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Kanada und Beschneidung

Ein Bericht über nicht-therapeutische Beschneidung in Kanada.

Geschichte

Die nicht-therapeutische Beschneidung von Kindern ist nicht Teil der Kultur vieler kanadischer Minderheiten. Die französischsprachigen Einwohner von Quebec und anderswo befürworten im Allgemeinen keine Beschneidung. Die männliche Beschneidung ist nicht Teil der einheimischen Kultur der indigenen Inuit-, First Nations- und Métis-Bevölkerung (4,3 % der Bevölkerung).

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 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.[1]

Pirie (1927) beschrieb in einer Präsentation vor der Canadian Society for the Study of Diseases of Children die Beschneidung als „sehr verbreitet“.[2]

Douglas Gairdners klassischer Aufsatz von 1949, „Das Schicksal der Vorhaut: Eine Studie über die Beschneidung“,[3] scheint in Kanada ignoriert worden zu sein.

Bruce Peter Reimer, später bekannt als David Reimer, wurde am 22. August 1965 in Winnipeg, Manitoba, geboren. Sein Penis wurde bei einem Unfall während einer medizinisch unnötigen, nicht therapeutischen Beschneidung zerstört.

Patel (1966) berichtete über seine Erkenntnisse über die Beschneidung von Neugeborenen in Kingston, Ontario, Kanada. Patel berichtete von einer Komplikationsrate von 55 Prozent bei einer Serie von 100 aufeinanderfolgenden männlichen Säuglingsbeschneidungen. Er berichtete auch über das Auftreten von Beschneidungen im Kingston General Hospital in Kingston, Ontario. Patel berichtete von einer Beschneidungshäufigkeit von 48 Prozent. Diese galt für ein Krankenhaus in Kingston, ON, wurde jedoch häufig und fälschlicherweise als Rate für ganz Kanada angegeben.[4]

Kanada hat wie andere englischsprachige Nationen früher viele seiner Jungen beschnitten, wobei die Beschneidungsrate in den 1960er Jahren zwischen 40 und 70 Prozent lag.[5]

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“.[6]

LeBourdais (1995) erklärte, dass die männliche Beschneidung „eindeutig nicht länger als Routineverfahren angesehen werden kann“.[7]

Dr. Arif Bhimji (2000) wandte internationales Menschenrechtsgesetz und die kanadische Charta der Rechte und Freiheiten auf die Praxis der nicht-therapeutischen Kinderbeschneidung an. Er schlussfolgerte:

Die Beschneidung männlicher Säuglinge ist eine klare Verletzung der Rechte, die allen Personen durch die kanadische Charta der Rechte und Freiheiten garantiert werden. Darüber hinaus verstößt die Praxis gegen Menschenrechtsgesetze auf Provinz- und internationaler Ebene.[8]

Berichtete Inzidenz von nicht-therapeutischer Kinderbeschneidung

Die gemeldete Inzidenz der Kinderbeschneidung in Kanada variiert je nach Provinz und hat im Laufe der Zeit abgenommen. Neufundland hatte schon immer eine sehr geringe Inzidenz von Kinderbeschneidungen, während Alberta und Ontario eine höhere Inzidenz von Kinderbeschneidungen hatten.

Johnston (1995) berichtete, dass die Inzidenz der Kinderbeschneidung in Kanada von 60 Prozent vor einer Generation auf geschätzte 25 Prozent gesunken sei.[9]

Die „Gazette“ aus Montreal (2006) berichtete, dass die Inzidenz der Beschneidung laut der Association for Genital Integrity um 36 Prozent auf 14 Prozent gesunken ist, während Statistics Kanada (2006) einen Höchstwert von 29,5 Prozent in PEI und ein Tief von 1,1 Prozent in Nova Scotia berichtete.[10][11]

Stellungnahmen medizinischer Fachgesellschaften

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".[6]

Der CPS griff die Beschneidung 1996 erneut auf und empfahl:

”Die Beschneidung sollte nicht routinemäßig durchgeführt werden.
– Canadian Pediatric Society 1996[1][12]

Die CPS überdachte 2015 erneut die Beschneidung von Säuglingen. Die CPS erklärte:

”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.
– Canadian Pediatric Society (2015)[13]

College of Physicians and Surgeons of British Columbia (CPSBC)

Das College of Physicians and Surgeons of British Columbia hat drei Leitlinien für seine Mitglieder bezüglich der nicht-therapeutischen männlichen Beschneidung von Kindern herausgegeben. Die neueste (2009) sagt ausschnittsweise:

”Sie sind nicht verpflichtet, einer Bitte auf Beschneidung eines Säuglings nachzukommen, aber Sie müssen die medizinischen Beweise und die aktuellen Gedanken in der Bioethik besprechen, die Sie davon abhalten, dieses Verfahren durchzuführen. Sie müssen die Eltern auch darüber informieren, dass sie das Recht haben, einen anderen Arzt aufzusuchen.
– College of Physicians and Surgeons of British Columbia (2009)[14]

