Legislation on male infant circumcision in Europe: a call to avoid paternalism and to promote evidence-based, patient-centred care


Maria Kristiansen a*
Maria Kristiansen is Assistant Professor at the Department of Public Health, University of Copenhagen, Denmark and honorary fellow at the University of Edinburgh, UK. She is involved in studies exploring the relationship between ethnic, religious and social inequality in health and access to health care.
& Aziz Sheikh b
Aziz Sheikh is Professor of Primary Care Research & Development and Co-Director of the Centre of Population Health Sciences at the University of Edinburgh. He has a long-standing interest in the interfaces between religion, health and health care delivery and has published widely on these issues.

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Global Discourse
Available online: 26 Jun 2013

ABSTRACT
Male infant circumcision is a controversial and debated topic in both scientific and public discourses in parts of Western Europe. Debates are heated and it is not always entirely clear what is in the best interest of the male infant. In this article, we discuss the importance of returning to core principles of evidence-based, patient-centred care that may help move the discussion away from the current, increasingly polarised positions. According to principles of evidence-based medicine, systematic retrieval and critical appraisal of the best evidence available should be a core consideration in all decisions regarding healthcare policy and practice. Applying this principle to male infant circumcision, we need a careful, dispassionate critique of the evidence in relation to the benefits and risks associated with the procedure and an assessment of the potential health gains and adverse effects of any interventions (such as legislation) that may be introduced. Currently, the more robust evidence-base has tended to focus on biomedical aspects of male infant circumcision and this shows consistent evidence of important benefits of this practice, but also some risks. However, health is multidimensional and when considering male infant circumcision, there is therefore a need to broaden the perspective to also include psycho-social considerations. It is also imperative that those striving to deliver patient-centred care keep the best interests of the patient/family at the heart of their decision-making, promote autonomy and do not inadvertently exceed the fine line between beneficence and medical paternalism.In summary, we argue that a more comprehensive and robust evidence-base is needed to enable evidence-based policy-making and that these uncertainties are communicated to patients/families so they can in the light of this evidence make an informed choice."

""Male infant circumcision should be available throughout the NHS. Although a handful of NHS trusts provide it, most parents are forced into the poorly regulated private sector," Professor Sheikh said."