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Question 2#

Which of these statements is CORRECT regarding religious circumcision?

A. Consent for surgery from the mother is sufficient
B. The father can provide consent only if he is married to the boy’s mother
C. Performing circumcision may be the least dangerous option
D. Where there is significant co-morbidity, counselling by a religious leader (e.g., priest) will have no value
E. Paediatric cardiology reassurance is required when the child has congenital heart disease

Correct Answer is C


. Answer C

This is a question about consent and ethics. The starting point is that the parents are requesting a surgical procedure that does not carry a clinical benefit. The BMA and GMC recommend that the consent of both parents should be obtained for a procedure that is non-therapeutic and ‘important and irreversible.’ Previously, fathers that were not married to the mother did not have parental responsibility and so were unable to give consent for surgical procedures. However, the law has changed. For children born after 1 December 2003, if their father’s name appears on the birth certificate, then the father does have parental responsibility. This does not apply to children born before this date. It should be remembered that grandparents, close family friends, etc cannot provide informed consent for a child’s surgery. Conversely a child with sufficient capacity may provide their own consent. The problems around religious circumcision come to a focus where the child has significant co-morbidity (e.g., cardiac disease or coagulopathy). Parents are often strongly motivated to have circumcision performed for cultural reasons. Where the child has significant co-morbidity these motivations should be carefully explored with the parents. Surgical circumcision does carry risk, but circumcision performed outside of a hospital in less controlled settings is a far less satisfactory option. Parents who are denied a hospital circumcision may proceed to arrange a circumcision in the community. It can be very helpful for the parent to meet and have a discussion with the religious leader from their religion (e.g., priest). The advice is often given that their religion discourages circumcision if it endangers the child. In my practice I also recommend that the parents have a discussion with an appropriate anaesthetist who is better able to counsel about anaesthetic risks in the face of significant cardiac or respiratory disease. For example, a cardiac anaesthetist is better placed to counsel about anaesthesia risk than a paediatric cardiologist where there is congenital heart disease.