchinson1855">{{REFjournal
 +
|last=Hutchinson
 +
|first=Jonathan
 +
|init=
 +
|author-link=Jonathan Hutchinson
 +
|title=On the Influence of Circumcision in Preventing Syphilis
 +
|journal=Medical Times and Gazette
 +
|date=1855
 +
|volume=32
 +
|issue=844
 +
|pages=542-543
 +
|url=
 +
|quote=
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|pubmedID=
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|pubmedCID=
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|DOI=
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|accessdate=2021-09-04
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}}</ref>
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[[Nathaniel Heckford]], a paediatrician at the East London Hospital for Children, wrote ''Circumcision as a Remedial Measure in Certain Cases of Epilepsy, Chorea, etc.'' (1865), in which he argued that circumcision acted as an effective remedial measure in the prevention of certain cases of epilepsy and chorea.<ref name="heckford1865!>{{Heckford1865}}</ref>
 +
 +
Sir Jonathan Hutchinson started to promote circumcision to prevent masturbation in 1890.<ref name="darby2017" /> He first published ''A Plea for Circumcison'',<ref name="hutchinson1990!>{{REFjournal
 +
|last=Hutchinson
 +
|init=
 +
|first=Jonathan
 +
|author-link=Jonathan Hutchinson
 +
|title=A plea for circumcision
 +
|journal=Archives of Surgery
 +
|url=
 +
|date=1890
 +
|volume=II
 +
|issue=
 +
|pages=15
 +
|accessdate=2021-09-04
 +
}}</ref>, followed by ''On circumcision as a preventive of masturbation''.<ref>{{REFjournal
 +
|last=Hutchinson
 +
|init=
 +
|first=Jonathan
 +
|author-link=
 +
|url=
 +
|title=On circumcision as a preventive of masturbation
 +
|journal=Archives of Surgery
 +
|date=1890
 +
|volume=II
 +
|issue=
 +
|pages=267-9
 +
|accessdate=2021-09-04
 +
}}</ref>
 +
 +
Sir Jonathan was not yet done. He published yet another article ''On Circumcision'' in 1893.<ref>{{REFjournal
 +
|last=Hutchinson
 +
|init=
 +
|first=Jonathan
 +
|author-link=Jonathan Hutchinson
 +
|url=
 +
|title=On circumcision
 +
|journal=Archives of Surgery
 +
|date=1893
 +
|volume=IV
 +
|issue=
 +
|pages=379-80
 +
|accessdate=2021-08-04
 +
}}</ref>
 +
 +
==Early Twentieth century==
 +
Sir [[Jonathan Hutchinson]] (1900) opened the twentieth century with an article advocating male circumcision as a way to decrease the pleasure of sex, and hence to discourage sexual immorality.<ref>{{REFjournal
 +
|last=Hutchinson
 +
|first=Jonathan
 +
|init=J
 +
|title=The advantages of circumcision
 +
|journal=The Polyclinic
 +
|date=1900-09
 +
|volume=3
 +
|issue=9
 +
|pages=129-131
 +
|url=
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|quote=
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|pubmedID=
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|pubmedCID=
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|DOI=
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|accessdate=2021-09-04
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}}</ref>
 +
 +
Sir Frederick Treves (1853 – 1923), a prominent Harley Street surgeon, who is known to us by ''The Elephant Man'' film, wrote an operative manual in 1903 to educate other surgeons in the performance of the circumcision [[amputation]].<ref name="treves1902>{{REFbook
 +
|last=Treves
 +
|first=Frederick
 +
|init=F
 +
|author-link=
 +
|year=1903
 +
|title=Circumcision
 +
|url=
 +
|work=A Manual of Operative Surgery, II.
 +
|editor=
 +
|edition=
 +
|volume=
 +
|chapter=Chapter VI
 +
|pages=670-3
 +
|location=London
 +
|publisher=Cassell
 +
|isbn=
 +
|quote=
 +
|accessdate=2021-09-04
 +
|note=
 +
}}</ref> The practice of male circumcision was well established in the United Kingdom as the twentieth century began.
 +
 +
[[R. W. Cockshut|Cockshut]] (1935) published a letter in the ''British Medical Journal'' that urged circumcision of all male infants because the "glans of the circumcised rapidly assumes a leathery texture less sensitive than [[skin]]." The advantage, according to [[R. W. Cockshut|Cockshut]], is that masturbation would be reduced.<ref name="cockshut1935">{{REFjournal
 +
|last=Cockshut
 +
|init=RW
 +
|author-link=R. W. Cockshut
 +
|etal=no
 +
|title=Circumcision
 +
|journal=BMJ
 +
|location=
 +
|date=1935-10-19
 +
|volume=2
 +
|issue=3902
 +
|pages=764
 +
|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2461310/pdf/brmedj07592-0054a.pdf
 +
|archived=
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|quote=
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|pubmedID=
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|pubmedCID=
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|DOI=
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|accessdate=2021-09-04
 +
}}</ref>
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 +
Rickwood et al. (2000) reported that the incidence of boys [[circumcised]] reached 35 percent by the early 1930s.<ref name="rickwood2000">{{REFjournal
 +
|last=Rickwood
 +
|first=
 +
|init=AMK
 +
|author-link=
 +
|last2=Kenny
 +
|first2=
 +
|init2=SE
 +
|author2-link=
 +
|last3=Donald
 +
|first3=
 +
|init3=SC
 +
|author3-link=
 +
|etal=no
 +
|title=Towards evidence based circumcision of English boys: survey of trends in practice
 +
|trans-title=
 +
|language=
 +
|journal=BMJ
 +
|location=
 +
|date=2000
 +
|volume=321
 +
|issue=
 +
|article=
 +
|page=
 +
|pages=792-3
 +
|url=https://www.bmj.com/content/321/7264/792.1.full
 +
|archived=
 +
|quote=
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|pubmedID=11009516
 +
|pubmedCID=27490
 +
|DOI=10.1136/bmj.321.7264.792
 +
|accessdate=2021-09-05
 +
}}</ref>
 +
 +
Despite these efforts to promote [[circumcision]], [[foreskinned]] men have always been and remain the norm in the United Kingdom.
 +
 +
==Reduction of practice==
 +
A national election was held in the United Kingdom at the end of World War II. The Labour Party gained a majority of the seats in Parliament and its leader, Clement Atlee, became prime minister. The party leaned to the left and supported social welfare. Aneurin Bevan was Minister of Health. [https://www.nhs.uk/ The National Health Service] (NHS) was created in 1948 to provide free medical treatment for all. Services were provided based on clinical need, not ability to pay. The NHS did not provide non-therapeutic [[circumcision]], so the incidence of circumcision dropped to a very low level.<ref name="gollaher1994">{{GollaherDL 1994}}</ref>
 +
 +
Sir [[James Calvert Spence]], a prominent senior British paediatrician, urged his younger colleague, [[Douglas Gairdner]], to produce a paper on infant circumcision. The now famous classic paper, ''The fate of the foreskin: a study of circumcision'', was published in the ''British Medical Journal'' on Christmas Eve, 1949. The paper reported 16 deaths per year from non-therapeutic infant circumcision and concluded in part: "'''The prepuce of the young infant should therefore be left in its natural state.'''"<ref name="gairdner1949">{{GairdnerDM 1949}}</ref>
 +
 +
The NHS provides male circumcision only when there was a clinical need.<ref>{{REFweb
 +
|url=https://www.nhs.uk/conditions/circumcision-in-men/
 +
|archived=
 +
|title=Circumcision in men
 +
|trans-title=
 +
|language=
 +
|last=
 +
|first=
 +
|author-link=
 +
|publisher=National Health Service
 +
|website=
 +
|date=2018-11-05
 +
|accessdate=2021-09-05
 +
|format=
 +
|quote=
 +
}}</ref> The NHS performs circumcisions on boys only for therapeutic need.<ref name="nhschild">{{REFweb
 +
|url=https://www.nhs.uk/conditions/circumcision-in-boys/
 +
|archived=
 +
|title=Circumcision in boys
 +
|trans-title=
 +
|language=
 +
|last=
 +
|first=
 +
|author-link=
 +
|publisher=National Health Service
 +
|website=
 +
|date=2018-11-20
 +
|accessdate=2021-09-05
 +
|format=
 +
|quote=
 +
}}</ref>
 +
 +
The ''British Medical Journal'', the house organ of the [https://www.bma.org.uk British Medical Association], in an unsigned editorial in 1979, slammed the practice of child circumcision, calling it unnecessary, and citing the danger of contracting staphylococcal [[infection]] in the newborn nursery.<ref>{{REFjournal
 +
|last=Van Howe
 +
|first=Robert S.
 +
|init=RS
 +
|author-link=Robert S. Van Howe
 +
|last2=Robson
 +
|first2=
 +
|init2=WM
 +
|author2-link=
 +
|etal=no
 +
|title=The possible role of circumcision in newborn outbreaks of community-associated methicillin-resistant Staphylococcus aureus
 +
|journal=Clin Pediatr (Phila)
 +
|location=
 +
|date=2007-05
 +
|volume=46
 +
|issue=4
 +
|article=
 +
|page=
 +
|pages=356-8
 +
|url=
 +
|archived=
 +
|quote=
 +
|pubmedID=17475996
 +
|pubmedCID=
 +
|DOI=10.1177/0009922806294847
 +
|accessdate=2021-09-10
 +
}}</ref> The editorial reported that the incidence of newborn circumcision in Britain had dropped from one-third in the 1930s to one
 +
fifth in 1949, to ten percent in 1963, and to six percent in 1975.<ref name="bmj1979">{{REFjournal
 +
|last=Anonymous
 +
|first=
 +
|init=
 +
|author-link=
 +
|etal=no
 +
|title=The case against circumcision
 +
|trans-title=
 +
|language=
 +
|journal=BMJ
 +
|location=
 +
|date=1979-05-05
 +
|volume=6172
 +
|issue=
 +
|article=
 +
|page=
 +
|pages=1163-64
 +
|url=http://www.cirp.org/library/general/BMJ/
 +
|archived=
 +
|quote=
 +
|pubmedID=444990
 +
|pubmedCID=1599351
 +
|DOI=
 +
|accessdate=2021-09-05
 +
}}</ref>
 +
===Phimosis diagnosis issues===
 +
Fewer boys were being [[circumcised]] so there were more [[intact]] boys. The general practitioners (GPs) in the UK seemed to be unable to distinguish between true [[phimosis]] and developmentally non-retractile healthy [[foreskin]] and were referring numerous boys for unnecessary [[circumcision]].
 +
 +