Canadian Urological Association (CUA)

Die Canadian Urological Association (CUA) befasste sich mit der Frage der Beschneidung und gab im Februar 2018 eine Erklärung ab. Die CUA kam zu dem Schluss:

”Angesichts des sozioökonomischen, Bildungsstands und der gesundheitlichen Demographie unserer Bevölkerung kann eine universelle Neugeborenenbeschneidung nicht gerechtfertigt werden auf der Grundlage der derzeit verfügbaren Beweise.
– Canadian Urological Association (CUA)[15]
(Dieser Artikel wurde noch nicht aus dem Englischen übersetzt oder enthält noch englische Textpassagen. Bitte beziehe dich vorerst auf die Informationen im englischen Artikel. Klicke dazu in der IntactiWiki-Navigation im Abschnitt "In anderen Sprachen" auf "English".)

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 St. Boniface Hospital.[16]

Third-party payment for non-therapeutic circumcision is not presently available anywhere in Canada.[17] Parents who wish to have a son circumcised must pay out-of-pocket for the costs of the circumcision.[18]

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."[19] [18]

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.

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), Article 7 provides every Canadian with the right to security of the person.[1]

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, then 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.[20]

Several decisions of the 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.

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.[21]

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.[22]

Lawsuit

The New York Post (2019) reports that a Canadian woman of African ancestry took her nine-day-old son to the 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 Regina General Hospital was unable to reattach the severed part.

The family has retained Kolade Oladokun who has filed a lawsuit.[23]

Canada and circumcision in the 21st century

Jackie Smith (2002) discussed the growing consensus against non-therapeutic child circumcision.[24]

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."[25]

The 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.[26]

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.[27]

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.[18] 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.[28]
  • Most hospitals do not provide non-therapeutic circumcision, however 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' 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.[29]

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

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.[30]

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,[17] 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.[31]

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,[19] [18] 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.[32]

Schröder et al. (2021) reviewed the experience of the 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.[33] Based on the data provided, the estimated death rate is one dead boy for every 84,000 circumcisions.

Video

Christopher Guest, M.D.[a 1], FRCPC[a 2], of Barrie, ON, discusses circumcision in Canada:


Siehe auch

Weblinks

Abkürzungen

  1. ↑ REFweb Doctor of Medicine, Wikipedia (englisch). Abgerufen 14. Juni 2021.
  2. ↑ REFweb Royal College of Physicians and Surgeons of Canada, Wikipedia. Abgerufen 13. Januar 2021.

