Kanada: Unterschied zwischen den Versionen

Die medizinisierte Genitalbeschneidung von Säuglingen und Kindern wurde zuerst in Kanada während der Mitte bis Ende des 19. Jahrhunderts von englischsprachigen Personen aufgrund der damaligen Mode des [[Großbritannien|Vereinigten Königreichs]] gefördert. Ärzte empfahlen die Genitalbeschneidung sowohl bei männlichen als auch bei weiblichen Kindern, um Masturbation sowie verschiedene Krankheiten wie Epilepsie und Tuberkulose zu verhindern.<ref name="chhrp2018">{{REFdocument

Die [[Canadian Pediatric Society]] (CPS) veröffentlichte 1975 ihre erste Erklärung zur Beschneidung von Neugeborenen. Die Erklärung besagte: „Es gibt keine medizinische Indikation für die Beschneidung während der Neugeborenenzeit.“ Die CPS bezeichnete die Amputation als „obsolete Operation“ und rechnete mit einem „stärkeren Rückgang des Prozentsatzes beschnittener Säuglinge“.<ref name="cps1975">{{REFjournal

=== Canadian Pediatric Society (CPS) ===

Die [[Canadian Pediatric Society]] (CPS) nahm 1975 Stellung gegen die nicht-therapeutische Beschneidung von Jungen und erklärte, sie habe "keine medizinische Indikation" und sei eine "obsolete Operation".<ref name="cps1975"/>  

  |Autor=[[Canadian Pediatric Society]] 1996

  |Text=Während es für einige Jungen in Hochrisikopopulationen und unter Umständen, in denen das Verfahren zur Verringerung oder Behandlung der Krankheit in Betracht gezogen werden könnte, einen Vorteil geben kann, empfiehlt die Canadian Pediatric Society nicht die routinemäßige Beschneidung jedes männlichen Neugeborenen.

  |Autor=[[Canadian Pediatric Society]] (2015)

==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. 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

[[Third-party payment]] for non-therapeutic circumcision is not presently available anywhere in Canada.<ref name="jamesloewen2019">[[James Loewen]] (2019). Personal communication.</ref> Parents who wish to have a son circumcised must pay out-of-pocket for the costs of the circumcision.<ref name="rediger-muller2013">{{REFjournal

==Reasons for circumcision==

Brown & Brown (1987) and Rediger & Muller (2013), working in Saskatoon, found "newborn male circumcision rates continue to be heavily influenced by the circumcision status of the child's father."<ref name="brown-brown1987">{{REFjournal

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

With the decline in the incidence of circumcision in Canada that started decades ago, there are fewer and fewer circumcised fathers, so one would expect the incidence of circumcision in Canada to continue to decline.

==Canadian circumcision deaths==

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

*  Chino Burrell: 7-months-old, [[Fatalities| death by circumcision]], [https://www.sickkids.ca/ Hospital for Sick Children], Toronto, Ontario, Canada, June 9, 1974.

See also: [[Fatalities]].

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

[[Margaret A. Somerville]], then Director of the [https://www.mcgill.ca/study/2010-2011/faculties/law/information/law_centre_for_medicine_ethics_and_law McGill Centre for Medicine, Ethics and Law], wrote to Pierre Blais in 1993, then Minister for Justice and Attorney-General, to propose that "male circumcision would not be totally banned. Rather circumcision of those persons unable to consent for themselves (which would, of course, include all infants) would not be allowed under the Criminal Code as it presently stands." However, no action was taken.<ref>{{REFweb

Several decisions of the [https://www.scc-csc.ca/home-accueil/index-eng.aspx Supreme Court of Canada] call consent for non-therapeutic circumcision of a child into question, but no case so far has ruled on the matter of circumcision.

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

Public awareness is increasing, as evidenced by the numerous parents, health practitioners, children’s rights activists, ethicists, lawyers, and concerned citizens who have voiced their opinion. Insofar as male circumcision is the removal of healthy erogenous flesh without medical purpose and without the consent of the child and given that it is a painful procedure, neonatal circumcision is unnecessary and may well violate a child’s bodily integrity.<ref name="bouclin2005">{{REFjournal

===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

===Lawsuit===

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

The family has retained [https://ca.linkedin.com/in/kolade-oladokun-llb-llm-bl-827886114 Kolade Oladokun] who has filed a lawsuit.<ref>{{REFnews

==Canada and circumcision in the 21st century==

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

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.

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

The [https://www.canada.ca/en/public-health.html Public Health Agency of Canada] carried out a survey of mothers' birth experiences in 2006-7. Item 38 was male infant non-therapeutic circumcision. (See pages 224-5.)

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

In all provinces and territories, only a minority of boys are being circumcised. The incidence of circumcision in Labrador and Newfoundland is reported to be close to zero.<ref>{{REFweb

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 health insurance plans (HIPs) do not support non-therapeutic circumcision.

* 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.<ref name="rediger-muller2013" /> 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.<ref>{{REFnews

* Most hospitals do not provide non-therapeutic circumcision, however [https://www.wrh.on.ca/ Windsor Regional Hospital] is an exception to the general rule. Windsor Regional Hospital still promotes medically-unnecessary, non-therapeutic [[circumcision]] to parents of normal, healthy male infants in apparent violation of the infants' [https://www.justice.gc.ca/eng/csj-sjc/rfc-dlc/ccrf-ccdl/check/art7.html Section 7 rights]. The hospital is reported to circumcise 51 percent of boys born in the hospital. This is far higher than the incidence of non-therapeutic circumcision elsewhere in Ontario and Canada.<ref>{{REFnews

  |quote=Dr. Tony Hammer, a Windsor family doctor, said his colleagues may be performing the medically unnecessary procedure simply to make a buck. <b>…</b> There is a financial incentive for physicians, and I wonder if they are fully informing their patients of a lack of medical need.

DeMaria et al. (2013) surveyed physicians in southwest Ontario who still perform circumcisions. They concluded from their survey:

<blockquote>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 name="demaria2013">

}}</ref></blockquote>

As of 2022, [[third-party payment]] for non-therapeutic [[circumcision]] has not been available anywhere in Canada since 2006. 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

  |quote=We found that circumcision was not independently associated with the risk of acquiring [[HIV]] among men from Ontario, Canada.

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

}}</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, ON, discusses circumcision in Canada:

 

* [[Foreskin]]