Rickwood et al. (1980) had provided guidance on diagnosis of [[phimosis]]. According to Rickwood et al. true [[phimosis]] occurs when the [[foreskin]] has been attacked by [[balanitis xerotica obliterans]] (BXO) (also known as lichen sclerosis). If BXO is not present then true phimosis does not exist.<ref name="rickwood1980">{{REFjournal
 +
|last=Rickwood
 +
|first=
 +
|init=AMK
 +
|author-link=
 +
|last2=Hemalatha
 +
|first2=
 +
|init2=V
 +
|author2-link=
 +
|last3=Batcup
 +
|first3=
 +
|init3=G
 +
|author3-link=
 +
|last4=Spitz
 +
|first4=
 +
|init4=L
 +
|author4-link=
 +
|etal=no
 +
|title=Phimosis in boys
 +
|trans-title=
 +
|language=
 +
|journal=Brit J Urol
 +
|location=
 +
|date=1980-04
 +
|volume=52
 +
|issue=
 +
|article=
 +
|page=
 +
|pages=147-60
 +
|url=http://www.cirp.org/library/treatment/phimosis/rickwood/
 +
|archived=
 +
|quote=
 +
|pubmedID=7191744
 +
|pubmedCID=
 +
|DOI=10.1111/j.1464-410x.1980.tb02945.x
 +
|accessdate=2021-09-05
 +
}}</ref>
 +
 +
Several papers critical of phimosis diagnosis practice in the UK were published in the late 1980s and early 1990s. Rickwood & Walker (1989) reported that in the Mersey region (northwest England) "many boys are [[circumcised]] for development non-retractability of the prepuce rather than for true [[phimosis]] and that in consequence some two-thirds of the operations are unnecessary."<ref name="rickwood1989">{{REFjournal
 +
|last=Rickwood
 +
|first=
 +
|init=AMK
 +
|author-link=
 +
|last2=walker
 +
|first2=Jenny
 +
|init2=
 +
|author2-link=
 +
||etal=no
 +
|title=Is phimosis overdiagnosed in boys and are too many circumcisions performed in consequence?
 +
|trans-title=
 +
|language=
 +
|journal=Ann R Coll Surg Engl
 +
|location=
 +
|date=1989-09
 +
|volume=71
 +
|issue=5
 +
|article=
 +
|page=
 +
|pages=275-7
 +
|url=http://www.cirp.org/library/treatment/phimosis/rickwood2/
 +
|archived=
 +
|quote=
 +
|pubmedID=2802472
 +
|pubmedCID=2499015
 +
|DOI=
 +
|accessdate=2021-09-05
 +
}}</ref> Griffiths & Frank (1992) also expressed concern regarding the apparent inability of general practitioners to distinguish between a true phimosis and a developmentally non-retractile [[foreskin]]. They pointed out, "Not surprisingly, the diagnostic inaccuracy was greatest when the referring doctor did not examine the patient."<ref name="griffiths1992">{{REFjournal
 +
|last=Griffiths
 +
|first=
 +
|init=D
 +
|author-link=
 +
|last2=Frank
 +
|first2=
 +
|init2=JD
 +
|author2-link=
 +
|etal=no
 +
|title=Inappropriate circumcision referrals by GPs
 +
|trans-title=
 +
|language=
 +
|journal=J R Soc Med
 +
|location=
 +
|date=1992
 +
|volume=85
 +
|issue=
 +
|article=
 +
|page=
 +
|pages=324-5
 +
|url=http://www.cirp.org/library/procedure/griffiths-frank/
 +
|archived=
 +
|quote=
 +
|pubmedID=1625262
 +
|pubmedCID=1293493
 +
|DOI=
 +
|accessdate=2021-09-05
 +
}}</ref> Gordon & Collin (1993) attempted to cast some light in the darkness by providing factual information about actual indications for circumcision and how to distinguish between physiological and pathological phimosis.<ref>{{REFjournal
 +
|last=Gordon
 +
|first=Andrew
 +
|init=
 +
|author-link=
 +
|last2=Collin
 +
|first2=Jack
 +
|init2=
 +
|author2-link=
 +
|etal=no
 +
|title=Save the normal foreskin
 +
|trans-title=
 +
|language=
 +
|journal=BMJ
 +
|location=
 +
|date=1993-01-02
 +
|volume=306
 +
|issue=6869
 +
|article=
 +
|page=
 +
|pages=1-2
 +
|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1676363/pdf/bmj00001-0005.pdf
 +
|archived=
 +
|quote=A better understanding of the normal physiology, developmental anatomy, and pathology of the prepuce could prevent the removal of thousands of normal foreskins over the next 20 years.
 +
|pubmedID=8435567
 +
|pubmedCID=1676363
 +
|DOI=10.1136/bmj.306.6869.1
 +
|accessdate=2021-09-05
 +
}}</ref> Williams et al. (1993) complained that most of the 30,000 circumcisions that were being done in the UK were on boys under 15. They reported that of 69 boys referred by GPs, 29 had a healthy retractile [[foreskin]], 30 had a healthy non-retractile foreskin, and only 9 had a phimosis requiring circumcision.<ref name="williams1993"> {{REFjournal
 +
|last=Williams
 +
|first=Nigel
 +
|init=
 +
|author-link=
 +
|last2=Chell
 +
|first2=Julian
 +
|init2=
 +
|author2-link=
 +
|last3=Kapila
 +
|first3=Leela
 +
|init3=
 +
|author3-link=
 +
|etal=no
 +
|title=Why are children referred for circumcision?
 +
|trans-title=
 +
|language=
 +
|journal=BMJ
 +
|location=
 +
|date=1993-01-02
 +
|volume=306
 +
|issue=6859
 +
|article=
 +
|page=28
 +
|pages=
 +
|url=http://www.cirp.org/library/general/williams/
 +
|archived=
 +
|quote=
 +
|pubmedID=843557
 +
|pubmedCID=1676352
 +
|DOI=10.1136/bmj.306.6869.28
 +
|accessdate=2021-09-05
 +
}}</ref>
 +
 +
In defence of the much criticised British GPs, it should be stated that the data they were provided by [[Douglas Gairdner]] regarding development of foreskin retractability was very inaccurate,<ref>{{REFjournal
 +
|last=Denniston
 +
|first=George C.
 +
|author-link=George C. Denniston
 +
|init=GC
 +
|last2=Hill
 +
|first2=George
 +
|init2=G
 +
|author2-link=George Hill
 +
|title=Gairdner was wrong.
 +
|journal=Can Fam Physician
 +
|date=2010-10
 +
|volume=56
 +
|issue=10
 +
|pages=986-7
 +
|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2954072/
 +
|quote=
 +
|pubmedID=20944034
 +
|pubmedCID=2954072
 +
|DOI=
 +
|accessdate=2021-09-05
 +
}}</ref> however this was not known at the time.
 +
 +
Cathcart et al. (2006) collected circumcision rates from 1997 through 2003. They reported a decline in the incidence of circumcision of about 20 percent over the period of their study, with about 10,000 circumcisions of boys per year at the end of the study. They commented that the circumcision rate for boys is still five times higher than the reported incidence of phimosis.<ref name="cathcart2006">{{REFjournal |last=Cathcart |init=P |last2=Nuttall |init2=M |last3=van der Meulen |init3=J |last4=Emberton |init4=M |last5=Kenny |init5=SE |date=2006-07 |title=Trends in paediatric circumcision and its complications in England between 1997 and 2003 |accessdate=2021-09-05 |url=http://www.cirp.org/library/procedure/cathcart1/ |journal=BJS |language=en |volume=93 |issue=7 |pages=885–890 |DOI=10.1002/bjs.5369 |pubmedID=16673355 |ISSN=1365-2168}} </ref>
 +
 +
===Decline in circumcision practice continues===
 +
 +
Rickwood & Walker (1989) reported that 21,000 circumcision were done annually on boys under 15 years of age,<ref name="rickwood1989" /> so Cathcart et al. (2006) are finding a reduction of 53 percent,<ref name="cathcart2006" /> although still much higher than it should be. It should be noted that manual [[stretching]] of the [[foreskin]] with the aid of topical steroid ointment to relieve [[phimosis]] had not yet entered general use.
 +
 +
The 2000 British ''National Survey of Sexual Attitudes and Lifestyles'' (Natsal 2000) found that 15.8 percent of British males aged 16 to 44 reported being [[circumcised]]. The incidence of circumcision was highest in the men aged 40-44 at 19.6 percent [born 1956-60] and lowest in the group aged 16-19 [born 1981-84] at 11.7 percent. Men of ethnic minorities (except black Caribbeans) were significantly more likely to circumcised than those described as "white". Jews were 98.7 percent circumcised and Sikhs, Hindus, and Buddhists were only 9.8 percent circumcised.<ref>{{REFjournal
 +
|last=Dave
 +
|first=
 +
|init=SS
 +
|author-link=
 +
|last2=Fenton
 +
|first2=
 +
|init2=KA
 +
|author2-link=
 +
|last3=Mercer
 +
|first3=
 +
|init3=CH
 +
|author3-link=
 +
|last4=Erens
 +
|first4=
 +
|init4=B
 +
|author4-link=
 +
|last5=Wellings
 +
|first5=
 +
|init5=K
 +
|author5-link=
 +
|last6=Johnson
 +
|first6=
 +
|init6=AM
 +
|author6-link=
 +
|etal=no
 +
|title=Male circumcision in Britain: findings from a national probability sample survey.
 +
|trans-title=
 +
|language=
 +
|journal=Sex Trans Infect
 +
|location=
 +
|date=2003-12
 +
|volume=79
 +
|issue=6
 +
|article=
 +
|page=
 +
|pages=499-500
 +
|url=http://www.cirp.org/library/general/dave1/
 +
|archived=
 +
|quote=
 +
|pubmedID=14663134
 +
|pubmedCID=1744763
 +
|DOI=10.1136/sti.79.6.499
 +
|accessdate=2021-09-05
 +
}}</ref>
 +
 +
Quaba & MacKindlay (2004) reported a 33.7% decline in the incidence of [[circumcision]] in Scotland from 1990 to 2000. This occurred because medical doctors were better trained in the recognition of [[Foreskin#Foreskin_in_infancy_and_childhood| healthy non-retractile foreskin in boys]].<ref name="quaba2004">{{REFjournal
 +
|last=Quaba
 +
|first=
 +
|init=O
 +
|author-link=
 +
|last2=MacKindlay
 +
|first2=
 +
|init2=GA
 +
|author2-link=
 +
|etal=no
 +
|title=Changing trends in a decade of circumcision in Scotland
 +
|trans-title=
 +
|language=
 +
|journal=J Pediatr Surg
 +
|location=
 +
|date=2004-7
 +
|volume=39
 +
|issue=7
 +
|article=
 +
|page=
 +
|pages=1037-9
 +
|url=https://www.jpedsurg.org/article/S0022-3468(04)00215-5/fulltext#relatedArticles
 +
|archived=
 +
|quote=
 +
|pubmedID=15213894
 +
|pubmedCID=
 +
|DOI=10.1016/j.jpedsurg.2004.03.061
 +
|accessdate=2021-11-16
 +
}}</ref>
 +
 +
Groves et al. (2010) reported a decline from 769 circumcisions of boys in Northern Ireland in 1991-1992 to 264 circumcisions of boys in 2001-2002 which represented a decline of 66 percent. This was said to be typical of trends in the United Kingdom.<ref name="groves2010">{{REFjournal
 +
|last=Groves
 +
|first=
 +
|init=H
 +
|author-link=
 +
|last2=Bailie
 +
|first2=
 +
|init2=A
 +
|author2-link=
 +
|last3=McCallion
 +
|first3=
 +
|init3=W
 +
|etal=yes
 +
|title=Childhood circumcision in Northern Ireland: A barometer of
 +
the current practice of general paediatric surgery
 +
|trans-title=
 +
|language=
 +
|journal=Ulster Med J
 +
|location=
 +
|date=2010
 +
|volume=79
 +
|issue=2
 
