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A report on non-therapeutic [[circumcision ]] in Canada.

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 native culture of indigenous Inuit, First Nations, and Métis populations (4.3% of the population).The Canadian Government established Residential Schools from about 1880 to assimilate the indigneous people into Euro-Canadian culture.<ref name="residential2021">{{REFweb |title=Residential Schools in Canada |url=https://www.thecanadianencyclopedia.ca/en/article/residential-schools |archived= |trans-title= |language= |last=Miller |first= |init=JR |author-link= |publisher=Canadian Encyclopedia |website= |date=2021-06-01 |accessdate=2022-10-26 |quote=}}</ref> The indigenous people who do circumcise today received [[circumcision]] as a cultural procedure from the English-speaking Canadians in the Residential Schools.<ref name="euringer2005">{{REFnews |title=BC Health Pays to Restore Man’s Foreskin |url=https://thetyee.ca/News/2006/07/25/Circumcision/ |last=Euringer |first=Amanda |init=A |publisher=The Tyee |date=2006-07-25 |accessdate=2022-08-21 }}</ref> [[Paul Tinari]], a Métis, attended a residential school near Montreal where he was [[circumcised]] at the age of eight by a Catholic priest and a Jewish [[mohel]]. Tinari states "thousands of young native and Métis boys were [[circumcised]] during their stays in the notorious residential school system."<ref name="euringer2005" />

The medicalized genital cutting of infants and children was first promoted in Canada during the mid to late 19th century by English-speakers after the fashion at the time of the [[United Kingdom]]. Doctors encouraged the genital cutting of both male and female children to prevent [[masturbation ]] as well as various diseases like epilepsy and tuberculosis.<ref name="chhrp2018">{{REFdocument

 Pirie (1927), in a presentation to the Canadian Society for the Study of Diseases of Children, described [[circumcision ]] as "very common".<ref name="pirie1927">{{REFjournal

Bruce Peter Reimer, later known as [[David Reimer]], was born in Winnipeg, Manitoba on 22 August 1965. His penis was destroyed in an accident during medically-unnecessary, non-therapeutic [[circumcision]] by Dr. [[Jean-Marie Huot]].

Patel (1966) reported his findings on neonatal [[circumcision]] in Kingston, Ontario, Canada. Patel reported a [[complication ]] rate of 55 percent experienced in a series of 100 consecutive male infant circumcisions. He also reported on the incidence of circumcision at [http://www.kingstonhsc.ca/ Kingston General Hospital] in Kingston, Ontario. Patel reported an incidence of [[circumcision ]] of 48 percent. This is for one hospital in Kingston, {{CAPTC|ON }} but has been widely and falsely cited as the rate for all Canada.<ref>{{REFjournal

Canada, like other English-speaking nations, formerly [[circumcised ]] many of its boys, with circumcision rates in the 40 to 70 percent range in the 1960s.<ref>{{REFjournal

The [[Canadian Paediatric Society]] (CPS) issued its first statement on neonatal circumcision in 1975. The statement said "there is no [[medical indication ]] for circumcision during the neonatal period." The CPS called the amputation an "obsolete operation" and anticipated a "sharper decrease in the percentage of infants circumcised".<ref name="cps1975">{{REFjournal

[[Eleanor LeBourdais ]] (1995) declared that male [[circumcision ]] is "clearly can no longer be regarded as routine procedure."<ref name="lebourdais1995">{{REFjournal

|date=1995-06-01

Circumcision of male infants is a clear violation of the rights guaranteed to all persons by the [https://www.canada.ca/en/canadian-heritage/services/how-rights-protected/guide-canadian-charter-rights-freedoms.html Canadian Charter of Rights and Freedoms]. Furthermore, the practice contravenes [[human rights]] legislation on provincial and international levels.<ref name="bhimji2000">{{REFjournal

The [[Canadian Paediatric Society]] (CPS) took a position against non-therapeutic circumcision of boys in 1975, declaring it to have "no [[medical indication]]" and to be an "obsolete operation".<ref name="cps1975" />

 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 1980s1984. Ontario HIP stopped payment for non-therapeutic circumcision in July 1995; Saskatchewan stopped in 1996. One by one, all other HIPs have stopped paying for non-therapeutic circumcision. In 2006, Manitoba HIP was the last to stop, but only after the wrong boy was [[circumcised ]] at [http://www.sbgh.mb.ca/ St. Boniface Hospital].<ref>{{REFnews

}}</ref> <ref name="rediger-muller2013"/>

Non-therapeutic [[circumcision ]] of children in Canada is a practice that is of uncertain lawfulnessin Canada.

