6870 An ethical analysis of the non-therapeutic male circumcision of infants and children

Objectives Non-therapeutic male circumcision (NTMC) is a procedure carried out by various communities in the UK for religious and cultural reasons. The NTMC of children and infants remains controversial amongst the public and medical profession, who continue to raise concerns surrounding both its ethical acceptability and regulation. We aimed to explore the ethical aspects of the NTMC of infants and children (0–16 years old) based on the experiences, opinions and knowledge of consultant paediatricians (CPs) and religious chaplains within the North Thames Paediatric Network (NTPN), and to draw recommendations regarding current service provision with reference to existing guidelines in order to inform future practice. Methods We conducted a service evaluation based on an online questionnaire and semi-structured interviews. The questionnaire was developed based on a literature review including key themes of the British Medical Association's (BMA) NTMC Toolkit,¹ the current law, health risks and benefits, determination of best interests, consent and provision of NTMC within the NHS. 108 CPs in the NTPN were sent an invitation to participate. Interviews were carried out with members of the chaplaincy at a tertiary children's hospital representing the Muslim, Christian, Orthodox Jewish, and Reform Jewish communities. Questionnaire responses were analysed using descriptive statistics and a thematic analysis approach was used for interview transcripts. Results 19% of CPs completed the survey. Whilst 95% of participants had been asked about NTMC and 48% to perform NTMC, only 27% were aware of guidance for clinicians and only 9% felt that they had access to resources to share with parents wishing to discuss NTMC. 95% had encountered children suffering from NTMC-associated complications, and 62% believed that only medically qualified individuals should perform NTMC. 68% of CPs were against NTMC. Ethical issues raised concerned the child's best interests, and children's rights. Participants interviewed detailed the religious and cultural significance of NTMC for the child's family and community. Conclusion CPs often encounter families that are seeking NTMC, or children that have had NTMC performed, and most clinicians report encountering complications of this procedure in clinical practice. The lack of guidance and formal approach by the NHS to reduce the morbidity and mortality of NTMC must be addressed. It is proposed that NHS England undertake an extensive audit and review of NTMC and its associated risks to clarify the approach of NHS Trusts and determine the need for involvement in the service. Reference Non-therapeutic male circumcision toolkit, BMA, 2020.