Following the loss of a one-month-old baby in Penticton after a routine circumcision in 2002, coroner Chico Newell, in his January 2004 report, found the death to be accidental. The boy suffered severe blood loss over the following day and a half.

Although it's extremely rare, death is one of the possible risks of circumcision. The debate on the merits and morality of removing a newborn's foreskin is a hot one.

Many followers of the Jewish and Muslim faiths have the procedure done because of religious reasons; some people view nonreligious circumcision merely as cosmetic surgery. Proponents argue that a circumcised penis is cleaner than an uncircumcised one; glands on the foreskin's inner surface secrete a lubricating fluid that can accumulate. Still others adopt a like-father-like-son philosophy.

A San Diego, California--based group called MGMbill.org recently submitted a bill for consideration to the U.S. Senate that would end the practice of "male genital mutilation". Doctors Opposing Circumcision, headquartered in Seattle, has members in the U.S., Canada, and other countries.

In 1975, the Canadian Paediatric Society took a stand, saying that the evidence of the benefits and harms is "so evenly balanced" that there's no medical indication to recommend circumcision as a routine procedure.

"When parents are making a decision about circumcision, they should be advised of the present state of medical knowledge about its benefits and harms," the CPS states on its Web site (www.cps.ca/). "Their decision may ultimately be based on personal, religious or cultural factors."

Typical methods involve such instruments as the Gomco (a bell-shaped clamp) used along with a scalpel or the Plastibell (a small plastic object that's tied to a baby's penis that allows the foreskin to desiccate over subsequent days).

Georgia Straight sex columnist Dan Savage isn't a supporter himself; he and his partner didn't circumcise their son, who's now six.

"The social argument 'I want my son to look like me,' well, I never compared my dick to my dad's," the Seattle-based Savage says on his cellphone. "My son and I don't compare dicks....A circumcised penis doesn't obviate the need for showering and bathing. My son knows when he's in the shower that he has to wash his legs and feet and has to roll back his foreskin and wash in, around, and underneath. If my six-year-old can do it, a 26-year-old can do it.

"After years of joking about my personal preferences as a gay person," he adds, "I think it's unnecessary and causes a great deal of pain to an infant."

Savage suspects that many people in North America are simply more accustomed to circumcision, and there might be a "fear of the unfamiliar". However, he notes that the anticircumcision crowd can sometimes get a little "hysterical".

"The anti-Semitic conspiracy theories do not help their cause," Savage says. "Some compare it to clitorectomy, which just doesn't wash."

Some circumcision critics are more vociferous than others. The U.S.--based National Organization to Halt the Abuse and Routine Mutilation of Males, for instance, has an article called "Male Circumcision: A Gender Perspective" on its Web site (www.noharmm.org/). Written by men's activist Joseph Zoske, the essay compares the act to voodoo.

"Circumcision requires that a male infant be taken from his parents and placed on a restraint table with his extremities fastened or held down, while a variety or surgical instruments (probes, clamps, scalpel) are used to grasp the foreskin, separate it from the glans, slit it, stretch it, crush it, and amputate it," Zoske writes, adding that if the same type of procedure were done on girls, there would be "legitimate charges of child abuse".

According to the CPS, benefits of circumcision include a reduction in the incidence of urinary-tract infections during infancy, as well as a decrease in the risk of penile cancer and the transmission of sexually transmitted diseases, including HIV. Potential side effects include infection, bleeding, pain, acute renal failure, sepsis, and death. Most doctors urge parents to seek immediate medical help if there is a blood stain on a baby's diaper that's larger than a quarter afterward.

According to the University of Michigan Health System, more than 80 percent of males in the world are not circumcised. By contrast, the Atlanta, Georgia--based Centers for Disease Control and Prevention states that in 1999 65 percent of all male newborns born in hospitals in the U.S. were circumcised.

Locally, statistics are hard to come by and often taken out of context, says Marisa Nichini, the head of communications at B.C.'s Children's Hospital. Babies born there often get the procedure done elsewhere, by a family doctor, obstetrician, pediatrician, surgeon, or urologist. (Mohels, nonmedical but trained Jewish people, also perform circumcisions.)

Neil Pollock, a Vancouver doctor, says he did about 2,000 circumcisions himself last year. He focuses his practice on the procedure (as well as no-scalpel vasectomy) and has developed a technique that he says is "virtually painless and bloodless".

"I'm not against circumcision or for circumcision," Pollack says in a phone interview. "I take the same position as the CPS in that people need to be educated about the benefits and risks so they can make their own unbiased decision."

Pollack uses a Mogen, a U-shaped clamp through which the foreskin is pulled. He uses a scalpel to remove the foreskin and says typically there is a drop or two of blood or none at all. He also administers Tylenol, a topical anesthetic cream, a local anesthetic, and sugar pacifiers. He charges $199.95, including taxes, for the procedure, which isn't covered by the Medical Services Plan.

Among the reasons to be cautious about proceeding, Pollock says, is a family history of a bleeding disorder such as hemophilia.

The B.C. HealthGuide has a worksheet available on-line to help people make their decision (www.bchealthguide.org/). Ultimately, to cut or not to cut seems to be a personal, not a medical, decision.