Sorry more to come but I overwhelmed the app. Going to eat dinner and will finish the rest of the article after that.
Sorry more to come but I overwhelmed the app. Going to eat dinner and will finish the rest of the article after that.
I agree with sweet seven, while its still legal there needs to be avenues of capable doctors to perfom this prodecure.
It makes me wonder if, it was to become illegal in the future, would people go to the 'black market' to still have this procedure done?? VERY SCAREY
Omg. That is so distressing That poor, poor child
I think this is what scares me most about removing access to this procedure in mainstream health. There will always be people who want to have it done and these people will turn to *doctors* who lack skill and appropriate hygiene, follow up care and bedside manner, most likely charging a premium to do so. It reminds me of dodgy back room abortions. I don't know what the answer is, but it is not what this poor little baby had to endure.
Chapter 1 (cont):
For some, the horrific experience of this young boy could stand as a perfect example of why circumcision should be subject to strict government regulation. "If you want to avoid circumcision complications, the only certain way is to avoid unnecessary circumcision operations," says Robert Darby, a Canberra-based medical researcher and author of a book on the history of circumcision. Like many people opposed to the practice, Darby believes non-medical circumcisions are a violation of both children's rights and medical ethics.
Yet those who support the rights of parents to choose circumcision see another lesson in this case. Dr Nick Demediuk, a Melbourne GP who has performed thousands of circumcisions, says the Khans' experience shows that the medical profession's hostile attitude towards the practice has actually increased the risks of injury to children. Restricting access to circumcision has ratcheted up the cost of the procedure, says Demediuk, so many parents now delay getting it done, which means the child may be a fearful and squirming two-year-old rather than a compliant infant. It also means parents may gravitate to doctors or religious practitioners who offer the cheapest rates but not necessarily the best skills. "If a person says, 'Look, I'm thinking of getting my child circumcised', they are looked at like a leper," says Demediuk. "Hospital staff won't refer you to anyone who might be able to do the job. It's like you're a child molester.
"I'm not a proponent for male circumcision, don't get me wrong," he adds. "But I think it's really unfair to treat people like that. Some people have a genuine religious conviction that you have to have it done."
MAN has a special bond with his penis, which may explain why cutting off a piece of it is a practice guaranteed to incite furious argument. To Muslims and Jews, removal of the foreskin is a tradition going back several millennia; others advocate it for hygiene reasons, or simply out of family tradition. But since the middle of last century, routine circumcision of boys has fallen increasingly out of favour in the West. Paediatricians first voiced objections in the 1940s, and child-rights activists picked up the issue in the 1970s.
Surveys in Australia show that roughly 65 per cent of men born between 1942 and 1972 were circumcised; today, according to Medicare statistics, only 13 per cent of newborn males are circumcised. But a counter-attack is now being mounted by sexual-health physicians who argue that the benefits of circumcision in preventing sexually transmitted diseases are being ignored. The passions that the issue can generate were evident in Germany two months ago when a court in Cologne ruled that circumcision amounts to assault of a minor, sparking an international furore in which one rabbi decried the ruling as "the worst attack on Jewish life since the Holocaust". Closer to home, the Tasmania Law Reform Institute this week recommended that the state government criminalise the circumcision of boys, except when there are "well-established" religious or ethnic reasons.
"It's an emotive issue," says Professor Brian Morris of Sydney University. "You've got genitalia, you've got religion, you've got children and you've got surgery - all the hot buttons in one."
Morris himself is not averse to pushing those buttons; in recent years he's become one of the world's most outspoken advocates for circumcision. He wages his crusade from a 2nd-floor office in the neo-gothic Anderson Stuart Building at Sydney University. Simply put, Brian Morris believes the world would be a better place if every man on it were circumcised. The health benefits would be enormous, he argues, and the dangers negligible. Spend an hour with him and you might feel an urge to book yourself in for surgery. "It's very, very, very safe," he says, leaning into that last adverb with a penetrating stare. "Incredibly safe ... The fact is that these days it carries enormous health benefits and the medical evidence is overwhelming."
