Doctor rejects unkind cuts

MARGARET Somerville takes a call from a medical news journal seeking a comment on a new service available over the Internet that matches patients with a doctor who can diagnose their ailments.

Dr Somerville, founding director of the McGill Centre for Medicine, Ethics and Law, found an immediate cause for concern - the doctor never knows who he or she is treating. "What if a patient said he wanted to commit suicide? The doctor can't then take any steps."

Although she can receive up to 20 calls a day from the media, regularly writes newspaper articles and addresses international symposia on almost every tortuous area of medical and bio-ethics, from physician-assisted suicide to reproductive technology, one issue her friends told her she should never have raised is circumcision.

Dr Somerville lobbed a Molotov cocktail into the media late last year when she wrote to the New England Journal of Medicine in response to its debate on the efficacy of local anaesthesia for "medical" circumcisions. She and fellow doctor David Alwin used the opportunity to suggest that doctors should "end the persistent efforts to find a medical rationale to circumcision by removing the cloak of medicine from this procedure".

Since the Canadian Paediatric Society concluded that any small medical benefits do not outweigh the risks to the child, then, she later suggested, circumcision could technically be considered assault.

The fallout was enormous. But after the dust settled, Dr Somerville seemed satisfied - far removed from someone recovering from attacks by radio phone-in callers and lessons from rabbis on television news shows.

She recalled a favourite moment in an interview with a female television host. On air, Dr Somerville said: "Here are two middle-aged women talking in detail about men's foreskins." They both burst out laughing.

"Part of your ethical responsibility is to have a sense of humility and a sense of humour," Dr Somerville, a professor at McGill since 1978, said.

Media appearances have become part of her mandate at the centre, founded in the early 1980s as both a resource and teaching arm of the faculty of medicine. "TV is the public square. What doesn't happen on television seems not to exist," she said.

Fellow ethicist Ian Kennedy, a professor at University College London, has seen many ethical issues handled in the press and television by simply quoting "anyone who can string three words together".

Dr Somerville's propensity for the many-sided opinion has led to her being referred to as "Margaret 'on the other hand' Somerville" by the CBC (Canadian Broadcasting Corporation).