Ethics

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Declining requests for non-therapeutic circumcision

 

 

What if I don’t believe that NTMC (non-therapeutic male circumcision) is in a child’s overall best interests?

Doctors can refuse to perform NTMC if they do not believe it is in the overall best interests of a child.  

Doctors are under no obligation to comply with a request to circumcise a child. In these circumstances, doctors should explain this to the child and his parents, and if appropriate, explain their right to seek a second opinion. 

 

Am I obliged to refer the child to another practitioner?

Where the procedure is not therapeutic, there is arguably no ethical obligation to refer on. On a practical level, as NTMC is not routinely funded by the NHS, referring on could be a challenge in some areas. 

The family is, of course, free to see another doctor and some doctors may wish to suggest an alternative practitioner. 

Of note for doctors working in Scotland, the Scottish government’s NHS staff leaflet on NTMC states that ‘If the GP does not agree to the referral on non-clinical grounds, he or she should suggest an alternative doctor to the patient, in accordance with the GMC's advice that the patient has the right to seek a second opinion.’

GMC guidance – seeking a second opinion 

'9. You must give patients the information they want or need about: … i) their right to seek a second opinion’

GMC, Consent: patients and doctors making decisions together

 

What if I have a moral objection to the practice of non-therapeutic circumcision?

If a doctor declines a request to perform NTMC solely on the basis of his or her moral beliefs about the practice, irrespective of an assessment of a child’s best interests, a doctor is obliged to follow the GMC’s guidance on conscientious objection – see below – and should explain this to the parents.  

GMC guidance - conscientious objection

'21. If you judge that a procedure is not in the best interests of a child, you must explain this to the child (if he or she can understand) and to their parents… You are not obliged to provide treatments in such cases. If you hold objections to the procedure as a result of your religious or moral beliefs, you should follow our advice on conscientious objection.’

GMC, Personal beliefs and medical practice

The GMC’s advice on conscientious objection states that doctors must:

  • tell the patient that they have a right to discuss options for treatment with another practitioner 
  • make sure that the patient has enough information to arrange to see another doctor who does not hold the same objection as you
  • if it’s not practical for a patient to arrange to see another doctor, the doctor must make sure that arrangements are made – without delay – for another suitably qualified colleague to advise, treat or refer the patient.

GMC, Personal beliefs and medical practice

In these circumstances, although the BMA recognises the importance of frankness and openness with patients, this does not extend to doctors offering unsolicited opinions about their own moral views. Although all doctors have private moral views, they should not share them unless explicitly asked by patients to do so. 

In particular, doctors should avoid making pejorative or judgemental comments about patients' or parents’ values or behaviour. Doctors must avoid language or actions that imply discrimination. NHS guidance makes clear that such behaviour in a health care setting could be construed as harassment. 

Next page - Providing NTMC

 

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Download the full guidance here

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