Morris is neither Jewish nor Muslim and his scientific specialty - molecular genetics - has no obvious connection to matters below the waist. But a research project more than 20 years ago alerted him to studies which suggest that circumcised men are less likely to transmit the human papilloma virus, which can cause cervical cancer in women. Further reading led him to discover that HIV infections in Africa had markedly declined in areas where routine circumcision was introduced. Soon Morris was making contact with a growing band of medical researchers who advocate circumcision as a vital disease-prevention measure. Among them are the University of Illinois epidemiologist Professor Robert Bailey, Harvard AIDS researcher Dr Daniel Halperin and Australian drug law reform advocate Dr Alex Wodak. In collaboration with these and other researchers, Morris has in recent years unleashed a tsunami of journal articles and science papers extolling the virtues of the snip.
Morris argues that science is now confirming what ancient cultures understood intuitively: the foreskin is a breeding ground for bacteria and is best removed. The Prophet Mohammed may have advocated circumcision as a sign of refinement for Muslims, and the Torah may have told Jews it was a sacrifice for the blessing of God, but in Morris's view these religious strictures were really designed to promote hygiene. Similarly, 19th-century physicians promoted circumcision because they understood that syphilis was sexually transmitted, even if they didn't understand what germs were.
By contrast, Morris says, modern opposition to circumcision has wrought enormous suffering. "It was an absolute disaster for public health," he says. "Cervical cancer is a common cancer and the government was initially willing to put half a billion dollars into vaccinating girls. Why aren't they putting the same resources into male circumcision? Where is the bus that's going around to schools circumcising boys? Medically and rationally it doesn't make sense, because the benefits would be far greater."
You might gather that Brian Morris is not a man for half-measures. Paediatricians at The Children's Hospital at Westmead in Sydney have complained to the university administration about his outspoken views. Professor David Forbes, a paediatrician who chairs the Royal Australasian College of Physicians panel on circumcision, refers obliquely to Morris when he criticises the "extreme" views of activists who have no expertise in the area of children's health. "I don't think there is that much debate about circumcision in scientific circles," says Forbes. "If you look at paediatricians, who are scientists who deal with children in the first days of life, there are no paediatric health organisations in the world that I am aware of that are promoting newborn circumcision. There is fairly extreme pressure from some groups of scientists who actually don't work in the area. [But] I don't know that there's a lot of debate."
Scientific studies on circumcision are bewilderingly contradictory. Research from Africa suggests it can reduce sexually transmitted diseases, including AIDS, among heterosexuals. But in the West AIDS largely affects gay men, for whom circumcision seems to have little benefit. The US, for instance, suffers one of the developed world's worst AIDS problems while also having a high rate of circumcision. How circumcision affects men's sexual performance is a similarly charged arena: there are studies which suggest it causes loss of sensation and increased sexual problems, and there is also evidence that any loss of sensation is negligible.
Professor Forbes acknowledges that circumcision may help stop the spread of human papilloma virus but says that immunising girls and boys is a far cheaper and safer solution. And, while there is evidence that it might reduce the incidence of sexually transmitted diseases in some high-risk groups, he says there is no evidence that the benefits of routine infant circumcision outweigh the risk of injury or infection.
UNDER the vaulted ceiling of the ultra-modern, 2000-seat Central Synagogue in Bondi Junction, Sydney, Dr David Robinson lays out his surgical kit on a table. Scalpel, plastic tweezers, sterile dressing, Betadine, disposable nappies, bottled sugar-water ... it's not your standard kit for an eye surgeon, which is Robinson's regular job, because today he is performing the role of mohel - circumciser of babies - to the Jewish community. The infant son of a local couple, Ivan and Tali Rubinstein, is about to undergo the religious ritual known as brit milah. As stipulated in the Torah, the boy will not be named until after the ceremony; at 10 days old, he is close to the Torah's stipulated age of eight days.