The ''Charter of Rights and Freedoms'' (1982), [https://www.canada.ca/en/canadian-heritage/services/how-rights-protected/guide-canadian-charter-rights-freedoms.html#a2e Article Section 7] provides every Canadian with the right to security of the person.<ref name="chhrp2018" />

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

Given that a portion of the medical community has agreed that routine infant male circumcision is nontherapeutic and that it may be in and of itself be a harmful practice, it is arguable that when performed on neonates for nontherapeutic reasons, it amounts to a violation of the child’s [https://www.justice.gc.ca/eng/csj-sjc/rfc-dlc/ccrf-ccdl/check/art7.html Section 7] rights. As stated at the [[Declaration of the First International Symposium on Circumcision (1989)| Declaration of the First International Symposium on Circumcision]], “parents and/or guardians do not have the right to consent to the surgical removal or modification of their children’s normal genitalia.” The Declaration adds that the only person who may consent to medically unnecessary procedures upon herself or himself is that individual, having reached a stage in life where she or he can consent and only upon being fully informed about the risks and benefits of the procedure. Note, however, that the Declaration is not a binding legal instrument.

The ''New York Post'' (2019) reports reported that a Canadian woman of African ancestry took her nine-day-old son to the [https://www.vemcregina.com/ Victoria East Medical Clinic] in Regina, SK to be [[circumcised]]. In the course of the circumcision, the tip of his penis was allegedly cut off. An ambulance was called but the [http://www.rqhealth.ca/facilities/regina-general-hospital Regina General Hospital] was unable to reattach the severed part.

Jackie Smith (2002) discussed the growing consensus against non-therapeutic child circumcision, which she called an "anachronism".<ref name="smith2002">{{REFnews

===Third-party payment is not available=== At the beginning of the 21st Century, only the Manitoba Health Insurance Plan (HIP) still paid for non-therapeutic circumcision, however that Manitoba HIP ended payment in 2006.<ref name="skeldon2008" />No insurance coverage of non-therapeutic circumcision is currently available. ===The incidence of circumcision varies widely by region===

In all provinces and territories, only a minority of boys are being [[circumcised]]. Sheldon (2008) reported an incidence of 13.9 percent.<ref name="skeldon2008" /> The incidence of circumcision in Labrador and Newfoundland is reported to be close to zero.<ref>{{REFweb

The incidence of circumcision in Canada is believed to be one-half or less than that of the [[United States]]. The above referenced survey provides the most recent available statistics on the incidence of non-therapeutic child circumcision in Canada.  ===Factors pushing the incidence of non-therapeutic circumcision down=== It is likely that the incidence of circumcision has further declined since the survey was taken for the following reasons:

* The ratio of [[intact]] fathers to [[circumcised]] fathers is changing toward more [[intact]] fathers and fewer [[circumcised ]]fathers. Boys who were born after the decline in circumcision started and who are [[intact]] are now reaching the age at which they start families and become fathers. [[Intact]] men usually do not want any son to be [[circumcised]](See [[Adamant father syndrome]]), so they will usually not have a son [[circumcised]].<ref name="rediger-muller2013" /> This will cause a further decline in the incidence of [[circumcision]].

* The large numbers of [[intact]] boys growing up healthy and happy is further eroding support for non-therapeutic [[circumcision]]. * The survey (2006) found that the incidence of circumcision on Prince Edward Island was 38 percent. A recent report (2019) indicated that non-therapeutic circumcision of boys is no longer available on P.E.I. because no practitioner will perform the non-therapeutic [[amputation]] of part of a boy's [[penis]].<ref>{{REFnews

}}</ref>  * The [https://www.cpso.on.ca/ College of Physicians and Surgeons of Ontario] (2010) issued a special order to prohibit paediatrician [[Daniel Marshall]], who operated the Circumcision Centre in Hamilton, {{CAPTC|ON}} from examining or being alone with youths.