  |article=
 
  |article=
 
  |page=
 
  |page=
−
  |pages=283-319
+
  |pages=80-1
−
  |url=https://d1wqtxts1xzle7.cloudfront.net/33685574/RD-Pathologising.pdf?
+
|url=
 +
|archived=
 +
|quote=
 +
|pubmedID=21116424
 +
|pubmedCID=2993140
 +
|DOI=
 +
|accessdate= 2021-11-16
 +
}}</ref>
 +
 
 +
The percentage of males [[circumcised]] in the United Kingdom (prevalence) is reported to be 20.7%.<ref>{{REFweb
 +
  |url=https://circstatistics.github.io/
 +
|title=Global Circumcision Statistics and Estimates
 +
|last=
 +
|first=
 +
|init=
 +
|publisher=https://circstatistics.github.io
 +
|date=2024-04-01
 +
|accessdate=2024-04-01
 +
}}</ref>
 +
 
 +
==Legal matters==
 +
===Early Development of circumcision law===
 +
The relevant statutes are the [http://www.cirp.org/library/legal/UKlaw/oap1861/ Offences Against the Person Act (1861)] and the [https://www.swarb.co.uk/acts/1933CaYPAct.shtml Children and Young Persons Act 1933].
 +
 
 +
A 1985 decision of the Law Lords ruled:
 +
<blockquote>
 +
Having regard to the reality that a child became increasingly independent as it grew older and that parental authority dwindled correspondingly, the law did not recognise any rule of absolute parental authority until a fixed age. Instead, [[parental rights]] were recognised by the law only as long as they were needed for the protection of the child and such rights yielded to the child's right to make his own decisions when he reached a sufficient understanding and intelligence to be capable of making up his own mind.<ref name="gillick1985>{{REFdocument
 +
|title=Gillick v West Norfolk and Wisbech Area Health Authority [1985] 3 All ER 402
 +
|url=http://www.cirp.org/library/legal/UKlaw/gillickvwestnorfolk1985/
 +
|contribution=
 +
|last=
 +
|first=
 +
|publisher=Circumcision Reference Library
 +
|format=
 +
|date=1985
 +
|accessdate=2021-09-07
 +
}}</ref>
 +
</blockquote>
 +
''Gillick'' affirmed the right and duty of parents to protect their child.
 +
 
 +
Sebastian Poulter, a legal writer, in a book entitled ''English Criminal Law and Ethnic Minority Customs'' (1986), stated:
 +
<blockquote>
 +
"The basic right to bodily integrity which everyone possesses under the English common law means that any unlawful interference in this right amounts to an assault or battery, at the very least, and might in appropriate circumstances entail the statutory offence of grievous bodily harm. The question raised in cases of circumcision, [[excision]] or [[infibulation]] is whether the operation can be justified as constituting lawful as opposed to unlawful interference with this right."
 +
 
 +
"...although the matter is not entirely free from doubt, it seems that a parent may equally authorise a non-therapeutic operation, provided it is not actively against the child's interests. This would appear to have been the basis upon which the vast majority of male infants have been circumcised in this country with impunity from time immemorial.[sic]"
 +
 
 +
"It thus appears that, at common law, while the circumcision of male infants here is lawful, provided that parental consent has been given, no amount of parental agreement or support can legitimise the circumcision, [[excision]] or [[infibulation]] of a young girl in this country, unless the operation is for therapeutic purposes."<ref name="poulter1986">{{REFbook
 +
|last=Poulter
 +
|first=Sebastian
 +
|init=S
 +
|year=1986
 +
|title=English Criminal Law and Ethnic Minority Customs
 +
|url=http://www.cirp.org/library/legal/poulter/
 +
|pages=
 +
|location=London
 +
|publisher=Butterworths
 +
|isbn=
 +
|accessdate=2021-09-07
 +
}}</ref>
 +
</blockquote>
 +
 
 +
Poulter's claims are controversial. Recent court decisions cast further doubt on their legitmacy.
 +
 
 +
===Children Act 1989===
 +
 
 +
Parliament in 1989 passed the [[Children Act 1989]]. This is a very extensive act to provide for the care, welfare and protection of persons under 18 years of age. The Children Act 1989 introduced the legal term ''significant harm''.<ref>{{REFweb
 +
|url=https://www.virtual-college.co.uk/resources/what-is-the-children-act
 +
|archived=
 +
|title=What is the Children Act?
 +
|trans-title=
 +
|language=
 +
|last=
 +
|first=
 +
|author-link=
 +
|publisher=Virtual College
 +
|website=
 +
|date=2021-04-23
 +
|accessdate=2021-09-07
 +
|format=
 +
|quote=Under the Children Act 1989, ‘harm’ is defined as any “ill-treatment or the impairment of the health or development of the child”. Whether the harm is deemed ‘significant’ is decided by comparing the health and development of the child with what would generally be expected of another, similar child and judging if there is a big difference.
 +
}}</ref> One perhaps unexpected effect of the Children Act 1989 was to bring circumcision cases into family court when parents disagreed about circumcision of a son.
 +
 
 +
The [https://www.lawcom.gov.uk/ Law Commission of England and Wales] had proposed to recommend that circumcision of male children be made lawful. The late [[Christopher P. Price]], solicitor, (1996) submitted a brief to the Law Commission in opposition to the proposal,<ref>{{REFdocument
 +
|title=Male Circumcision: A Legal Affront
 +
|url=http://www.cirp.org/library/legal/price-uklc/
 +
|contribution=
 +
|last=Price
 +
|first=Christopher P.
 +
|init=CP
 +
|author-link=Christopher P. Price
 +
|publisher=Circumcision Reference Library
 +
|format=
 +
|date=1996-12
 +
|accessdate=2021-09-07
 +
}}</ref> after which the proposal was dropped.
 +
 
 +
The ''Guardian'' (1999) reported the family law case of ''Re J (child's religious upbringing and circumcision)''<ref>{{REFweb
 +
|url=http://www.cirp.org/library/legal/Re_J/2000.html
 +
|title=Re J (child's religious upbringing and circumcision)
 +
|last=
 +
|first=
 +
|date=1999-11-25
 +
|accessdate=2021-09-07
 +
}}</ref> in which the Muslim father wanted a son circumcised but the British mother did not. The Court of Appeals stated in part:
 +
<blockquote>
 +
The judge said it was not in the best interests of the child to be circumcised, with its risk of pain and psychological damage which the boy would find hard to understand.
 +
 
 +
He said the boy might be traumatised by the operation. "The operation and the period leading up to it was also likely to be highly stressful to the mother."<ref>{{REFnews
 +
|title=Muslim father loses court battle
 +
|url=http://www.cirp.org/news/1999.11.26_Guardian/
 +
|last=
 +
|first=
 +
|coauthors=
 +
|publisher=The Guardian
 +
|website=
 +
|date=1999-11-26
 +
|accessdate=2021-09-07
 +
|quote=
 +
}}</ref>
 +
</blockquote>
 +
 
 +
===Forward into the 21st century===
 +
Welch solicitor [[Christopher P. Price]] led us into the 21st century with an essay highly critical of child non-therapeutic circumcision in every form.<ref name="price1999">{{REFbook
 +
|last=Price
 +
|first=Christopher P.
 +
|init=CP
 +
|author-link=Christopher P. Price
 +
|year=1999
 +
|title=Male Non-therapeutic circumcision: The Legal and Ethical Issues
 +
|url=http://www.cirp.org/library/legal/price2/
 +
|work=Male and Female Circumcision, Medical, Legal, and Ethical Considerations in Pediatric Practice
 +
|editor=Denniston GC, Hodges FM and Milos MF eds.
 +
|edition=
 +
|volume=
 +
|chapter=
 +
|pages=
 +
|location=New York
 +
|publisher=Kluwer Academic/Plenum Publishers
 +
|isbn=
 +
|quote=
 +
|accessdate=2021-09-07
 +
|note=
 +
}}</ref>
 +
 
 +
The family law case of [[Re B and G (children) (No 2) EWFC 3]] (2015) was about two children in need of care. This required [https://en.wikipedia.org/wiki/James_Munby Judge Munby] to consider both male and female circumcision. Judge Munby realised that male circumcision inflicted at least as much harm as lesser forms of female circumcision. This caused him to rule that male circumcision caused ''significant harm'', which now allows courts to issue care orders to prevent male circumcision.<ref name="munby2015">{{REFdocument
 +
|title=Re B and G (Children) (No 2) [2015] EWFC 3, [2015]
 +
|url=https://www.judiciary.uk/wp-content/uploads/2015/01/BandG_2_.pdf
 +
|contribution=
 +
|last=Munby
 +
|first=James
 +
|publisher=Royal Courts of Justice
 +
|format=PDF
 +
|date=2015-01-14
 +
|accessdate=2024-07-11
 +
}}</ref> Munby cited the Brief to the Law Commission of England and Wales by the late [[Christopher P. Price]] entitled ''Male Circumcision: A Legal Affront'',<ref name="price1996">{{REFweb
 +
|url=http://www.cirp.org/library/legal/price-uklc/
 +
|title=Male Circumcision: A Legal Affront
 +
|last=Price
 +
|first=Christopher
 +
|author-link=
 +
|publisher=Circumcision Reference Library
 +
|website=
 +
|date=1996
 +
|accessdate=2020-09-12
 +
|format=
 +
|quote=
 +
}}</ref>
 +
 
 +
The case of [[Re L and B (CHILDREN)| L and B (2016)]] was a case in which parents disagreed about the circumcision of two boys. The Muslim father wanted the boys circumcised, however the court ruled that no order should be issued so the boys could decide for themselves when they are of age. In this highly significant case, Mrs. Justice Roberts took the decision away from either parents and gave it to the boys, thereby recognising the boys' right to self-determination. Her conclusion is entirely consistent with the rights of the child under [[Human rights|human rights law]]. Her order also is entirely in accord with [https://assembly.coe.int/nw/xml/XRef/Xref-XML2HTML-en.asp?fileid=20174 Resolution 1952] of the [https://www.coe.int/en/web/portal Council of Europe].<ref name="resolution1952">{{REFdocument
 +
|title=Children's right to physical integrity
 +
|url=http://semantic-pace.net/tools/pdf.aspx?doc=aHR0cDovL2Fzc2VtYmx5LmNvZS5pbnQvbncveG1sL1hSZWYvWDJILURXLWV4dHIuYXNwP2ZpbGVpZD0yMDE3NCZsYW5nPUVO&xsl=aHR0cDovL2Fzc2VtYmx5LmNvZS5pbnQvbncveG1sL3hzbC1mby9QZGYvWFJlZi1XRC1BVC1YTUwyUERGLnhzbA==&xsltparams=ZmlsZWlkPTIwMTc0
 +
|contribution=
 +
|last=
 +
|first=
 +
|publisher=Parliamentary Assembly
 +
|format=PDF
 +
|date=2013-10-01
 +
|accessdate=2021-01-03
 +
}}</ref>
 +
 
 +
The National Secular Society (2023) has called for the end of genital cutting of children.<ref name="nss2023">{{REFweb
 +
|url=https://www.secularism.org.uk/religious-surgery/
 +
|title=End forced genital cutting
 +
|last=Anonymous
 +
|first=
 +
|init=
 +
|publisher=National Secular Society
 +
|date=2023
 +
|accessdate=2023-09-23
 +
}}</ref>
 +
 
 +
A court (Miss Nageena Khalique KC) has rejected a father's request  to have a 16-month-old boy [[circumcised]]. The court said the boy can have it done later if he wishes.<ref>{{REFweb
 +
|url=https://www.localgovernmentlawyer.co.uk/child-protection/392-children-protection-news/58547-high-court-rejects-application-by-father-for-young-boy-subject-to-care-order-to-be-circumcised
 +
|title=High Court rejects application by father for young boy subject to care order to be circumcised
 +
|last=Anonymous
 +
|first=
 +
|init=
 +
|author-link=
 +
|publisher=LocalGovernmentLawyer
 +
|date=2024-09-18
 +
|accessdate=2024-09-19
 +
}}</ref>
 +
 
