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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" />
→Factors pushing the incidence of non-therapeutic circumcision down: Wikify.
==History==
The medicalized genital cutting of infants and children was first promoted in Canada during the mid to late 19th century by English-speakers after the fashion at the time of the [[United Kingdom]]. Doctors encouraged the genital cutting of both male and female children to prevent [[masturbation ]] as well as various diseases like epilepsy and tuberculosis.<ref name="chhrp2018">{{REFdocument
|title=International NGO Council on Genital Autonomy Supplementary Country Report Submission on Canada to the U.N. Committee on the Rights of the Child
|url=http://chhrp.org/wp-content/uploads/2019/11/Canada-Supplementary-Report.pdf
|accessdate=2020-06-23
}}</ref>
Pirie (1927), in a presentation to the Canadian Society for the Study of Diseases of Children, described [[circumcision ]] as "very common".<ref name="pirie1927">{{REFjournal
|last=Pirie
|first=George R.
[[Douglas Gairdner]]'s classic 1949 paper, ''The Fate of the Foreskin: A Study of Circumcision'',<ref name="gairdner1949">{{GairdnerDM 1949}}</ref> seems to have been ignored in Canada.
Bruce Peter Reimer, later known as [[David Reimer]], was born in Winnipeg, Manitoba on 22 August 1965. His penis was destroyed in an accident during medically-unnecessary, non-therapeutic [[circumcision]] by Dr. [[Jean-Marie Huot]].
Patel (1966) reported his findings on neonatal [[circumcision]] in Kingston, Ontario, Canada. Patel reported a [[complication ]] rate of 55 percent experienced in a series of 100 consecutive male infant circumcisions. He also reported on the incidence of circumcision at [http://www.kingstonhsc.ca/ Kingston General Hospital] in Kingston, Ontario. Patel reported an incidence of [[circumcision ]] of 48 percent. This is for one hospital in Kingston, {{CAPTC|ON }} but has been widely and falsely cited as the rate for all Canada.<ref>{{REFjournal
|last=Patel
|first=Hawa
}}</ref>
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
|last=Wirth
|first=John L.
}}</ref>
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
|last=Swyer
|init=PW
}}</ref>
[[Eleanor LeBourdais ]] (1995) declared that male [[circumcision ]] is "clearly can no longer be regarded as routine procedure."<ref name="lebourdais1995">{{REFjournal
|last=LeBourdais
|first=Eleanor
|journal=Can Med Assoc J
|location=
|date=1995-06-01
|volume=152
|issue=11
Dr. [[Arif Bhimji]] (2000) applied international [[human rights]] law and the Canadian Charter of Rights and Freedoms to the practice of non-therapeutic child circumcision. He concluded:
<blockquote>
Circumcision of male infants is a clear violation of the rights guaranteed to all persons by the [https://www.canada.ca/en/canadian-heritage/services/how-rights-protected/guide-canadian-charter-rights-freedoms.html Canadian Charter of Rights and Freedoms]. Furthermore, the practice contravenes [[human rights]] legislation on provincial and international levels.<ref name="bhimji2000">{{REFjournal
|last=Bhimji
|first=Arif
}}</ref>
</blockquote>
== Research into pain of circumcision ==
Canada has been the the location of important research regarding the [[pain]] of circumcision.
[[Janice Lander| Lander]] et al. (1997) conducted a comparison of neonatal non-therapeutic circumcision without anesthesia (current practice in 1997), ring block, dorsal penile nerve block, and a topical eutectic mixture of local anesthetics ([[EMLA]]) at the {{UNI|University of Alberta|UAlberta}}, Edmonton, AB.<ref name="lander1997">{{LanderJ etal 1997}}</ref>
With no anaesthesia, the infants screamed continuously. Newborns in the untreated placebo group exhibited homogeneous responses that consisted of sustained elevation of heart rate and high pitched cry throughout the [[circumcision]] and following. Two newborns in the placebo group became ill following circumcision (choking and apnea). One experienced projectile vomiting.<ref name="lander1997" />
[[EMLA]] was the least effective pain control. Dorsal penile nerve block (DPNB) was more effective, and ring block was the most effective. The authors reported "[w]ithout exception, newborns in this study who did not receive an analgesic suffered great distress during and following the circumcision, and they were exposed to unnecessary risk (from choking or apnea)." The authors were so alarmed that they terminated the no anaesthesia arm of the study early.<ref name="lander1997" />
Taddio et al. (1997), working at the [https://www.sickkids.ca/ Hospital for Sick Children], Toronto, {{CAPTC|ON}}, concluded:
{{Citation
|Text=Although postsurgical central sensitisation (allodynia and hyperalgesia) can extend to sites of the body distal from the wound, suggesting a supraspinal effect, the long-term consequences of surgery done without anaesthesia are likely to include post-traumatic stress as well as pain. It is, therefore, possible that the greater vaccination response in the infants circumcised without anesthesia may represent an <u>infant analogue of a post-traumatic stress disorder</u> triggered by a traumatic and painful event and re-experienced under similar circumstances of pain during vaccination.