|ref=<ref name="demaria2013">{{REFjournal

The CBC (2018) reported that Pakistani [https://www.ratemds.com/doctor-ratings/78555/Dr-Ejaz-Ahmad-Winnipeg-MB.html/ Dr. Ejaz Ahmad], who practiced medicine on Portage Avenue in Winnipeg, had been suspended from the practice of medicine for five months by the [https://cpsm.mb.ca/ College of Physicians and Surgeons of Manitoba], after he performed 18 circumcisions from June 2016 to July 2017 on pediatric patients and two boys almost bled to death.<ref name="glowaki2018">{{REFnews |title=2 boys almost bled to death in botched circumcisions by Manitoba doctor |url=https://www.cbc.ca/news/canada/manitoba/winnipeg-doctor-suspended-botched-circumcisions-1.4953561 |last=Glowaki |first=Laura |init= |author-link= |last2= |init2= |author2-link= |publisher=CBC News |website= |date=2018-12-20 |season= |accessdate=2022-07-05 |format= |quote=}}</ref> The CBC reported: <blockquote>Among the complications, two boys were rushed to hospital with potentially life-threatening bleeds, one after a portion of his [[penis]] was amputated and the other with arterial bleeding. Other boys experienced complications like swelling, pain, embedded gauze from improper wound care, possible infections and disfigurement. At least one boy's [[penis]] was left so deformed he required a revision surgery.<ref name="glowaki2018" /></blockquote> The circumcisions performed by Dr. Ahmad were performed for cultural reasons, not medical reasons, so they were not insured by Manitoba Health. The CBC reported: <blockquote>Along with malpractice, the college found Ahmad displayed several "multi-dimensional" professional shortcomings. He neglected to warn parents about the risks of their surgeries, failed to create records and when families went to other doctors for help, he told them not to disclose who had carried out the surgeries. In one instance, Ahmad told a doctor and nurses in an emergency room the procedure had been performed by a "traditional man" and not, in fact, himself.<ref name="glowaki2018" /></blockquote> The [https://www.gov.mb.ca/health/ Manitoba Department of Health] issued a ''Patient Safety Learning Advisory'' in February 2018 regarding an incident in which a newly [[circumcised]] infant boy experienced [[bleeding]] after his non-therapeutic [[circumcision]]. A blood pressure cuff suitable for infants was not available so a proper diagnosis was not made. The boy was discharged home, however [[bleeding]] continued and the boy was returned to the emergency department but was then transferred to a tertiary care facility. The boy suffered multiple complications.<ref>{{REFweb |title=Patient Safety Learning Advisory |url=https://www.gov.mb.ca/health/patientsafety/docs/psla61.pdf |archived= |trans-title= |language= |last= |first= |author-link= |publisher=Manitoba Health, Seniors and Active Living |website= |date=2018-02 |accessdate=2022-07-04 |format=PDF |quote=The infant required transfer to a tertiary care site by the neonatal transport team due to multiple complications.}}</ref> Infant boys have very little blood in their tiny bodies so the ability to withstand [[bleeding]] is very limited. Typically, exsanguination and hypovolemic shock occurs. Manitoba Services (2022) reported Winnipeg attorney [https://www.bestlawyers.com/lawyers/martin-j-pollock/76357 Martin Pollock] filed a Statement of Claim on 22 June 2022 in the Court of Queen's Bench on behalf of the Muslim mother of a five-year-old boy who was circumcised in Portage la Prairie in 2017. The suit names [https://www.gov.mb.ca/health/ Manitoba Health] and three health care workers as defendants. The mother "alleges in the lawsuit that the injuries suffered by her son were caused or contributed to by the negligence of the two doctors, the nurse and the health region named in the suit, which led to 'severe and permanent injuries.'"<ref>{{REFnews |title=Baby who bled for hours after circumcision was sent home from ER twice, suffered brain damage: lawsuit |url=https://manitobaservices.com/news/baby-who-bled-for-hours-after-circumcision-was-sent-home-from-er-twice-suffered-brain-damage-lawsuit/ |last=Manny |first= |init= |author-link= |last2= |init2= |author2-link= |publisher=Manitoba Services |website= |date=2022-07-03 |season= |accessdate=2022-07-05 |format= |quote=The child, now five years old, lives with motor impairment, irreversible brain damage, impaired vision and speech, and developmental delay. He “will continue to suffer the effects of his disabilities for the balance of his lifetime,” the suit says.}}</ref> As of 2022, [[third-party payment]] for non-therapeutic [[circumcision]] has not been available anywhere in Canada since 2006.<ref name="skeldon2008" /> Moreover, non-therapeutic circumcision is not done in most hospitals,<ref name="jamesloewen2019" /> so parents who want to have a boy [[circumcised ]] must take the boy to the surgery of a practitioner who specializes in non-therapeutic male circumcision, and furthermore must pay out of pocket. For example, the cost of circumcision of a newborn boy in New Brunswick is C$425 ranging up to C$1500 for a teenager or adult.<ref>{{REFweb

The prevalence of circumcision is higher among older males, but lower among younger males. As older, mostly [[circumcised]] males die and are replaced in the population by younger, mostly [[intact]] males, the overall prevalence of [[circumcised ]] men in Canada is gradually declining. [[Intact]] males usually do not want any son to be [[circumcised]],<ref name="brown-brown1987" /> <ref name="rediger-muller2013" /> so the demand for [[circumcision]] in Canada is declining.

Mayan et al. (2021) carried out a massive empirical study of the male population of the province of Ontario, Canada (569,950 males), of whom 203,588 (35.7%) were [[circumcised ]] between 1991 and 2017. The study concluded that circumcision status is not related to risk of [[HIV]] infection.<ref name="mayan2021">{{REFjournal

Schröder et al. (2021) reviewed the experience of the [https://www.sickkids.ca Hospital for Sick Children] in Toronto with regard to circumcision-related emergency admissions between 2000 and 2013. They found that 19 previously healthy neonates had emergency admissions for circumcision complications. The records of patients who had died were searched to identify those who had been [[circumcised]].

}}</ref> Based on the data provided, the estimated [[death ]] rate is one dead boy for every 84,000 circumcisions.

 [[Christopher Guest]], {{MD}}, {{FRCPC}}, of Barrie, {{CAPTC|ON}}, discusses circumcision in Canada: