Canada

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A Report on circumcision in Canada.

History

Non-therapeutic circumcision of children is not part of the culture of many Canadian minorities. The French-speaking people of Quebec and elsewhere generally do not favour circumcision. Male circumcision is not part of the culture of indigenous Inuit, First Nations, and Métis populations (4.3% of the population).

Pirie (1927), in a presentation to the Canadian Society for the Study of Diseases of Children, described circumcision as "very common".[1]

Douglas Gairdner,s classic 1949 paper, The Fate of the Foreskin: A Study of Circumcision, seems to have been ignored in Canada.[2]

Patel (1966) reported his findings on neonatal circumcision in Kingston, Ontario, Canada. Patel reported on the complications experienced in a series of 100 consecutive male infants. He also reported on the incidence of circumcision at Kingston General Hospital in Kingston, Ontario. Patel reported an incidence of circumcision of 48 percent. This is for one hospital in Kingston, ON but has been widely cited as the rate for all Canada.[3]

Canada, like other English-speaking nations formerly circumcised most of its boys, with circumcision rates in the 40 to 70 percent range in the 1960s.[4]

LeBourdais (1995) declared tha male circumccision is "clearly can no longer be reqarded as routine procedure."[5]

Reported incidence of non-therapeutic child circumcision

The reported incidence of child circumcision in Canada varies by province and has diminished over time. Newfoundland has always had a very low incidence of child circumcision while Alberta and Ontario have had a higher incidence of child circumcision.

Johnston (1995) reported that the incidence of child circumcision in Canada had fallen from 60 percent a generation ago to an estimated 25 percent.[6]

The Montreal Gazette (2006) reported that the incidence of circumcision has fallen by 36 percent to 14 percent according to the Association for Genital Integrity, while Statistics Canada reported a high of 29.5 percent in P.E.I. and a low of 1.1 percent in Nova Scotia.[7][8]

Position statements of medical societies

The Canadian Paediatric Society (CPS) took a position against non-therapeutic circumcision of boys in 1975, declaring it to have "no medical indication" and to be an "obsolete operation".[9]

The CPS revisited circumcision in 1996 and recommended, "Circumcision should not be routinely performed."[10]

The CPS again considered infant circumcision in 2015. The CPS stated:

While there may be a benefit for some boys in high-risk populations and circumstances where the procedure could be considered for disease reduction or treatment, the Canadian Paediatric Society does not recommend the routine circumcision of every newborn male.[11]

The Canadian Urological Association (CUA) considered the matter of circumcision and issued a statement in February 2018. The CUA concluded, "Given the socioeconomic, educational status, and health demographics of our population, universal neonatal circumcision cannot be justified based on the current evidence available.[12]

Availability of third-party payment

Canada has fourteen single-payer health insurance plans (HIPs) — one for each of the ten provinces and three territories and a 14th plan for government employees. The British Columbia HIP stopped paying for non-therapeutic circumcision in the 1980s. Ontario HIP stopped payment for non-therapeutic circumcision in July 1995; Saskatchewan stopped in 1996. One by one, all other HIPs have stopped paying for non-therapeutic circumcision. Manitoba HIP was the last to stop, but only after the wrong boy was circumcised at St. Boniface Hospital.[13]

Third-party payment for non-therapeutic circumcision is not presently available anywhere in Canada.[14] Parents who wish to have a son circumcised must pay out-of-pocket for the costs of the circumcision.[15]

Reasons for circumcision

Rediger & Muller (2013), working in Saskatoon, found "newborn male circumcision rates continue to be heavily influenced by the circumcision status of the child's father."[15]

Canadian circumcision deaths

Two deaths caused by circumcision have been reported in Canada, one in British Columbia and one in Ontario. There may be others because death by circumcision may not be properly reported.

Non-therapeutic circumcision and Canadian law

Non-therapeutic circumcision of children in Canada is a practice that is of uncertain lawfulness.

The Charter of Rights and Freedoms (1982), Article 7 provides every Canadian with the right to security of the person.

In addition, Canada is a state-party to the United Nations Covenant on Civil and Political Rights (1966) and the Convention on the Rights of the Child (1989), both of which provide various human rights to children, which are violated by non-therapeutic child circumcision.