|Author=Taddio et al. (1997)
|ref=<ref name="taddio1997">{{TaddioA KatzJ IlersichAL KorenG 1997}}</ref>
}}
==Reported incidence of non-therapeutic child circumcision==
=== Canadian Paediatric Society (CPS) ===
The [[Canadian Paediatric Society]] (CPS) took a position against non-therapeutic circumcision of boys in 1975, declaring it to have "no [[medical indication]]" and to be an "obsolete operation".<ref name="cps1975" />
The CPS revisited circumcision in 1996 and recommended:
=== College of Physicians and Surgeons of British Columbia (CPSBC) ===
The [https://www.cpsbc.ca/ College of Physicians and Surgeons of British Columbia] has issued three guidances for its members regarding non-therapeutic male circumcision of children. The most recent (2009) says in part:
=== Canadian Urological Association (CUA) ===
The [[Canadian Urological Association]] (CUA) considered the matter of circumcision and issued a statement in February 2018. The CUA concluded:
==Non-availability of third-party payment==
Canada has fourteen single-payer health insurance plans (HIPs) — one for each of the ten provinces and three territories and a 14th plan for government employees. The British Columbia HIP stopped paying for non-therapeutic [[circumcision ]] in 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
|title=Circumcision mix-up
|url=http://www.cirp.org/news/canadacom11-18-05/
|DOI=
|accessdate=2019-11-10
}}</ref> <ref name="rediger-muller2013"/>
With the decline in the incidence of [[circumcision]] in Canada that started decades ago, there are fewer and fewer [[circumcised]] fathers, so one would expect the incidence of circumcision in Canada to continue to decline.
==Non-therapeutic circumcision and Canadian law==
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" />
In addition, Canada is a state-party to the United Nations ''[https://www.ohchr.org/EN/ProfessionalInterest/Pages/CCPR.aspx Covenant on Civil and Political Rights]'' (1966) and the ''[https://www.ohchr.org/en/professionalinterest/pages/crc.aspx Convention on the Rights of the Child]'' (1989), both of which provide various [[human rights]] to children, which are violated by non-therapeutic child circumcision.
Where a parent or substitute decision maker has deemed that it is in the child’s best interest to undergo a treatment, there may be some conflict between that privilege and the fundamental right to security of the person protected under Section 7 of the Charter. Because the State’s power to intervene is broad and can be permanent, parental decision making has been protected under the Charter. Nevertheless, the Court has determined that parents’ rights are not absolute and that the State will intervene when necessity is demonstrated.
Section 7 of the Charter provides everyone with a certain degree of autonomy in decisions concerning their private lives, including those concerning medical treatment. The protection of the security of the person is so fundamental that medical treatment administered without a patient’s [[informed consent ]] may amount to battery. In the context of circumcision, if a medical practitioner performs routine neonatal circumcision without an infant’s parental consent, that practitioner may be liable for criminal assault as well as for damages for any harm that resulted from her or his negligence ([[Margaret A. Somerville|Somerville]], 2000).
Given that a portion of the medical community has agreed that 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.
'''…'''
===Canadian Medical Association Code of Ethics and Professionalism===
The CMA code has two statements relevant to the non-therapeutic circumcision of male infants:
* Never participate in or support practices that violate basic [[human rights]].
* Never participate in or condone the practice of torture or any form of cruel, inhuman, or degrading procedure.<ref name="cma2018">{{REFdocument
|accessdate=2021-07-08
}}</ref>
It therefore appears that non-therapeutic circumcision of boys is unethical in Canada.