 +
The [https://www.cps.gov.uk/ Crown Prosecution Service] charged Dr [[Mohammad Siddiqui]] with twenty-five [[circumcision]]-related crimes, to which he has pleaded guilty. He will be sentenced on 14 January 2025 in [https://www.find-court-tribunal.service.gov.uk/courts/southwark-crown-court Southwark Crown Court].<ref name="cps2024">{{REFweb
 +
|title=A former surgeon found guilty of causing harm during multiple male circumcision operations
 +
|url=https://www.cps.gov.uk/cps/news/former-surgeon-found-guilty-causing-harm-during-multiple-male-circumcision-operations
 +
|last=Anonymous
 +
|first=
 +
|init=
 +
|archived=
 +
|trans-title=
 +
|language=
 +
|publisher=Crown Prosecution Service
 +
|website=
 +
|date=2024-10-31
 +
|accessdate=2024-11-01
 +
|format=
 +
|quote=He showed a complete disregard for the impact of his actions on his victims, families, and communities. We hope that this conviction offers some comfort in seeing Siddiqui being brought to justice.
 +
}}</ref>
 +
 
 +
==International human rights law in the United Kingdom==
 +
===United Nations multi-lateral human rights treaties===
 +
The UK signed the ''[[International Covenant on Civil and Political Rights]]'' (ICCPR) on 16 September 1968 and formally ratified the [[ICCPR]] treaty on 11 December 1968.<ref name="ratstatus">{{REFweb
 +
|url=https://tbinternet.ohchr.org/_layouts/15/TreatyBodyExternal/Treaty.aspx?CountryID=185
 +
|archived=
 +
|title=Ratification Status for United Kingdom of Great Britain and Northern Ireland
 +
|trans-title=
 +
|language=
 +
|last=
 +
|first=
 +
|author-link=
 +
|publisher=UN Treaty Body Database
 +
|website=https://tbinternet.ohchr.org
 +
|date=
 +
|accessdate=2021-09-12
 +
|format=
 +
|quote=
 +
}}</ref> Article 2 of the [[ICCPR]] requires the UK to apply and enforce the provisions of the [[ICCPR]] within its territory. See [[International_Covenant_on_Civil_and_Political_Rights#Application_of_the_ICCPR_to_non-therapeutic_circumcision_of_children|ICCPR: Application of the ICCPR to non-therapeutic circumcision of children]] for detailed information on the rights applicable to non-therapeutic circumcision of children.
 +
 
 +
The UK signed the ''[https://www.ohchr.org/en/professionalinterest/pages/crc.aspx Convention on the Rights of the Child]'' (CRC) on 19 April 1990 an formally ratified the CRC treaty on 16 December 1991.<ref name="ratstatus" /> Article 2 of the CRC require the UK to respect and ensure the rights specified in the CRC to each child within its jurisdiction. See [[Human_rights#Application_of_the_CRC_to_non-therapeutic_circumcision_of_children| Application of the CRC to non-therapeutic circumcision of children]] for detailed information on the rights applicable to non-therapeutic circumcision of children.
 +
 
 +
===Human Rights Act 1998===
 +
The United Kingdom became a founder-member of the [https://www.coe.int/en/web/portal Council of Europe] on 5 May 1949 and therefore subject to the [https://rm.coe.int/1680a2353d ''European Convention on Human Rights''] (1950). Under that ''Convention'' the United Kingdom may be sued in the [https://www.echr.coe.int/Pages/home.aspx?p=home&c European Court of Human Rights] (Strasbourg) for alleged [[human rights]] violations.
 +
 
 +
Certain parts of the Convention seems applicable to the non-therapeutic circumcision of minor boys:
 +
 
 +
* Article 3: Freedom from torture and inhuman or degrading treatment
 +
* Article 5: Everyone has a right to liberty and security of person.
 +
* Article 8: Everyone has the right to respect for his private and family life, his home and his correspondence.
 +
 
 +
The case of ''A v. United Kingdom'' (1998) involved the beating of a child with a garden cane. The court ruled:
 +
<blockquote>
 +
States required to take measures designed to ensure individuals not ill-treated in breach of Article 3 by other private individuals – children entitled to protection, through effective deterrence, against such treatment.<ref>{{REFdocument
 +
|title=A. v United Kingdom. [1998] 2 FLR 959
 +
|url=http://www.cirp.org/library/legal/A_v_UK1998/
 +
|contribution=
 +
|last=
 +
|first=
 +
|publisher=Circumcision Reference Library
 +
|format=
 +
|date=1998
 +
|accessdate=2021-09-07
 +
}}</ref>
 +
</blockquote>
 +
The case clearly established the right of children in the UK to protection under the ECHR. Nevertheless, no known cases have applied international [[human rights]] law specifically to the practice of non-therapeutic child circumcision in the UK.
 +
 
 +
The [[human rights]] provisions of the Convention have now been brought into domestic law by the [https://www.legislation.gov.uk/ukpga/1998/42/contents Human Rights Act 1998], so violations of [[human rights]] law could be litigated in the domestic courts of the UK.
 +
 
 +
Resolution no. 1952 (2013) 'Children's right to physical integrity' of the Parliament Assembly of the Council of Europe, which includes the issue of physical integrity of intersex children for the first time, was adopted on October 1, 2013 following an initiative of the German SPD politician [[Marlene Rupprecht]].<ref name="aktor2016">{{REFbook
 +
|last=Aktor
 +
|first=Mikael
 +
|init=M
 +
|author-link=Mikael Aktor
 +
|last2=
 +
|first2=
 +
|author2-link=
 +
|year=2016
 +
|title=Whose Rights? The Danish Debate on Ritual Infant Male Circumcision as a Human Rights Issue
 +
|url=https://www.academia.edu/22644864
 +
|work=Contemporary Views on Comparative Religion: In Celebration of Tim Jensen's 65th Birthday
 +
|editor=Peter Antes, Armin W. Geertz, Mikael Rothstein
 +
|edition=
 +
|volume=
 +
|chapter=24
 +
|pages=311-24
 +
|location=Sheffield
 +
|publisher=Equinox Publishing
 +
|isbn=9781781791394
 +
|quote=
 +
|accessdate=2021-09-12
 +
|note=
 +
}}</ref>
 +
 
 +
The resolution includes other topics such as the [[FGM|female genital mutilation]], the [[MGM|male circumcision]] for religious reasons, and the submission or coercion of a child to piercings, tattoos or cosmetic surgery.
 +
 
 +
The resolution calls on all member States to "''examine the prevalence of different categories of non-medically justified operations and interventions impacting on the physical integrity of children in their respective countries, as well as the specific practices related to them, and to carefully consider them in light of the best interests of the child in order to define specific lines of action for each of them; initiate focused awareness-raising measures for each of these categories of violation of the physical integrity of children, to be carried out in the specific contexts where information may best be conveyed to families, such as the medical sector (hospitals and individual practitioners), schools, religious communities or service providers; [...].''"
 +
 
 +
This first resolution of its kind by a European institution is not legally binding, but an important signal for further debate and action. It shifts the approach of the point of view of the topic from the current medical domain towards a [[human rights]] approach and identifies the right to bodily integrity, autonomy and self-determination. It calls the for the end of non-therapeutic cosmetic medical and surgical interventions.<ref name="resolution1952" />
 +
 
 +
==The ethics of non-therapeutic circumcision==
 +
 
 +
The ''Journal of Medical Ethics'' (London) devoted its entire July 2013 issue to the question of non-therapeutic circumcision of children, where a variety of views are presented.<ref>{{REFjournal
 +
|last=
 +
|init=
 +
|author-link=
 +
|last2=
 +
|init2=
 +
|author2-link=
 +
|url=https://jme.bmj.com/content/39/7
 +
|title=July 2013 issue
 +
|journal=Journal of Medical Ethics
 +
|date=2013-07
 +
|volume=39
 +
|issue=7
 +
|pages=
 +
|accessdate=2021-09-11
 +
}}</ref>
 +
==General Medical Council==
 +
The [https://www.gmc-uk.org/ General Medical Council] (GMC) regulates medical practitioners in the United Kingdom.
 +
 
 +
The GMC issued an "interim guidance" on the [non-therapeutic] circumcision of male children in 1997.<ref>{{REFweb
 +
|url=http://www.cirp.org/library/statements/gmc/
 +
|archived=
 +
|title=Guidance for Doctors Who Are Asked to Circumcise Male Children
 +
|trans-title=
 +
|language=
 +
|last=Anonymous
 +
|first=
 +
|author-link=
 +
|publisher=General Medical Council
 +
|website=Circumcision Reference Library
 +
|date=1997
 +
|accessdate=2021-09-12
 +
|format=
 +
|quote=Listen to those with parental responsibility and give careful consideration to their views. You are not obliged to act on a request to circumcise a child, but you should explain if you are opposed to circumcision other than for therapeutic reasons. You should also tell those with parental responsibility that they have a right to see another doctor.
 +
}}</ref>
 +
 
 +
The GMC emphasises the importance of protecting children and young people,<ref>{{REFweb
 +
|url=https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/protecting-children-and-young-people
 +
|archived=
 +
|title=Protecting children and young people: The responsibilities of all doctors
 +
|trans-title=
 +
|language=
 +
|last=Anonymous
 +
|first=
 +
|author-link=
 +
|publisher=General Medical Council
 +
|website=
 +
|date=2018-05-25
 +
|accessdate=2021-09-12
 +
|format=
 +
|quote=
 +
}}</ref> but has not prohibited non-therapeutic circumcision of non-consenting minors.
 +
 
 +
Although the UK has been a member of the [[Council of Europe Debate Genital Cutting Of Boys| Council of Europe]], a [[human rights]] organisation since 1949, a state-party to the [[ICCPR]] since 1976, and the CRC since 1991, the General Medical Council has not revised its policies and procedures to recognise the [[human rights]] of child patients to the physical security of their person.
 +
 
 +
The GMC holds four disciplinary sessions a year. Over the last decade it has disciplined 39 doctors for ritual (non-therapeutic) [[circumcision]] issues. The Medical Protection Society warned circumcision carries "considerable risks and complications”.  Religious and cultural [[circumcision]] on boys is permitted, including by non-doctors, and largely occurs among Jewish, Muslim and some African Christian communities, where they are often considered a religious obligation.<ref>{{REFnews
 +
|title=Exposed: the horror statistics behind ritual circumcision of baby boys in the UK
 +
|url=https://www.mirror.co.uk/news/uk-news/exposed-horrors-ritual-circumcision-baby-28990951
 +
|last=Penmman
 +
|first=Andrew
 +
|init=
 +
|author-link=
 +
|publisher=Mirror
 +
|website=
 +
|date=2023-01-19
 +
|accessdate=2023-01-20
 +
|format=
 +
|quote=
 +
}}</ref>
 +
 
 +
The GMC will be holding a disciplinary hearing in the case of Dr Balvinder Mehat of Nottingham who has [[circumcised]] a second boy without the necessary two-parent surrogate consent and the wound became infected.<ref>{{REFnews
 +
|title=Doctor circumcised second boy without parent's consent
 +
|url=https://www.bbc.com/news/uk-england-nottinghamshire-68180929
 +
|last=Lowbridge
 +
|first=Caroline
 +
|init=
 +
|author-link=
 +
|publisher=BBC
 +
|website=
 +
|date=2024-05-18
 +
|accessdate=2024-05-30
 +
|format=
 +
|quote="I note that similar conduct by Dr Mehat has previously been determined to amount to serious misconduct. If it were found to have been repeated, this would be an aggravating factor."
 +
}}</ref>
 +
 
 +
==The guidance of the British Medical Association==
 +
The [[British Medical Association]] (BMA) is a [[medical trade association]]. It represents and protects the interests of its doctor-members. Unlike American medical trade associations, the BMA do not claim to be an authority on medical science. Its advice to members address ethical and legal issues to assist members in staying out of legal difficulties. The BMA have provided several statements regarding child circumcision to inform its members since 1996:
 +
 
 +
* 1996 [http://www.cirp.org/library/statements/bma/ Circumcision of Male Infants: Guidance for Doctors]
 +
 