A crowd of relatives, friends and local worshippers is gathering as Robinson pulls a white lab coat over his dark suit and prayer-shawl, then dons latex gloves. Men and boys mill around nearby, dressed in black suits, hats and skullcaps; women hang back in a cluster. The tall, slim figure of Rabbi Levi Wolff - bearded, bespectacled and behatted - moves among them. The star of the show is waiting in the wings, swaddled, sucking on a dummy. "We apply anaesthetic cream to the baby's penis an hour before the procedure, and give him Panadol drops," says Robinson, lighting a candle and placing it near his instruments. "But I reckon over half the babies I do cry more when they're having a nappy change." There's a ripple of nervous jocularity in the air, a sense of expectation undercut by sotto voce circumcision jokes. Finally, the swaddled infant is brought in, accompanied by his mother and an off-duty nurse. He is passed through the hands of relatives to a family friend sitting on the ceremonial Chair of Elijah. Prayers and incantations are said aloud. Rabbi Wolff reads passages from the Torah. The baby is unwrapped, his nappy removed, his minuscule genitals are swabbed in Betadine. Dr Robinson leans in with his instruments.
It's over in a flash. The baby utters four quick gulping cries and then starts sucking on his dummy as Dr Robinson drops a small tube of bloodied flesh into some gauze. In the space of less than two minutes he has snipped off the foreskin and applied a dressing to the baby's bleeding penis. Rabbi Wolff announces the boy's name as Noah, and ancient blessings are recited as the infant is reswaddled and carried back to his mother. The symbolic power of the ritual is evident on the face of Ivan Rubinstein, who is too overcome to speak, and in Rabbi Wolff's impassioned words afterwards: "This ritual has been going on for 4000 years," he says. "It really is embedded in the DNA of Jews. It's a very powerful, mystical ritual."
Chapter 3 (cont):
Religion is the wild card in the circumcision debate, the issue which pits the rights of children against the rights of parents to practise their spiritual beliefs. Last year a citizens' initiative to ban circumcision in San Francisco was defeated when Jewish groups mounted a legal challenge, joined by city officials. When the regional court in Cologne, Germany, ruled in June that circumcision constituted "illegal bodily harm" to a child, protests from Jewish and Muslim groups were so vocal that the German foreign minister called a press conference to announce that free exercise of religion, including circumcision, is protected by the German constitution.
In Australia, the Labor government of Bob Hawke discovered how thorny these issues can be in 1985, when it decided to remove circumcision from the list of procedures refundable under Medicare. Jewish and Muslim leaders promptly cried discrimination and forced health minister Neal Blewett to back down, earning him a memorable spray from the prime minister ("Neal," Hawke reputedly rasped, "you've united the Jews and Muslims for the first time in a thousand f ... ing years - against us!"). Circumcision remains on the Medicare schedule, although since 2000 all state health departments except Queensland have removed "elective circumcision" from the schedule of services offered in public hospitals.
The hospital ban caused the cost of circumcisions in Australia to spiral, with private hospital services now running at around $1000. That was the reason the Khan family turned to Dr Mohammed Jabbar - his charge of $650 seemed more reasonable, and he appeared to be experienced. But surgery is never without risks, and Dr Jabbar has been disciplined twice in recent years over his management of circumcision procedures. In 2009, he faced allegations of failing to provide adequate information about possible complications, failing to monitor a patient and failing to give advice about post-operative haemorrhaging; the last two charges were dismissed but the first was upheld and he was directed to change his circumcision practices. In the Khan case, one year later, he pleaded guilty to four counts of unprofessional conduct and was suspended for three months and ordered to limit his circumcision procedures to infants up to four months in his clinic or children between five and 18 in a hospital. The Victorian Civil and Administrative Tribunal found he had "failed this boy and his parents at each step in the process, resulting in what can only be described as a tragic outcome".
Dr Jabbar is not the only GP whose skill at circumcisions has been the subject of complaint in recent years. In 2008, a urologist at Royal Hobart Hospital was banned from performing surgery after botching a number of procedures, including circumcisions. A Queensland doctor is currently the subject of disciplinary proceedings following a complaint about a circumcision he performed. And in 2009, a New Zealand doctor severed the artery of a four-year-old boy while removing his foreskin at a medical clinic; his parents testified the doctor failed to allow time for the anaesthetic to take effect, forcing the medical team to hold their son "like a wild animal".