Margaret A. Somerville, Director of the McGill Centre for Medicine, Ethics and Law, wrote to Pierre Blais in 1993, then Minister for Justice and Attorney-General, to propose that "male circumcision would not be totally banned. Rather circumcision of those persons unable to consent for themselves (which would, of course, include all infants) would not be allowed under the Criminal Code as it presently stands." However, no action was taken.[16]

Several decisions of the Supreme Court of Canada call consent for non-therapeutic circumcision of a child in question, but no case so far has ruled on the matter of circumcision.

Suzanne Bouclin (2005) has examined the issues and concluded:

Where a parent or substitute decision maker has deemed that it is in the child’s best interest to undergo a treatment, there may be some conflict between that privilege and the fundamental right to security of the person protected under Section 7 of the Charter. Because the State’s power to intervene is broad and can be permanent, parental decision making has been protected under the Charter. Nevertheless, the Court has determined that parents’ rights are not absolute and that the State will intervene when necessity is demonstrated.

Section 7 of the Charter provides everyone with a certain degree of autonomy in decisions concerning their private lives, including those concerning medical treatment. The protection of the security of the person is so fundamental that medical treatment administered without a patient’s informed consent may amount to battery. In the context of circumcision, if a medical practitioner performs routine neonatal circumcision without an infant’s parental consent, that practitioner may be liable for criminal assault as well as for damages for any harm that resulted from her or his negligence (Somerville, 2000).

Given that a portion of the medical community has agreed that routine male circumcision is nontherapeutic and that it may be in and of itself be a harmful practice, it is arguable that when performed on neonates for nontherapeutic reasons, it amounts to a violation of the child’s Section 7 rights. As stated at the Declaration of the First International Symposium on Circumcision, “parents and/or guardians do not have the right to consent to the surgical removal or modification of their children’s normal genitalia.” The Declaration adds that the only person who may consent to medically unnecessary procedures upon herself or himself is that individual, having reached a stage in life where she or he can consent and only upon being fully informed about the risks and benefits of the procedure. Note, however, that the Declaration is not a binding legal instrument.

…

Public awareness is increasing, as evidenced by the numerous parents, health practitioners, children’s rights activists, ethicists, lawyers, and concerned citizens who have voiced their opinion. Insofar as male circumcision is the removal of healthy erogenous flesh without medical purpose and without the consent of the child and given that it is a painful procedure, neonatal circumcision is unnecessary and may well violate a child’s bodily integrity.[17]

Canada and circumcision in the 21st century

Jackie Smith (2002) discussed the growing consensus against non-therapeutic child circumcision.[18]

At the beginning of the 21st Century, only the Manitoba Health Insurance Plan (HIP) still paid for non-therapeutic circumcision, however that was ended in 2006.

The Public Health Agency of Canada carried out a survey of mother' birth experiences in 2006-7. Item 38 was male infant non-therapeutic circumcision.(See pages 224-5.)

Among women with a male baby, 31.9% (95% CI: 30.3–33.6) reported circumcising their baby. There was marked regional variation in circumcision. In the 10 jurisdictions in which at least five circumcisions were reported, the proportion of women who reported having their male baby circumcised ranged from 44.3% (95% CI: 39.2–49.4) in Alberta and 43.7% (95% CI: 40.6–46.8) in Ontario to 9.7%† (95% CI: 5.2–14.2) in the Northwest Territories and 6.8%† (95% CI: 3.6–10.0) in Nova Scotia.[19]

In all provinces and territories, only a minority of boys are being circumcised.

The above referenced survey provides the most recent available statistics on the incidence of non-therapeutic child circumcision in Canada. It is likely that the incidence of circumcision has further declined since the survey was taken for the following reasons:

  • The long-term trend in the incidence of circumcision in Canada is down.
  • The ratio of intact fathers to circumcised fathers is changing toward more intact fathers and fewer circumcised fathers. Boys who were born after the decline in circumcision started and who are intact are now reaching the age at which they start families and become fathers. Intact men usually do not want any son to be circumcised, so they will usually not have a son circumcised. This will cause a further decline in the incidence of circumcision.
  • The survey found that the incidence of circumcision on Prince Edward Island was 38 percent. A recent report indicated that non-therapeutic circumcision of boys is no longer available on P.E.I. because no practitioner will perform the non-therapeutic amputation of part of a boy's penis.[20]

As of 2019, third-party payment for circumcision is not available in Canada. Moreover, non-therapeutic circumcision is not done in hospitals,[14] so parents who want to have a boy circumcised must take the boy to the surgery of a practitioner who specializes in non-therapeutic male circumcision, and furthermore must pay out of pocket. For example, the cost of circumcision of a newborn boy in New Brunswick is C$425 ranging up to C$1500 for a teenager or adult.[21]

The prevalence of circumcision is high among older males, but low among younger males. As older mostly circumcised males die and are replaced by younger, mostly intact males, the prevalence of circumcision in Canada is gradually declining.