 +
The case of ''Re J (1999)'', ''Re S'', and the ''Human Rights Act 1998'' caused the BMA to revise its guidance to doctors and issued a new guidance in 2003.
 +
 
 +
{{UNI|Keele University|KU}} law professors Fox & Thomson 2005 reviewed the 2003 BMA statement and cited legal deficiencies in that statement.<ref>{{REFjournal
 +
|last=Fox
 +
|first=Marie
 +
|init=M
 +
|author-link=
 +
|last2=Thomson
 +
|init2=M
 +
|author2-link=
 +
|etal=no
 +
|title=A covenant with the status quo? Male circumcision and the new BMA guidance to doctors
 +
|journal=J Med Ethics
 +
|location=
 +
|date=2005
 +
|volume=31
 +
|issue=8
 +
|pages=463-9
 +
|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1734197/pdf/v031p00463.pdf
 +
|archived=
 +
|quote=
 +
|pubmedID=16076971
 +
|pubmedCID=1734197
 +
|DOI=10.1136/jme.2004.009340
 +
|accessdate=2021-09-11
 +
}}
 +
</ref> The BMA accepted the criticism, so the guidance was further revised in 2006.
 +
 
 +
* 2003 (with changes in 2006 indicated) [http://www.cirp.org/library/statements/bma2003/ The law & ethics of male circumcision - guidance for doctors]
 +
 
 +
The cases of ''[[Re B and G (children) (No 2) EWFC 3| Re R and B]]'' and ''[[Re L and B (CHILDREN)| Re L and B (CHILDREN)]]'' so alarmed the BMA's lawyers that a new guidance was issued in 2019. The new guidance advises extreme caution regarding performance of non-therapeutic circumcision of boys.
 +
 
 +
* 2019 [https://www.bma.org.uk/media/1847/bma-non-therapeutic-male-circumcision-of-children-guidance-2019.pdf Non-therapeutic male circumcision (NTMC) of children – practical guidance for doctors]
 +
 
 +
The 2019 BMA guidance regarding non-therapeutic circumcision of boys is divided into twelve “cards”. Card Four discusses law. [[Human rights]] law is recognised but the BMA fail to understand the significance of [[human rights]] law. The BMA do not clearly state that [[human rights]] law grants rights to children which helps to define the best interests of the child and should be respected and protected.
 +
 
 +
The BMA seems to lean toward protecting the alleged right of its members to profit from carrying out non-therapeutic circumcision on boys, in the face of increasingly severe legal concerns.
 +
 
 +
Lempert et al. (2022) criticized the 2019 BMA guidance for "serious weaknesses". They listed:
 +
# the absence of an explicit stance on the underlying ethical status of NPC, coupled with an implicit permissive stance,<br>
 +
# an incoherent and impracticable analysis of the child’s best interests,<br>
 +
# unbalanced guidance regarding cultural issues,<br>
 +
# unbalanced guidance regarding scientific issues,<br>
 +
# unjustified differential treatment of children of the same sex,<br>
 +
# unjustified differential treatment of children of different sexes,<br>
 +
# problems with child safeguarding, and (8) problems with regulation and training. <br>
 +
# an unjustified presumption of lawfulness of NPC of minors and<br>
 +
# failure adequately to address recent case law.<ref name="lempert2022">{{REFjournal
 +
|last=Lempert
 +
|first=Antony
 +
|init=A
 +
|author-link=Antony Lempert
 +
|last2=Chegwidden
 +
|first2=James
 +
|init2=J
 +
|author2-link=James Chegwidden
 +
|last3=Steinfeld
 +
|first3=Rebecca
 +
|init3=R
 +
|author3-link=Rebecca Steinfeld
 +
|last4=Earp
 +
|first4=Brian D.
 +
|init4=BD
 +
|author4-link=Brian D. Earp
 +
|etal=no
 +
|title=Non-therapeutic penile circumcision of minors: Current controversies in UK law and medical ethics.
 +
|journal=Clinical Ethics
 +
|location=
 +
|date=2022-05
 +
|season=
 +
|volume
 +
|issue=
 +
|article=
 +
|page=
 +
|pages=
 +
|url=https://www.researchgate.net/publication/360642209_Non-therapeutic_Penile_Circumcision_of_Minors_Current_Controversies_in_UK_Law_and_Medical_Ethics
 
  |archived=
 
  |archived=
 
  |quote=
 
  |quote=
−
  |pubmedID=15917258
+
  |pubmedID=
 
  |pubmedCID=
 
  |pubmedCID=
−
  |DOI=10.1093/jhmas/jri042
+
  |DOI=
−
  |accessdate=2021-09-04
+
|accessdate=2022-05-20
 +
}}</ref>
 +
 
 +
In addition, they noted an egregiously inadequate description of the male [[foreskin]] and its functions.<ref name="lempert2022"/>
 +
 
 +
==Symposia==
 +
The United Kingdom has been the site of several symposia regarding sexual integrity.
 +
 
 +
* The [[Fifth International Symposium]] convened at the {{UNI|University of Oxford|Oxon}}, Oxford, England, United Kingdom on 5-7 August 1998.
 +
 
 +
* The [[Tenth International Symposium]] on Circumcision, Genital Integrity and Human Rights convened at the {{UNI|University of Keele|KU}}, Keele, Newcastle, Staffordshire, England, United Kingdom on September 4-6, 2008.
 +
 
 +
* The [[Fourteenth International Symposium]] on Genital Autonomy and Children's Rights convened at the {{UNI|University of Keele|KU}}, Keele, Staffordshire, England, United Kingdom on September 14-16, 2016.
 +
 
 +
==A source of information and aid==
 +
 
 +
[[15 Square]] is a registered charity that provides information and aid to parents and both [[intact]] and [[circumcised]] males. The name refers to the approximate area of the adult male [[foreskin]] in square inches. 15 Square is based in Stone, Staffordshire.
 +
 
 +
==Circumcision deaths==
 +
Gairdner (1949) reported 16 deaths per year.<ref name="gairdner1949" /> Death from circumcision still occurs.
 +
 
 +
* Amitai Moshe, seven-days-old, stopped breathing and died after having been [[circumcised]] by a ''[[mohel]]'' (2007), who was a member of the [http://www.initiationsociety.net/ Initiation Society], at [https://www.goldersgreenshul.org.uk/ Golders Green Synagogue] in North London. It was thought that the infant had cardiac arrest, perhaps brought on by the [[Pain| painful circumcision]].<ref name="beckford2007">{{REFnews
 +
|title=Police investigate baby's death after circumcision
 +
|url=https://www.cirp.org/news/2007/2007-02-16_dailytelegraph.php
 +
|last=Beckford
 +
|first=Martin
 +
|coauthors=
 +
|publisher=The Daily Telegraph
 +
|website=
 +
|date=2007-02-16
 +
|accessdate=2021-09-12
 +
|quote=Police are investigating the circumstances of the death of a baby boy. Inquiries are being carried out by officers from the Serious Crime Directorate. The death is being treated as unexplained.
 +
}}</ref>
 +
 
 +
* Celian Noumbiwe, a nine-week-old baby, died in his mother's arms in 2007, after circumcision surgery at a doctor's surgery in Reading, apparently from loss of blood.<ref>{{REFnews
 +
|title=Baby bled to death after circumcision, inquest told
 +
|url=http://www.cirp.org/news/londontimes2009-02-13/
 +
|last=Bannerman
 +
|first=Lucy
 +
|coauthors=
 +
|publisher=The Times
 +
|website=
 +
|date=2009-02-13
 +
|accessdate=2021-09-12
 +
|quote=
 +
}}</ref>
 +
 
 +
* Goodluck Caubergs, four-weeks-old, bled to death in Oldham after Grace Adeleye [[circumcised]] him in April 2010. Adeleye was found guilty of manslaughter by gross negligence at Manchester Crown Court.<ref>{{REFnews
 +
|title=Grace Adeleye guilty of killing baby in botched circumcision
 +
|url=https://www.bbc.com/news/uk-england-manchester-20733674
 +
|last=
 +
|first=
 +
|coauthors=
 +
|publisher=BBC
 +
|website=
 +
|date=2012-12-14
 +
|accessdate=2021-09-12
 +
|quote=The boy bled to death before he could reach hospital the following day.
 +
}}</ref>
 +
 
 +
* Raju Miah: Death by circumcision. July 1991, Birmingham, England, United Kingdom.
 +
 
 +
* Boma Oruitemeka: Death by circumcision, severe hemorrhage. 1990, London, England, United Kingdom.
 +
 
 +
==Conclusion==
 +
The BMA (2019) reported that the NHS therapeutically circumcises about 10,000 boys under 18-years-of-age per year.<ref name="bma2019">{{REFdocument
 +
|title=Non-therapeutic male circumcision (NTMC) of children – practical guidance for doctors
 +
|url=https://www.bma.org.uk/media/1847/bma-non-therapeutic-male-circumcision-of-children-guidance-2019.pdf
 +
|contribution=
 +
|last=
 +
|first=
 +
|publisher=British Medical Association
 +
|format=PDF
 +
|date=2019
 +
  |accessdate=2021-09-10
 +
}}</ref> The Daily Mail (2022) alleged that 1/2 of the 10,000 NHS [[circumcision|circumcisions]] of boys are unnecessary.<ref>{{REFnews
 +
|title=Is the NHS carrying out thousands of unnecessary circumcisions on teenage boys? New report shows irreversible surgery is carried out 10,000 times per year
 +
|url=https://www.dailymail.co.uk/health/article-10554847/Is-NHS-carrying-thousands-unnecessary-circumcisions-teenage-boys.html
 +
|last=Ennals
 +
|first=Ethan
 +
|init=
 +
|author-link=
 +
|publisher=The Daily Mail
 +
|website=
 +
|date=2022-03-01
 +
|accessdate=2023-05-23
 +
|format=
 +
|quote=The analysis also found up to half of the boys who underwent medical circumcision at some trusts were under five, an age at which doctors agree the procedure is almost always unnecessary.
 +
}}</ref>
 +
 
 +
The incidence of non-therapeutic [[circumcision]] of boys in the United Kingdom has been substantially reduced from its former peaks in the 1930s and early 1940s. Non-therapeutic circumcision of boys remains lawful provided that both parents grant consent. The practice seems to be concentrated among ethnic minorities. Ethical and [[human rights]] concerns about the surgery persist.
 +
 
 +
Non-therapeutic [[circumcision]] usually is not covered by the NHS, so parents must find a private medical or non-medical operator such as a [[mohel]] to perform the [[foreskin]] [[amputation]] and must pay the fee out of pocket as [[third-party payment]] is not available. Given the recent legal cautions uttered by the BMA,<ref name="bma2019" /> it may not be easy to find a medical practitioner willing to accept the risk.
 +
 
 +
The NHS announced in November 2022 that it would no longer perform the 23,000 circumcisions that it had been performing every year.<ref name="warren2022">{{REFweb
 +
|url=https://www.dailymail.co.uk/news/article-11410577/Circumcisions-tummy-tucks-liposuction-operations-stop-funded-NHS.html
 +
|title=Circumcisions, tummy tucks and liposuction are among 13 operations which will stop being funded by the NHS in a 'crackdown' on wasteful spending in a bid to save £2bn a year
 +
|last=Warren
 +
|first=Jessica
 +
|publisher=Daily Mail
 +
|date=2022-11-09
 +
|accessdate=2023-04-07
 
}}</ref>
 
}}</ref>
  
 +
== Videos ==
 +
=== Maajid Nawaz: Male circumcision consent ===
 +
A discussion of consent for non-therapeutic male circumcision by Maajid Nawaz from Sky News
  
 +
<youtube>v=1mrAZnijYcc</youtube>
  
 +
=== Great Britain - History of Foreskin and Circumcision ===
  
 +
<youtube>v=OuDiIHRqEVA</youtube>
  
 +
=== Why my penis is in constant pain - BBC stories ===
 +
 +
<youtube>v=rXDoezKLZjc</youtube>
 +
===British Circumcision Debate - Should Human Rights Outweigh Religious Rights===
 +
<youtube>v=I4-r0hxChi0</youtube>
 +
 +
{{SEEALSO}}
 +
* [[15 Square]]
 +
* [[Genital Autonomy]]
 +
* [[Men Do Complain]]
 +
* [[Secular Medical Forum]]
 +
{{LINKS}}
 +
* {{URLwikipedia|United_Kingdom|United Kingdom}}
  
 
{{REF}}
 
{{REF}}
 +
 +
 +
 +
[[Category:Male circumcision]]
 +
[[Category:History]]
 +
[[Category:Statistics]]
  
 
[[Category:UK]]
 
[[Category:UK]]
 +
[[Category:Europe]]
 +
 +
 +
[[de:Vereinigtes Königreich]]

Latest revision as of 12:22, 2 November 2024

Flag of the United Kingdom

The United Kingdom (UK) was the scene of early efforts to promote male circumcision. It influenced the adoption of male circumcision in other English-speaking nations. Later it was the scene of efforts to reduce and eliminate the practice.