Einzelnachweise

  1. ↑ a b c REFdocument Antinuk, Kira: International NGO Council on Genital Autonomy Supplementary Country Report Submission on Canada to the U.N. Committee on the Rights of the Child PDF, Children's Health & Human Rights Partnership. (11. Juli 2018). Abgerufen 23. Juni 2020.
  2. ↑ REFjournal Pirie GR. The story of circumcision. Can Med Assoc J. Juli 1927; 17(12): 1540-2. Abgerufen am 26. Oktober 2019.
  3. ↑ REFjournal Gairdner DM. The fate of the foreskin: a study of circumcision [Das Schicksal der Vorhaut: eine Studie über die Beschneidung] (English). British Medical Journal. 1949; 2(4642): 1433-1437. PMID. PMC. DOI. Abgerufen am 28. Oktober 2019.
  4. ↑ REFjournal Patel H. The problem of routine infant circumcision. Can Med Assoc J. 1966; 95: 576-81. Abgerufen am 25. Oktober 2019.
  5. ↑ REFjournal Wirth JL. Current circumcision practices: Canada. Pediatrics. 1980; 66(5): 705-8. PMID. Abgerufen am 25. Oktober 2019.
  6. ↑ a b REFjournal Swyer PW, Boston RW, et al. FN 75-01 Circumcision in the newborn period. Canadian Paediatric Society News Bulletin Supplement. 1975; 88(2): 1-2. Abgerufen am 18. März 2022.
  7. ↑ REFjournal LeBourdais, Eleanor. Circumcision no longer a "routine" surgical procedure.. Can Med Assoc J. 1995; 152(11): 1873-6. PMID. PMC. Abgerufen am 4. November 2019.
  8. ↑ REFjournal Bhimji A. Infant Male Circumcision: A violation of the Canadian Charter of Rights and Freedoms.. Health Law in Canada Journal (HLCJ). Januar 2000; 1: 1-33. Abgerufen am 7. November 2019.
  9. ↑ REFnews Johnston, David (11. September 1995)."Under the Knife", Toronto Star. Abgerufen 26. Oktober 2019.
  10. ↑ REFnews (23. März 2006)."Rates of circumcision slashed in past 30 years.", The Gazette. Abgerufen 26. Oktober 2019.
  11. ↑ REFnews MacDonald, Andrea (25. März 2006)."Circumcisions continue to drop: Province has second-lowest rate in the country", Halifax Daily News. Abgerufen 26. Oktober 2019.
  12. ↑ REFjournal Outerbridge E. Neonatal circumcision revisited. Can Med Assoc J. 15. März 1996; 154(6): 769-80. PMID. PMC. Abgerufen am 26. Oktober 2019.
  13. ↑ REFjournal Sorokin ST, Finlay JC, Jeffries AL, et al. Newborn male circumcision. Paediatr Child Health. August 2015; 20(6): 311-20. PMID. PMC. DOI. Abgerufen am 26. Oktober 2019.
  14. ↑ REFdocument Circumcision (Infant Male) PDF, College of Physicians and Surgeons of British Columbia. (September 2009). Abgerufen 18. November 2019.
  15. ↑ REFjournal Dave S, 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. Februar 2018; 12(2): 18-28. PMID. PMC. Epub 2017 Dec 1 DOI. Abgerufen am 26. Oktober 2019.
  16. ↑ REFnews "Circumcision mix-up", Canada.com. Abgerufen 26. Oktober 2019.
  17. ↑ a b James Loewen (2019). Personal communication.
  18. ↑ a b c d REFjournal Rediger C, Muller AJ. Parents' rationale for male circumcision. Can Fam Physician. Februar 2013; 59(2): e110-115. PMID. PMC. Abgerufen am 26. Oktober 2019.
  19. ↑ a b REFjournal Brown MS, Brown CA. Circumcision Decision: Prominence of Social Concerns. Pediatrics. August 1987; 80(2): 215-219. PMID. Abgerufen am 10. November 2019.
  20. ↑ REFweb Somerville, Margaret (28. Januar 1993). Letter to Pierre Blais, Minister of Justice. Abgerufen 4. November 2019.
  21. ↑ REFjournal Bouclin S. An examination of legal and ethical issues surrounding male circumcision: the Canadian context. Int J Mens Health. 2005; 4(3): 205-23. Abgerufen am 27. Oktober 2019.
  22. ↑ REFdocument CMA Code of Ethics and Professionalism, Canadian Medical Association. (2018). Abgerufen 8. Juli 2021.
  23. ↑ REFnews Steinbuch, Yaron (19. August 2019)."Canadian woman sues after tip of son’s penis cut off in circumcision", New York Post. Abgerufen 16. Juni 2020.
  24. ↑ REFnews Smith, Jackie (30. August 2002)."The growing consensus against circumcision", National Post. Abgerufen 27. Oktober 2019.
  25. ↑ REFnews Driver, Deana (19. März 2002)."Sask. college wants circumcision rates reduced", Medical Post. Abgerufen 22. Juli 2021.
  26. ↑ REFdocument What Mothers Say: The Canadian Maternity Experiences Survey PDF, Public Health Agency of Canada. (2009). Abgerufen 27. Oktober 2019.
  27. ↑ REFweb Goodwin, Caitlin (6. Mai 2019). Circumcision: Pros and Cons, MomLovesBest. Abgerufen 10. Juli 2021.
    Zitat: Labrador and Newfoundland have close to zero
  28. ↑ REFnews Williams, Nicole (24. Juni 2019)."Mom 'enraged' she can't find doctor to perform circumcision on P.E.I.", CBC News. Abgerufen 27. Oktober 2019.
  29. ↑ REFnews Williamson, Doug (19. März 2005)."Circumcisions spark debate", Windsor Star. Abgerufen 22. Juli 2021. "Dr. Tony Hammer, a Windsor family doctor, said his colleagues may be performing the medically unnecessary procedure simply to make a buck. … There is a financial incentive for physicians, and I wonder if they are fully informing their patients of a lack of medical need."
  30. ↑ REFjournal De Maria J, Abdulla A, Pemberton J, Roees A, Braga LH. Are Physicians Performing Neonatal Circumcisions Well Trained?. Can Urol Assoc J. 2013; 7(7-8): 260-4. PMID. DOI. Abgerufen am 24. Juni 2021.
  31. ↑ REFweb Circumcision Pricing & Insurance Coverage, Gentle Procedures Clinic. Abgerufen 6. November 2019.
  32. ↑ REFjournal Mayan, Madhur, Hamilton, Robert J., Juurlink, David N., Austin, Peter C., Jarvi, Keith A.. Circumcision and Risk of HIV Among Males From Ontario, Canada. J Urol. 23. September 2021; PMID. DOI. Abgerufen am 2. Oktober 2021.
    Zitat: We found that circumcision was not independently associated with the risk of acquiring HIV among men from Ontario, Canada.
  33. ↑ REFjournal Schröder, Annette, Farhat, Walid A., Chiasson, David, Wilson, Gregory J., Koyle, Martin A.. Serious and Fatal Complications after Neonatal Circumcision. Eur Urol. 12. Dezember 2021; 29: S2405-4569(21)00316-3. PMID. DOI. Abgerufen am 15. Januar 2022.
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