Ethics of circumcision questioned in Finland

Finland Questions Ethics of Circumcision

Contents (more recent items first):
Report (in Finnish and English)
Investigation - six botched circumcisions



Working group wants to prevent complications from back-alley procedures

In spite of a recommendation made on Thursday by a working group of the Ministry for Social Affairs and Health, there are no immediate plans at Finnish public hospitals to start religiously-motivated circumcisions of boys.

A number of hospitals in Finland have refused to perform such circumcisions, and say that they will not do so until legislation is passed that mandates such operations.

Even a law might not lead to much change; paediatric surgeons at the Helsinki University Central Hospital have said that they will continue to refuse to perform the procedure even if such a law is passed.

In its proposal the working group said that municipal hospitals should be required by law to perform circumcisions on young boys.

The proposal will be circulated among experts and interest groups for comment, and is to go before Parliament in the autumn.

There has been no increase in circumcisions at public hospitals even though the Ministry of Social Affairs and Health urged them to provide such services in a letter sent to Finland's university hospitals last year.

A number of hospitals will only perform the procedures for medical reasons.

"Some doctors have performed the operations privately", says Kristiina Stenman, a lawyer who had helped the working group.

"Some of the operations are performed by doctors visiting Finland. The situation has caused confusion especially in Uusimaa."

The issue arose in Kuopio in August 2001 when seven Muslim boys of different ages underwent circumcisions in their homes. All of the boys had to be treated for complications at the Kuopio University Hospital.

The African-born doctor who performed the operations was reprimanded over the incident, which led to demands that circumcisions be made available at public hospitals to avoid problems caused by botched procedures.

After the controversy, the Kuopio University Hospital decided to adhere to its policy of not circumcising. The Finnish Medical Association has come out against the procedure, and many Finnish hospitals concur.

Many religiously and culturally mandated circumcisions are performed at private hospitals, and some take place abroad.



Thu, 12 Feb 2004

Finnish task force issues report

Tiedote 52/2004
Press release 52/2004
(12 February 2004) (unofficial translation)
Poikien ympärileikkaukset julkiseen terveydenhuoltoon Circumcision of boys in public health care system
Sosiaali- ja terveysministeriön asettama työryhmä katsoo, että uskonnollisten ja kulttuuristen perinteiden vuoksi tehtävät poikien ympärileikkaukset olisi sallittava pojan huoltajien suostumuksella. The Task Force convened by the Ministry of Social Affairs and Health has concluded that parents should be permitted to consent to circumcision of boys for religious or cultural reasons.
Ympärileikkauksia saisi tehdä vain laillistettu tai luvan saanut lääkäri. Circumcision should be performed exclusively by licensed physicians.
Nämä ympärileikkaukset olisi rinnastettava lääketieteellisin perustein tehtäviin ympärileikkauksiin ja julkisen terveydenhuollon olisi huolehdittava niistä samaan tapaan kuin ei-lääketieteellisistä ympärileikkauksista. These circumcisions should be placed on the same medical level as therapeutic circumcision, and should be provided by the public health care system on the same basis as non-therapeutic circumcision.
Vanhemmat voisivat halutessaan teettää ympärileikkaukset myös yksityisessä terveydenhuollossa. Parents should also be able to have it done in the private health care system.
Koska ympärileikkauksessa puututaan pojan ruumiilliseen koskemattomuuteen, toimenpiteestä olisi säädettävä laissa. Since circumcision infringes on a boy's physical integrity, measures should be taken to amend the law.
Keskeisenä tavoitteena on oltava pojan eduista huolehtiminen sekä se, että ympärileikkaus tehdään turvallisissa olosuhteissa. The central objective is to ensure that the boy's interests are protected, and also that circumcision is performed safely.
Työryhmä perustelee esitystään ympärileikkausten ottamisesta julkiseen terveydenhuoltoon sillä, että jos ympärileikkauksesta aiheutuu esimerkiksi monilapsiselle perheille suuria kustannuksia, on vaarana, että niitä tehdään varojen puutteessa julkisen terveydenhuoltojärjestelmän ulkopuolella.
The Task Force notes that circumcision could be a major expense for families with many children, and argues that circumcision should be offered by the public health care system to reduce risks associated with having the operation performed outside the system.


The task of the Working Group was to discuss the grounds for non-medical circumcision of young boys in the light of e.g. the Council of Europe’s Convention on Human Rights and Biomedicine, the new Constitution of Finland, and the UN Convention on the Rights of the Child. The Working Group should monitor and assess international developments with respect to the legislative basis for, and current practice of, circumcision, as well as to survey the situation in regard to circumcisions in public and private health care and outside these systems. The Working Group should also assess, based on the aforesaid, the need for legislation on circumcisions, preconditions for having the operation, and prepare the related proposals for legislation.

The acceptability of non-medical circumcision of boys in our society has been raised for critical consideration.

Those circumcisions have been considered problematic both ethically and from the point of view of international treaties and legislation in force.