While Jews residing in the UK practiced ritual circumcision of boys on the eighth day of life in accordance with the Abrahamic covenant, the practice was nearly unknown among gentiles.

Introduction of circumcision as a medical practice

French physician Claude François Lallemand (1790 – 1854) recommended circumcision as a treatment for spermatorrhea (excessive, involuntary ejaculation), which was then believed to be a disease. Lallemand influenced later English physicians such as William Acton.[1]

Edward H. Dixon (1845) from New York, USA, advocated circumcision to prevent masturbation.[2]

Sir Jonathan Hutchinson (1828 – 1913) was an English surgeon, dermatologist, ophthalmologist, pathologist and venereologist.[3] Darby describes Hutchinson as a puritanical and gloomy Quaker who disapproved of masturbation on moral grounds.[4] Sir Jonathan advocated circumcision to prevent syphilis.[5]

Nathaniel Heckford, a paediatrician at the East London Hospital for Children, wrote Circumcision as a Remedial Measure in Certain Cases of Epilepsy, Chorea, etc. (1865), in which he argued that circumcision acted as an effective remedial measure in the prevention of certain cases of epilepsy and chorea.[6]

Sir Jonathan Hutchinson started to promote circumcision to prevent masturbation in 1890.[4] He first published A Plea for Circumcison,[7], followed by On circumcision as a preventive of masturbation.[8]

Sir Jonathan was not yet done. He published yet another article On Circumcision in 1893.[9]

Early Twentieth century

Sir Jonathan Hutchinson (1900) opened the twentieth century with an article advocating male circumcision as a way to decrease the pleasure of sex, and hence to discourage sexual immorality.[10]

Sir Frederick Treves (1853 – 1923), a prominent Harley Street surgeon, who is known to us by The Elephant Man film, wrote an operative manual in 1903 to educate other surgeons in the performance of the circumcision amputation.[11] The practice of male circumcision was well established in the United Kingdom as the twentieth century began.

Cockshut (1935) published a letter in the British Medical Journal that urged circumcision of all male infants because the "glans of the circumcised rapidly assumes a leathery texture less sensitive than skin." The advantage, according to Cockshut, is that masturbation would be reduced.[12]

Rickwood et al. (2000) reported that the incidence of boys circumcised reached 35 percent by the early 1930s.[13]

Despite these efforts to promote circumcision, foreskinned men have always been and remain the norm in the United Kingdom.

Reduction of practice

A national election was held in the United Kingdom at the end of World War II. The Labour Party gained a majority of the seats in Parliament and its leader, Clement Atlee, became prime minister. The party leaned to the left and supported social welfare. Aneurin Bevan was Minister of Health. The National Health Service (NHS) was created in 1948 to provide free medical treatment for all. Services were provided based on clinical need, not ability to pay. The NHS did not provide non-therapeutic circumcision, so the incidence of circumcision dropped to a very low level.[14]

Sir James Calvert Spence, a prominent senior British paediatrician, urged his younger colleague, Douglas Gairdner, to produce a paper on infant circumcision. The now famous classic paper, The fate of the foreskin: a study of circumcision, was published in the British Medical Journal on Christmas Eve, 1949. The paper reported 16 deaths per year from non-therapeutic infant circumcision and concluded in part: "The prepuce of the young infant should therefore be left in its natural state."[15]

The NHS provides male circumcision only when there was a clinical need.[16] The NHS performs circumcisions on boys only for therapeutic need.[17]

The British Medical Journal, the house organ of the British Medical Association, in an unsigned editorial in 1979, slammed the practice of child circumcision, calling it unnecessary, and citing the danger of contracting staphylococcal infection in the newborn nursery.[18] The editorial reported that the incidence of newborn circumcision in Britain had dropped from one-third in the 1930s to one fifth in 1949, to ten percent in 1963, and to six percent in 1975.[19]

Phimosis diagnosis issues

Fewer boys were being circumcised so there were more intact boys. The general practitioners (GPs) in the UK seemed to be unable to distinguish between true phimosis and developmentally non-retractile healthy foreskin and were referring numerous boys for unnecessary circumcision.

Rickwood et al. (1980) had provided guidance on diagnosis of phimosis. According to Rickwood et al. true phimosis occurs when the foreskin has been attacked by balanitis xerotica obliterans (BXO) (also known as lichen sclerosis). If BXO is not present then true phimosis does not exist.[20]

Several papers critical of phimosis diagnosis practice in the UK were published in the late 1980s and early 1990s. Rickwood & Walker (1989) reported that in the Mersey region (northwest England) "many boys are circumcised for development non-retractability of the prepuce rather than for true phimosis and that in consequence some two-thirds of the operations are unnecessary."[21] Griffiths & Frank (1992) also expressed concern regarding the apparent inability of general practitioners to distinguish between a true phimosis and a developmentally non-retractile foreskin. They pointed out, "Not surprisingly, the diagnostic inaccuracy was greatest when the referring doctor did not examine the patient."[22] Gordon & Collin (1993) attempted to cast some light in the darkness by providing factual information about actual indications for circumcision and how to distinguish between physiological and pathological phimosis.[23] Williams et al. (1993) complained that most of the 30,000 circumcisions that were being done in the UK were on boys under 15. They reported that of 69 boys referred by GPs, 29 had a healthy retractile foreskin, 30 had a healthy non-retractile foreskin, and only 9 had a phimosis requiring circumcision.[24]

In defence of the much criticised British GPs, it should be stated that the data they were provided by Douglas Gairdner regarding development of foreskin retractability was very inaccurate,[25] however this was not known at the time.

Cathcart et al. (2006) collected circumcision rates from 1997 through 2003. They reported a decline in the incidence of circumcision of about 20 percent over the period of their study, with about 10,000 circumcisions of boys per year at the end of the study. They commented that the circumcision rate for boys is still five times higher than the reported incidence of phimosis.[26]

Decline in circumcision practice continues

Rickwood & Walker (1989) reported that 21,000 circumcision were done annually on boys under 15 years of age,[21] so Cathcart et al. (2006) are finding a reduction of 53 percent,[26] although still much higher than it should be. It should be noted that manual stretching of the foreskin with the aid of topical steroid ointment to relieve phimosis had not yet entered general use.

The 2000 British National Survey of Sexual Attitudes and Lifestyles (Natsal 2000) found that 15.8 percent of British males aged 16 to 44 reported being circumcised. The incidence of circumcision was highest in the men aged 40-44 at 19.6 percent [born 1956-60] and lowest in the group aged 16-19 [born 1981-84] at 11.7 percent. Men of ethnic minorities (except black Caribbeans) were significantly more likely to circumcised than those described as "white". Jews were 98.7 percent circumcised and Sikhs, Hindus, and Buddhists were only 9.8 percent circumcised.[27]

Quaba & MacKindlay (2004) reported a 33.7% decline in the incidence of circumcision in Scotland from 1990 to 2000. This occurred because medical doctors were better trained in the recognition of healthy non-retractile foreskin in boys.[28]

Groves et al. (2010) reported a decline from 769 circumcisions of boys in Northern Ireland in 1991-1992 to 264 circumcisions of boys in 2001-2002 which represented a decline of 66 percent. This was said to be typical of trends in the United Kingdom.[29]

The percentage of males circumcised in the United Kingdom (prevalence) is reported to be 20.7%.[30]

Legal matters

Early Development of circumcision law

The relevant statutes are the Offences Against the Person Act (1861) and the Children and Young Persons Act 1933.

A 1985 decision of the Law Lords ruled:

Having regard to the reality that a child became increasingly independent as it grew older and that parental authority dwindled correspondingly, the law did not recognise any rule of absolute parental authority until a fixed age. Instead, parental rights were recognised by the law only as long as they were needed for the protection of the child and such rights yielded to the child's right to make his own decisions when he reached a sufficient understanding and intelligence to be capable of making up his own mind.[31]

Gillick affirmed the right and duty of parents to protect their child.

Sebastian Poulter, a legal writer, in a book entitled English Criminal Law and Ethnic Minority Customs (1986), stated:

"The basic right to bodily integrity which everyone possesses under the English common law means that any unlawful interference in this right amounts to an assault or battery, at the very least, and might in appropriate circumstances entail the statutory offence of grievous bodily harm. The question raised in cases of circumcision, excision or infibulation is whether the operation can be justified as constituting lawful as opposed to unlawful interference with this right."

"...although the matter is not entirely free from doubt, it seems that a parent may equally authorise a non-therapeutic operation, provided it is not actively against the child's interests. This would appear to have been the basis upon which the vast majority of male infants have been circumcised in this country with impunity from time immemorial.[sic]"

"It thus appears that, at common law, while the circumcision of male infants here is lawful, provided that parental consent has been given, no amount of parental agreement or support can legitimise the circumcision, excision or infibulation of a young girl in this country, unless the operation is for therapeutic purposes."[32]

Poulter's claims are controversial. Recent court decisions cast further doubt on their legitmacy.

Children Act 1989

Parliament in 1989 passed the Children Act 1989. This is a very extensive act to provide for the care, welfare and protection of persons under 18 years of age. The Children Act 1989 introduced the legal term significant harm.[33] One perhaps unexpected effect of the Children Act 1989 was to bring circumcision cases into family court when parents disagreed about circumcision of a son.

The Law Commission of England and Wales had proposed to recommend that circumcision of male children be made lawful. The late Christopher P. Price, solicitor, (1996) submitted a brief to the Law Commission in opposition to the proposal,[34] after which the proposal was dropped.

The Guardian (1999) reported the family law case of Re J (child's religious upbringing and circumcision)[35] in which the Muslim father wanted a son circumcised but the British mother did not. The Court of Appeals stated in part:

The judge said it was not in the best interests of the child to be circumcised, with its risk of pain and psychological damage which the boy would find hard to understand.

