In reply to the letters received, it would appear that the article has been largely misunderstood. Clearly, our assumption that an issue such as circumcision does not largely polarise opinion is far from the truth. However, the actual point of the article was not to raise issues of ethics regarding the correctness, or otherwise, of neonatal circumcision, nor to impose it as a compulsory procedure. As stated in the closing paragraphs, we were merely making suggestions of a logistical and socio-political nature. We agree wholeheartedly that the articles in the BMJ were far better at discussing whether circumcision was an abuse on the rights of the child,1 but that was never the purpose of our article.
The advice to the authors of the emotive letters received would be to take a more pragmatic approach to the issue, and indeed the article. As it stands, neonatal circumcision is not technically recognised, by any of our professional bodies, as a ‘barbaric and inhumane’1 act, and nor is it illegal. What was aired in the article was the view that the current regulation of the procedure by private practitioners may leave something to be desired, and a possible solution was posited, numbers were not exactly crunched, but reducing complications post-procedure would presumably reduce costs to the NHS.
Now, we would obviously welcome a debate on the morality and ethics surrounding the issue of medical intervention/surgery, major or otherwise, in neonates and children, but this was not the piece for that. The point being made was noted by one respondent himself, in that there is a role in harm reduction.2 The bottom line remains that circumcision is currently legal; circumcision is also currently poorly regulated. Suggestions were made as to the way forward. Our ‘extraordinary argument’2 is not actually an argument — our role IS to advise, but ISN'T, currently, to legalise or outlaw any medical procedures. We can advise what is and isn't legal, but of those procedures that are legal, our professional duty is merely to advise and then carry out patients' wishes.
We were obviously delighted to receive the responses, but apologise for the ambiguity that may have been present within the article. The points made would be better saved for an article, when written, that is actually discussing the ethics of circumcision.
- © British Journal of General Practice, 2010.