See also

References

  1. ↑ REFjournal Pirie, George R.. The story of circumcision. Can Med Assoc J. July 1927; 17(12): 1540-2. Retrieved 26 October 2019.
  2. ↑ REFjournal Gairdner, D.M.. The fate of the foreskin: a study of circumcision. British Medical Journal. 1949; 2(4642): 1433-1437. PMID. PMC. DOI. Retrieved 28 October 2019.
  3. ↑ REFjournal Patel, Hawa. The problem of routine infant circumcision. Can Med Assoc J. 1066; 95: 576-81. Retrieved 25 October 2019.
  4. ↑ REFjournal Wirth, John L.. Current circumcision practices: Canada. Pediatrics. 1980; 66(5): 705-8. PMID. Retrieved 25 October 2019.
  5. ↑ REFjournal LeBourdais, Eleanor. Circumcision no longer a "routine" surgical procedure.. Canad Med Assoc J. 1995; 152(11): 1873-6. PMID. PMC. Retrieved 4 November 2019.
  6. ↑ REFnews Johnston, David (11 September 1995)."Under the Knife", Toronto Star. Retrieved 26 October 2019.
  7. ↑ REFnews (23 March 2006)."Rates of circumcision slashed in past 30 years.", The Gazette. Retrieved 26 October 2019.
  8. ↑ REFnews MacDonald, Andrea (25 March 2006)."Circumcisions continue to drop: Province has second-lowest rate in the country", Halifax Daily News. Retrieved 26 October 2019.
  9. ↑ REFjournal Swyer, P.R., Boston, R.W., Murdock, A., Paré, C., Rees, E., Segal, S., Sinclair, J.C.. FN 75 Circumcision in the newborn period. CPS News Bull Suppl. 1975; 8(2): 1-2. Retrieved 25 October 2019.
  10. ↑ REFjournal Outerbridge, Eugene. Neonatal circumcision revisited. Can Med Assoc J. 15 March 1996; 154(6): 769-80. PMID. PMC. Retrieved 26 October 2019.
  11. ↑ REFjournal Sorokin, S. Todd, Finlay, J.C., Jeffries, A.L., et al. Newborn male circumcision. Paediatr Child Health. August 2015; 20(6): 311-20. PMID. PMC. DOI. Retrieved 26 October 2019.
  12. ↑ REFjournal Dave, Sumit, et al. Canadian Urological Association guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants (abridged version). Can Urol Assoc J. February 2018; 12(2): 18-28. Retrieved 26 October 2019.
  13. ↑ REFnews "Circumcision mix-up", Canada.com. Retrieved 26 October 2019.
  14. ↑ a b James Loewen (2019). Personal communication.
  15. ↑ a b REFjournal Rediger, Chris, Muller, Andries J.. Parents' rationale for male circumcision. Can Fam Physician. February 2013; 59(2): e110-115. PMID. PMC. Retrieved 26 October 2019.
  16. ↑ REFweb Somerville, Margaret (28 January 1993). Letter to Pierre Blais, Minister of Justice. Retrieved 4 November 2019.
  17. ↑ REFjournal Bouclin, Suzanne. An examination of legal and ethical issues surrounding male circumcision: the Canadian context. Int J Mens Health. 2005; 4(3): 205-23. Retrieved 27 October 2019.
  18. ↑ REFnews Smith, Jackie (30 August 2002)."The growing consensus against circumcision", National Post. Retrieved 27 October 2019.
  19. ↑ REFdocument What Mothers Say: The Canadian Maternity Experiences Survey PDF, Public Health Agency of Canada. (2009). Retrieved 27 October 2019.
  20. ↑ REFnews Williams, Nicole (24 June 2019)."Mom 'enraged' she can't find doctor to perform circumcision on P.E.I.", CBC News. Retrieved 27 October 2019.
  21. ↑ REFweb Circumcision Pricing & Insurance Coverage, Gentle Procedures Clinic. Retrieved 6 November 2019.
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