He said the boy might be traumatised by the operation. "The operation and the period leading up to it was also likely to be highly stressful to the mother."[36]

Forward into the 21st century

Welch solicitor Christopher P. Price led us into the 21st century with an essay highly critical of child non-therapeutic circumcision in every form.[37]

The family law case of Re B and G (children) (No 2) EWFC 3 (2015) was about two children in need of care. This required Judge Munby to consider both male and female circumcision. Judge Munby realised that male circumcision inflicted at least as much harm as lesser forms of female circumcision. This caused him to rule that male circumcision caused significant harm, which now allows courts to issue care orders to prevent male circumcision.[38] Munby cited the Brief to the Law Commission of England and Wales by the late Christopher P. Price entitled Male Circumcision: A Legal Affront,[39]

The case of L and B (2016) was a case in which parents disagreed about the circumcision of two boys. The Muslim father wanted the boys circumcised, however the court ruled that no order should be issued so the boys could decide for themselves when they are of age. In this highly significant case, Mrs. Justice Roberts took the decision away from either parents and gave it to the boys, thereby recognising the boys' right to self-determination. Her conclusion is entirely consistent with the rights of the child under human rights law. Her order also is entirely in accord with Resolution 1952 of the Council of Europe.[40]

The National Secular Society (2023) has called for the end of genital cutting of children.[41]

A court (Miss Nageena Khalique KC) has rejected a father's request to have a 16-month-old boy circumcised. The court said the boy can have it done later if he wishes.[42]

The Crown Prosecution Service charged Dr Mohammad Siddiqui with twenty-five circumcision-related crimes, to which he has pleaded guilty. He will be sentenced on 14 January 2025 in Southwark Crown Court.[43]

International human rights law in the United Kingdom

United Nations multi-lateral human rights treaties

The UK signed the International Covenant on Civil and Political Rights (ICCPR) on 16 September 1968 and formally ratified the ICCPR treaty on 11 December 1968.[44] Article 2 of the ICCPR requires the UK to apply and enforce the provisions of the ICCPR within its territory. See ICCPR: Application of the ICCPR to non-therapeutic circumcision of children for detailed information on the rights applicable to non-therapeutic circumcision of children.

The UK signed the Convention on the Rights of the Child (CRC) on 19 April 1990 an formally ratified the CRC treaty on 16 December 1991.[44] Article 2 of the CRC require the UK to respect and ensure the rights specified in the CRC to each child within its jurisdiction. See Application of the CRC to non-therapeutic circumcision of children for detailed information on the rights applicable to non-therapeutic circumcision of children.

Human Rights Act 1998

The United Kingdom became a founder-member of the Council of Europe on 5 May 1949 and therefore subject to the European Convention on Human Rights (1950). Under that Convention the United Kingdom may be sued in the European Court of Human Rights (Strasbourg) for alleged human rights violations.

Certain parts of the Convention seems applicable to the non-therapeutic circumcision of minor boys:

  • Article 3: Freedom from torture and inhuman or degrading treatment
  • Article 5: Everyone has a right to liberty and security of person.
  • Article 8: Everyone has the right to respect for his private and family life, his home and his correspondence.

The case of A v. United Kingdom (1998) involved the beating of a child with a garden cane. The court ruled:

States required to take measures designed to ensure individuals not ill-treated in breach of Article 3 by other private individuals – children entitled to protection, through effective deterrence, against such treatment.[45]

The case clearly established the right of children in the UK to protection under the ECHR. Nevertheless, no known cases have applied international human rights law specifically to the practice of non-therapeutic child circumcision in the UK.

The human rights provisions of the Convention have now been brought into domestic law by the Human Rights Act 1998, so violations of human rights law could be litigated in the domestic courts of the UK.

Resolution no. 1952 (2013) 'Children's right to physical integrity' of the Parliament Assembly of the Council of Europe, which includes the issue of physical integrity of intersex children for the first time, was adopted on October 1, 2013 following an initiative of the German SPD politician Marlene Rupprecht.[46]

The resolution includes other topics such as the female genital mutilation, the male circumcision for religious reasons, and the submission or coercion of a child to piercings, tattoos or cosmetic surgery.

The resolution calls on all member States to "examine the prevalence of different categories of non-medically justified operations and interventions impacting on the physical integrity of children in their respective countries, as well as the specific practices related to them, and to carefully consider them in light of the best interests of the child in order to define specific lines of action for each of them; initiate focused awareness-raising measures for each of these categories of violation of the physical integrity of children, to be carried out in the specific contexts where information may best be conveyed to families, such as the medical sector (hospitals and individual practitioners), schools, religious communities or service providers; [...]."

This first resolution of its kind by a European institution is not legally binding, but an important signal for further debate and action. It shifts the approach of the point of view of the topic from the current medical domain towards a human rights approach and identifies the right to bodily integrity, autonomy and self-determination. It calls the for the end of non-therapeutic cosmetic medical and surgical interventions.[40]

The ethics of non-therapeutic circumcision

The Journal of Medical Ethics (London) devoted its entire July 2013 issue to the question of non-therapeutic circumcision of children, where a variety of views are presented.[47]

General Medical Council

The General Medical Council (GMC) regulates medical practitioners in the United Kingdom.

The GMC issued an "interim guidance" on the [non-therapeutic] circumcision of male children in 1997.[48]

The GMC emphasises the importance of protecting children and young people,[49] but has not prohibited non-therapeutic circumcision of non-consenting minors.

Although the UK has been a member of the Council of Europe, a human rights organisation since 1949, a state-party to the ICCPR since 1976, and the CRC since 1991, the General Medical Council has not revised its policies and procedures to recognise the human rights of child patients to the physical security of their person.

The GMC holds four disciplinary sessions a year. Over the last decade it has disciplined 39 doctors for ritual (non-therapeutic) circumcision issues. The Medical Protection Society warned circumcision carries "considerable risks and complications”. Religious and cultural circumcision on boys is permitted, including by non-doctors, and largely occurs among Jewish, Muslim and some African Christian communities, where they are often considered a religious obligation.[50]

The GMC will be holding a disciplinary hearing in the case of Dr Balvinder Mehat of Nottingham who has circumcised a second boy without the necessary two-parent surrogate consent and the wound became infected.[51]

The guidance of the British Medical Association

The British Medical Association (BMA) is a medical trade association. It represents and protects the interests of its doctor-members. Unlike American medical trade associations, the BMA do not claim to be an authority on medical science. Its advice to members address ethical and legal issues to assist members in staying out of legal difficulties. The BMA have provided several statements regarding child circumcision to inform its members since 1996:

The case of Re J (1999), Re S, and the Human Rights Act 1998 caused the BMA to revise its guidance to doctors and issued a new guidance in 2003.

Keele University law professors Fox & Thomson 2005 reviewed the 2003 BMA statement and cited legal deficiencies in that statement.[52] The BMA accepted the criticism, so the guidance was further revised in 2006.

The cases of Re R and B and Re L and B (CHILDREN) so alarmed the BMA's lawyers that a new guidance was issued in 2019. The new guidance advises extreme caution regarding performance of non-therapeutic circumcision of boys.

The 2019 BMA guidance regarding non-therapeutic circumcision of boys is divided into twelve “cards”. Card Four discusses law. Human rights law is recognised but the BMA fail to understand the significance of human rights law. The BMA do not clearly state that human rights law grants rights to children which helps to define the best interests of the child and should be respected and protected.

The BMA seems to lean toward protecting the alleged right of its members to profit from carrying out non-therapeutic circumcision on boys, in the face of increasingly severe legal concerns.

Lempert et al. (2022) criticized the 2019 BMA guidance for "serious weaknesses". They listed:

  1. the absence of an explicit stance on the underlying ethical status of NPC, coupled with an implicit permissive stance,
  2. an incoherent and impracticable analysis of the child’s best interests,
  3. unbalanced guidance regarding cultural issues,
  4. unbalanced guidance regarding scientific issues,
  5. unjustified differential treatment of children of the same sex,
  6. unjustified differential treatment of children of different sexes,
  7. problems with child safeguarding, and (8) problems with regulation and training.
  8. an unjustified presumption of lawfulness of NPC of minors and
  9. failure adequately to address recent case law.[53]

In addition, they noted an egregiously inadequate description of the male foreskin and its functions.[53]

Symposia

The United Kingdom has been the site of several symposia regarding sexual integrity.

A source of information and aid

15 Square is a registered charity that provides information and aid to parents and both intact and circumcised males. The name refers to the approximate area of the adult male foreskin in square inches. 15 Square is based in Stone, Staffordshire.

Circumcision deaths

Gairdner (1949) reported 16 deaths per year.[15] Death from circumcision still occurs.

  • Celian Noumbiwe, a nine-week-old baby, died in his mother's arms in 2007, after circumcision surgery at a doctor's surgery in Reading, apparently from loss of blood.[55]
  • Goodluck Caubergs, four-weeks-old, bled to death in Oldham after Grace Adeleye circumcised him in April 2010. Adeleye was found guilty of manslaughter by gross negligence at Manchester Crown Court.[56]
  • Raju Miah: Death by circumcision. July 1991, Birmingham, England, United Kingdom.
  • Boma Oruitemeka: Death by circumcision, severe hemorrhage. 1990, London, England, United Kingdom.

Conclusion

The BMA (2019) reported that the NHS therapeutically circumcises about 10,000 boys under 18-years-of-age per year.[57] The Daily Mail (2022) alleged that 1/2 of the 10,000 NHS circumcisions of boys are unnecessary.[58]

The incidence of non-therapeutic circumcision of boys in the United Kingdom has been substantially reduced from its former peaks in the 1930s and early 1940s. Non-therapeutic circumcision of boys remains lawful provided that both parents grant consent. The practice seems to be concentrated among ethnic minorities. Ethical and human rights concerns about the surgery persist.

Non-therapeutic circumcision usually is not covered by the NHS, so parents must find a private medical or non-medical operator such as a mohel to perform the foreskin amputation and must pay the fee out of pocket as third-party payment is not available. Given the recent legal cautions uttered by the BMA,[57] it may not be easy to find a medical practitioner willing to accept the risk.

The NHS announced in November 2022 that it would no longer perform the 23,000 circumcisions that it had been performing every year.[59]

Videos

Maajid Nawaz: Male circumcision consent

A discussion of consent for non-therapeutic male circumcision by Maajid Nawaz from Sky News