===Lawsuit===
|quote=
}}</ref>
===Third-party payment is not available===
At the beginning of the 21st Century, only the Manitoba Health Insurance Plan (HIP) still paid for non-therapeutic circumcision, however 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===
Saskatchewan had an incidence of circumcision in 2000 and 2001 of 27.6 percent. The Saskatchewan College of Physicians and Surgeons said in 2002 that was much too high and should be reduced substantially. The Registrar, Dr. Dennis Kimble, said, "they [doctors] aren't required to carry out a procedure simply because parents want it done."<ref>{{REFnews
|title=Sask. college wants circumcision rates reduced
|quote=
}}</ref>
===The most recent survey was done in 2006-7===
</blockquote>
In all provinces and territories, only a minority of boys are being [[circumcised]]. Sheldon (2008) reported an incidence of 13.9 percent.<ref name="skeldon2008" /> The incidence of circumcision in Labrador and Newfoundland is reported to be close to zero.<ref>{{REFweb
|url=https://momlovesbest.com/choosing-circumcision
|title=Circumcision: Pros and Cons
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.
===There are various factors 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.
DeMaria et al. (2013) surveyed physicians in southwest Ontario who still perform circumcisions. They concluded from their survey:
{{Citation
|Text=Our survey findings indicate that most physicians performing neonatal circumcisions in our community have received informal and unstructured training. This lack of formal instruction may explain the complications and unsatisfactory results witnessed in our pediatric urology practice. Many practitioners are not aware of the contraindications to neonatal circumcision and most non-surgeons perform the procedure without being able to handle common post-surgical complications.
|ref=<ref name="demaria2013">{{REFjournal
|last=De Maria
|first=
|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.
}}</ref>
As of 2022, [[third-party payment]] for non-therapeutic [[circumcision]] has not been available anywhere in Canada since 2006.<ref name="skeldon2008" /> Moreover, non-therapeutic circumcision is not done in most hospitals,<ref name="jamesloewen2019" /> so parents who want to have a boy [[circumcised ]] must take the boy to the surgery of a practitioner who specializes in non-therapeutic male circumcision, and furthermore must pay out of pocket. For example, the cost of circumcision of a newborn boy in New Brunswick is C$425 ranging up to C$1500 for a teenager or adult.<ref>{{REFweb
|url=https://gentleproceduresnb.ca/circumcision/cost-how-much/
|title=Circumcision Pricing & Insurance Coverage
}}</ref>
The prevalence of circumcision is higher among older males, but lower among younger males. As older, mostly [[circumcised]] males die and are replaced in the population by younger, mostly [[intact]] males, the overall prevalence of [[circumcised ]] men in Canada is gradually declining. [[Intact]] males usually do not want any son to be [[circumcised]],<ref name="brown-brown1987" /> <ref name="rediger-muller2013" /> so the demand for [[circumcision]] in Canada is declining.
Mayan et al. (2021) carried out a massive empirical study of the male population of the province of Ontario, Canada (569,950 males), of whom 203,588 (35.7%) were [[circumcised ]] between 1991 and 2017. The study concluded that circumcision status is not related to risk of [[HIV]] infection.<ref name="mayan2021">{{REFjournal
|last=Mayan
|first=Madhur
}}</ref>
Schröder et al. (2021) reviewed the experience of the [https://www.sickkids.ca Hospital for Sick Children] in Toronto with regard to circumcision-related emergency admissions between 2000 and 2013. They found that 19 previously healthy neonates had emergency admissions for circumcision complications. The records of patients who had died were searched to identify those who had been [[circumcised]].
Four of the boys had post-circumcision [[bleeding]]. Four of the boys had [[glans]] amputations. Two previously healthy boys died.<ref name="shroder2021">{{REFjournal
==Video==
[[Christopher Guest]], {{MD}}, {{FRCPC}}, of Barrie, {{CAPTC|ON}}, discusses circumcision in Canada:
<youtube>7-vbutOy4X8</youtube>
A news report on circumcision in Canada.
<youtube>Yf06OSHcZc8</youtube>
{{SEEALSO}}
* [[Circumcision: The Whole Story]]
* [[Child Circumcision: Rites or Rights?]]
* [[College_of_Physicians_and_Surgeons_of_Ontario]]
* [[Foreskin]]
* [[Trauma]]
* [[2020 USA & Canada Circumcision Crisis Protests]]