The Working Group is of the opinion that non-medical circumcision of boys can be allowed on certain conditions. The starting point is the child’s best interests, which are looked at from a wider perspective than health perspective by emphasising socially adequate grounds arising from [religious] and cultural traditions.

It is also of significance that by observing the methods used in circumcisions on medical grounds an operation can be carried out as safely as possible and harms ensuing from operations in uncontrolled circumstances can be avoided.

Since a circumcision means an interference in a boy’s physical integrity, under the present legal circumstances it must be laid down in legislation when it is allowed. The preconditions for circumcision must be laid down in a law.

A circumcision can according to the Working Group's proposal only be performed by a licensed physician who has got a permission for that, and upon the consent of the boy’s parents or other legal guardians. In the Working Group’s opinion these circumcisions must be arranged within public health care in the same way as measures that are performed on medical grounds.

Full text PDF, nearly 50 pages:


Wednesday, August 22, 2001
Hufvudstadsbladet (=Capital City News), Helskini, Finland

Circumcisions under the magnifying glass

The County Administrative Board in Eastern Finland is investigating why newly circumcised boys in Kuopio have recently had to be taken to hospital afterwards. Circumcision of boys is not prohibited in Finland, but Assistant Parliamentary Ombudsman, Riitta-Leena Paunio, in a decision from 1999 raised very serious concerns about the circumcision of small boys for religious reasons and stated firmly that, at the least, this was not a task for the publicly financed health care service.

It was on the basis of reports in the press that on Monday, County Medical Officer, Antti Turunen, contacted Tarja Holi, who is Deputy Director of the Legal Protection Office with the Health Care Service. Turunen notified Holi that the Country Administrative Bound would investigate the circumstances around this prominent case. Yesterday he said the hospital that took care of several children with complications after a doctor conducted the procedure in a kitchen in Kuopio, had until the end of the month to explain in writing what had actually happened.

“So far we have no details other than what we’ve read in the newspapers, namely that seven children were circumcised by a doctor who is said to be registered, but that three or four of them required medical care after the operation, which was done on a kitchen table in a private home.”

First we’ll find out if the doctor is in fact registered. Whether he had the right to carry out the operation is the next question regarding the circumstances around the circumcisions, said Turunen. He added that if the answers to these questions were satisfactory, then “things would be going well for the doctor”.

The Administrative Board’s investigation is expected to be finished in about one month. It was Turunen, who works at St. Michel, who initiated the investigation, but Jari Vepsäläinen, County Mecial Officer with the board’s Kuopio division, will take over the case when he returns from holidays.

The government’s Assistant Parliamentary Ombudsman, Riitta-Leena Paunio, investigated the Finish approach to male circumcision in 1999. The basis for the inquiry was a case in which a complainant was critical of boys being circumcised without medical reason at the University Hospital and that public resources were used. Paunio’s position involved several points and in fundamental principles related to the discussion that has now arisen. Paunio stated, for example, that “circumcision of children of the male gender does not have any clearly favourable effects for the child.” In fact the risk for complications may be four percent and some complications can be serious.

Consent needed in principle
Paunio’s conclusion was that circumcision is an operation that the health care service is not liable to perform. This could explain why the operation in the current case was done in a home. But she also expressed doubt whether the operation in general was one that the public health care service had a right to perform at the request of parents. However, the Health and Welfare Ministry proposed at the beginning of the 1990s that local health authorities would “take a positive stance on performing the operation” – to cite the ombudsman’s annual report of 1999.

The issue is now complicated further since Finland has signed the Council of Europe’s convention on human rights and biomedicine. This has the central principle that if a person cannot give consent of their own – and in our case this applies to children under 10 years – then a procedure affecting a person’s integrity can only be permitted if the procedure is of immediate benefit to the patient. According to medical expertise, the operation does not positively affect the child’s health except in a few very exceptional cases. Circumcision of Finnish children is sometimes done for medical reasons if the child has an exceptionally tight foreskin and this can lead, for example, to infections.

Paunio’s conclusion was that, in the absence of medical reasons, circumcision of male children is obviously questionable, so long as they cannot themselves give consent to the operation. Female circumcision, however, is treated as assault in Finland and is always prohibited.

Not assault in Sweden
In Sweden the High Court has addressed whether circumcision of boys under seven years should be treated as assault, but in a judgement from 1997 it determined this was not the case when the parents had consented to the operation and the child was not subject to excessive pain.

The reports that Paunio’s position was based on, showed that among other things, circumcision of boys is very common, even if it hardly ever occurs in Northern Europe and particularly not in the Nordic countries. In the USA, 80 percent of boys are said to be circumcised, in Australia around 70 percent, in Canada 48% and in England 24% . [These figures are all too high. The current neonatal circumcision rates are more like US 65%, Australia 13%, Canada 20%, UK 1-2% - though the proportion of living males who are circumcised is higher, because rates have been falling.]


Hufvudstadsbladet, HELSINKI, 20020205
In English and Swedish

Hospitals should do circumcisions


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