Great Britain - History of Foreskin and Circumcision

Why my penis is in constant pain - BBC stories

British Circumcision Debate - Should Human Rights Outweigh Religious Rights

See also

External links

References

  1. ↑ REFjournal Darby R. Pathologizing Male Sexuality: Lallemand, Spermatorrhea, and the Rise of Circumcision. J Hist Med Allied Sci. July 2005; 60(3): 283-319. PMID. DOI. Retrieved 4 September 2021.
  2. ↑ REFbook Dixon EH (1845): Ch. IX: Phimosis and Circumcision, in: A Treatise on Diseases of the Sexual Organs. New York: William Taylor. Pp. 158-65. Retrieved 30 October 2021.
  3. ↑ REFweb Zhang, Gary (2020). Jonathan Hutchinson, Life in the Fast Lane. Retrieved 4 September 2021.
  4. ↑ a b REFweb Darby, Robert. The crotchets of Sir Jonathan Hutchinson, The History of Circumcision. Retrieved 4 September 2021.
  5. ↑ REFjournal Hutchinson, Jonathan. On the Influence of Circumcision in Preventing Syphilis. Medical Times and Gazette. 1855; 32(844): 542-543. Retrieved 4 September 2021.
  6. ↑ REFjournal Heckford N. Circumcision as a remedial measure in certain cases of epilepsy and chorea. Clinical Lectures and Reports by the Medical and Surgical Staff of the London Hospital. 1865; 2: 58-64.
  7. ↑ REFjournal Hutchinson, Jonathan. A plea for circumcision. Archives of Surgery. 1890; II: 15. Retrieved 4 September 2021.
  8. ↑ REFjournal Hutchinson, Jonathan. On circumcision as a preventive of masturbation. Archives of Surgery. 1890; II: 267-9. Retrieved 4 September 2021.
  9. ↑ REFjournal Hutchinson, Jonathan. On circumcision. Archives of Surgery. 1893; IV: 379-80. Retrieved 4 August 2021.
  10. ↑ REFjournal Hutchinson J. The advantages of circumcision. The Polyclinic. September 1900; 3(9): 129-131. Retrieved 4 September 2021.
  11. ↑ REFbook Treves F (1903): Chapter VI, in: Circumcision. Work: A Manual of Operative Surgery, II.. London: Cassell. Pp. 670-3. Retrieved 4 September 2021.
  12. ↑ REFjournal Cockshut RW. Circumcision. BMJ. 19 October 1935; 2(3902): 764. Retrieved 4 September 2021.
  13. ↑ REFjournal Rickwood AMK, Kenny SE, Donald SC. Towards evidence based circumcision of English boys: survey of trends in practice. BMJ. 2000; 321: 792-3. PMID. PMC. DOI. Retrieved 5 September 2021.
  14. ↑ REFjournal Gollaher DL. From ritual to science: the medical transformation of circumcision in America. Journal of Social History. September 1994; 28(1): 5-36. Retrieved 26 October 2021.
  15. ↑ a b REFjournal Gairdner DMT. The fate of the foreskin: a study of circumcision. British Medical Journal. 1949; 2(4642): 1433-7. PMID. PMC. DOI. Retrieved 28 October 2019.
  16. ↑ REFweb (5 November 2018). Circumcision in men, National Health Service. Retrieved 5 September 2021.
  17. ↑ REFweb (20 November 2018). Circumcision in boys, National Health Service. Retrieved 5 September 2021.
  18. ↑ REFjournal Van Howe RS, Robson WM. The possible role of circumcision in newborn outbreaks of community-associated methicillin-resistant Staphylococcus aureus. Clin Pediatr (Phila). May 2007; 46(4): 356-8. PMID. DOI. Retrieved 10 September 2021.
  19. ↑ REFjournal Anonymous. The case against circumcision. BMJ. 5 May 1979; 6172: 1163-64. PMID. PMC. Retrieved 5 September 2021.
  20. ↑ REFjournal Rickwood AMK, Hemalatha V, Batcup G, Spitz L. Phimosis in boys. Brit J Urol. April 1980; 52: 147-60. PMID. DOI. Retrieved 5 September 2021.
  21. ↑ a b REFjournal Rickwood AMK, walker, Jenny. Is phimosis overdiagnosed in boys and are too many circumcisions performed in consequence?. Ann R Coll Surg Engl. September 1989; 71(5): 275-7. PMID. PMC. Retrieved 5 September 2021.
  22. ↑ REFjournal Griffiths D, Frank JD. Inappropriate circumcision referrals by GPs. J R Soc Med. 1992; 85: 324-5. PMID. PMC. Retrieved 5 September 2021.
  23. ↑ REFjournal Gordon, Andrew, Collin, Jack. Save the normal foreskin. BMJ. 2 January 1993; 306(6869): 1-2. PMID. PMC. DOI. Retrieved 5 September 2021.
    Quote: A better understanding of the normal physiology, developmental anatomy, and pathology of the prepuce could prevent the removal of thousands of normal foreskins over the next 20 years.
  24. ↑ REFjournal Williams, Nigel, Chell, Julian, Kapila, Leela. Why are children referred for circumcision?. BMJ. 2 January 1993; 306(6859): 28. PMID. PMC. DOI. Retrieved 5 September 2021.
  25. ↑ REFjournal Denniston GC, Hill G. Gairdner was wrong.. Can Fam Physician. October 2010; 56(10): 986-7. PMID. PMC. Retrieved 5 September 2021.
  26. ↑ a b REFjournal Cathcart P, Nuttall M, van der Meulen J, Emberton M, Kenny SE. Trends in paediatric circumcision and its complications in England between 1997 and 2003. BJS. July 2006; 93(7): 885–890. PMID. DOI. Retrieved 5 September 2021.
  27. ↑ REFjournal Dave SS, Fenton KA, Mercer CH, Erens B, Wellings K, Johnson AM. Male circumcision in Britain: findings from a national probability sample survey.. Sex Trans Infect. December 2003; 79(6): 499-500. PMID. PMC. DOI. Retrieved 5 September 2021.
  28. ↑ REFjournal Quaba O, MacKindlay GA. Changing trends in a decade of circumcision in Scotland. J Pediatr Surg. July 2004; 39(7): 1037-9. PMID. DOI. Retrieved 16 November 2021.
  29. ↑ REFjournal Groves H, Bailie A, McCallion W, et al. Childhood circumcision in Northern Ireland: A barometer of the current practice of general paediatric surgery. Ulster Med J. 2010; 79(2): 80-1. PMID. PMC. Retrieved 16 November 2021.
  30. ↑ REFweb (1 April 2024). Global Circumcision Statistics and Estimates, https://circstatistics.github.io. Retrieved 1 April 2024.
  31. ↑ REFdocument Gillick v West Norfolk and Wisbech Area Health Authority [1985 3 All ER 402], Circumcision Reference Library. (1985). Retrieved 7 September 2021.
  32. ↑ REFbook Poulter S (1986): English Criminal Law and Ethnic Minority Customs. London: Butterworths. Retrieved 7 September 2021.
  33. ↑ REFweb (23 April 2021). What is the Children Act?, Virtual College. Retrieved 7 September 2021.
    Quote: Under the Children Act 1989, ‘harm’ is defined as any “ill-treatment or the impairment of the health or development of the child”. Whether the harm is deemed ‘significant’ is decided by comparing the health and development of the child with what would generally be expected of another, similar child and judging if there is a big difference.
  34. ↑ REFdocument Price, Christopher P.: Male Circumcision: A Legal Affront, Circumcision Reference Library. (December 1996). Retrieved 7 September 2021.
  35. ↑ REFweb (25 November 1999). Re J (child's religious upbringing and circumcision). Retrieved 7 September 2021.
  36. ↑ REFnews (26 November 1999)."Muslim father loses court battle", The Guardian. Retrieved 7 September 2021.
  37. ↑ REFbook Price CP (1999): Male Non-therapeutic circumcision: The Legal and Ethical Issues. Work: Male and Female Circumcision, Medical, Legal, and Ethical Considerations in Pediatric Practice. Denniston GC, Hodges FM and Milos MF eds. (ed.). New York: Kluwer Academic/Plenum Publishers. Retrieved 7 September 2021.
  38. ↑ REFdocument Munby, James: Re B and G (Children) (No 2) [2015 EWFC 3, [2015]] PDF, Royal Courts of Justice. (14 January 2015). Retrieved 11 July 2024.
  39. ↑ REFweb Price, Christopher (1996). Male Circumcision: A Legal Affront, Circumcision Reference Library. Retrieved 12 September 2020.
  40. ↑ a b REFdocument Children's right to physical integrity PDF, Parliamentary Assembly. (1 October 2013). Retrieved 3 January 2021.
  41. ↑ REFweb Anonymous (2023). End forced genital cutting, National Secular Society. Retrieved 23 September 2023.
  42. ↑ REFweb Anonymous (18 September 2024). High Court rejects application by father for young boy subject to care order to be circumcised, LocalGovernmentLawyer. Retrieved 19 September 2024.
  43. ↑ REFweb Anonymous (31 October 2024). A former surgeon found guilty of causing harm during multiple male circumcision operations, Crown Prosecution Service. Retrieved 1 November 2024.
    Quote: He showed a complete disregard for the impact of his actions on his victims, families, and communities. We hope that this conviction offers some comfort in seeing Siddiqui being brought to justice.
  44. ↑ a b REFweb Ratification Status for United Kingdom of Great Britain and Northern Ireland, https://tbinternet.ohchr.org, UN Treaty Body Database. Retrieved 12 September 2021.
  45. ↑ REFdocument A. v United Kingdom. [1998 2 FLR 959], Circumcision Reference Library. (1998). Retrieved 7 September 2021.
  46. ↑ REFbook Aktor M (2016): 24, in: Whose Rights? The Danish Debate on Ritual Infant Male Circumcision as a Human Rights Issue. Work: Contemporary Views on Comparative Religion: In Celebration of Tim Jensen's 65th Birthday. Peter Antes, Armin W. Geertz, Mikael Rothstein (ed.). Sheffield: Equinox Publishing. Pp. 311-24. ISBN 9781781791394. Retrieved 12 September 2021.
  47. ↑ REFjournal July 2013 issue. Journal of Medical Ethics. July 2013; 39(7) Retrieved 11 September 2021.
  48. ↑ REFweb Anonymous (1997). Guidance for Doctors Who Are Asked to Circumcise Male Children, Circumcision Reference Library, General Medical Council. Retrieved 12 September 2021.
    Quote: Listen to those with parental responsibility and give careful consideration to their views. You are not obliged to act on a request to circumcise a child, but you should explain if you are opposed to circumcision other than for therapeutic reasons. You should also tell those with parental responsibility that they have a right to see another doctor.
  49. ↑ REFweb Anonymous (25 May 2018). Protecting children and young people: The responsibilities of all doctors, General Medical Council. Retrieved 12 September 2021.
  50. ↑ REFnews Penmman, Andrew (19 January 2023)."Exposed: the horror statistics behind ritual circumcision of baby boys in the UK", Mirror. Retrieved 20 January 2023.
  51. ↑ REFnews Lowbridge, Caroline (18 May 2024)."Doctor circumcised second boy without parent's consent", BBC. Retrieved 30 May 2024.
    Quote: "I note that similar conduct by Dr Mehat has previously been determined to amount to serious misconduct. If it were found to have been repeated, this would be an aggravating factor."
  52. ↑ REFjournal Fox M, Thomson M. A covenant with the status quo? Male circumcision and the new BMA guidance to doctors. J Med Ethics. 2005; 31(8): 463-9. PMID. PMC. DOI. Retrieved 11 September 2021.
  53. ↑ a b REFjournal Lempert A, Chegwidden J, Steinfeld R, Earp BD. Non-therapeutic penile circumcision of minors: Current controversies in UK law and medical ethics.. Clinical Ethics. May 2022; Retrieved 20 May 2022.
  54. ↑ REFnews Beckford, Martin (16 February 2007)."Police investigate baby's death after circumcision", The Daily Telegraph. Retrieved 12 September 2021.
    Quote: Police are investigating the circumstances of the death of a baby boy. Inquiries are being carried out by officers from the Serious Crime Directorate. The death is being treated as unexplained.
  55. ↑ REFnews Bannerman, Lucy (13 February 2009)."Baby bled to death after circumcision, inquest told", The Times. Retrieved 12 September 2021.
  56. ↑ REFnews (14 December 2012)."Grace Adeleye guilty of killing baby in botched circumcision", BBC. Retrieved 12 September 2021.
    Quote: The boy bled to death before he could reach hospital the following day.
  57. ↑ a b REFdocument Non-therapeutic male circumcision (NTMC) of children – practical guidance for doctors PDF, British Medical Association. (2019). Retrieved 10 September 2021.
  58. ↑ REFnews Ennals, Ethan (1 March 2022)."Is the NHS carrying out thousands of unnecessary circumcisions on teenage boys? New report shows irreversible surgery is carried out 10,000 times per year", The Daily Mail. Retrieved 23 May 2023.
    Quote: The analysis also found up to half of the boys who underwent medical circumcision at some trusts were under five, an age at which doctors agree the procedure is almost always unnecessary.
  59. ↑ REFweb Warren, Jessica (9 November 2022). Circumcisions, tummy tucks and liposuction are among 13 operations which will stop being funded by the NHS in a 'crackdown' on wasteful spending in a bid to save £2bn a year, Daily Mail. Retrieved 7 April 2023.
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