Melbourne GP Dr Nick Demediuk says current paediatric guidelines, which recommend circumcision should only be performed on children over the age of six months, mean that children undergoing the procedure are increasingly older and more difficult to control. "To say that it's best done after six months is rubbish," he says. "A kid of two or older is going to be scared witless; they're going to assume they will be in pain. And a two-year-old is far harder to hold down than a two-day-old baby."
Whether injuries are becoming more common is difficult to gauge, however, as the Australian Health Practitioner Regulation Agency does not compile statistics on circumcision-related complaints. Dr Neil McMullin, who was head of urology at the Royal Children's Hospital when the Khans' injured son was admitted, believes it is almost inevitable that banning elective circumcision in public hospitals leads to more adverse outcomes. That was the consensus among paediatricians at the hospital, he says, and the Khan case crystallised their concerns. Dr McMullin believes that because the boy suffered a condition that made him vulnerable to infection, he should have been admitted to the hospital for the circumcision when his parents first requested it. "But the almost knee-jerk response, based on the edict from the Health Department, was, 'We can't do that here,' without much thought about what might happen if it wasn't done at the hospital."
Dr McMullin gave evidence in the Medical Board case against Dr Jabbar, and was so concerned by the case that he notified the Victorian Health Department's surgical consultative committee of his belief that the hospital ban should be re-examined and made more flexible. He can't recall getting a response, although he believes the Royal Children's Hospital has since changed its internal procedures on circumcision. Neither the hospital nor the Victorian Health Department responded to this magazine's questions about the Khan case, although the hospital says it does not believe Emergency admissions for circumcision-complications have increased since the hospital ban was introduced in Victoria in 2007.
It's a debate that's unlikely to go away soon, as the Tasmania Law Reform Institute proved this week when it suggested the state government should ban circumcision of young children, except in cases of well-established religious or ethnic motivation. In a 101-page report, the institute also advised the government to enact a criminal law defining minimum standards for doctors performing the procedure, and to introduce court hearings for parents who are unable to agree on circumcising their child.
They are bold proposals which Tasmania's former Commissioner for Children, Paul Mason, can take major credit for. Mason is a vehement opponent of infant circumcision, which he has described as tantamount to sexual abuse. It was he who asked the Law Reform Institute to clarify whether doctors could be open to criminal charges for conducting non-therapeutic circumcisions on children, leading to publication of the new report.
The institute's suggestions will now have to be taken up by brave politicians willing to craft a law that defines which religious and ethnic groups would be exempt from prosecution. Professor David Forbes notes that these kinds of legal and ethical ambiguities make any attempt at legislation extremely difficult. Why, for instance, does Western society abhor female genital mutilation - a long-established cultural practice in some countries - but accept the removal of an infant boy's foreskin? "It's very difficult to legislate a process through this," he says.
The Khan family's experience itself demonstrates some of those ambiguities, for the case is one that appears to make both sides of the debate equally uncomfortable. Opponents of circumcision are loath to admit that by restricting the availability of the procedure, they might have put children more at risk. And advocates of circumcision are leery because it suggests the operation is nowhere near as straightforward as they suggest.
At the Medical Board hearing of their case in 2010, the Khans reported that their son had recovered physically from his ordeal, although he has suffered permanent scarring. The family sued Dr Jabbar and reached an out-of-court settlement last September. But the psychological toll from the boy's ordeal will take longer to heal. He is scared of hospitals and doctors, his father told the Medical Board hearing, and disturbed by what he has been through. "He keeps asking the same question - whether he is going to be all right."
I know people hate when there are comparisons drawn to FGM, but researchers have stated that at least 700 girls are circumcised each year in australia - either by being taken back to their country of origin, or more likely, backyard jobs and having those who perform the surgery flown into australia to do large groups at a time.
And yet its still illegal. And as horrified as i am about these people breaking the law, i would not wish to see it become legal.
I feel the same way about male circumcision (including the one described).
i am heartbroken for the child - and because of that feeling, i wish that it were illegal to do it, so those who have it done regardless could be punished. because *to me* it is horrific, and appalling.
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