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August 30, 2014 / 4 Elul, 5774
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Posts Tagged ‘Bris Milah’

Another Baby (Almost) Bites the Dust

Friday, April 5th, 2013

There has been yet another case of neonatal herpes reported in the media. From the Forward:

Another Jewish newborn — the second in three months — has contracted neonatal herpes due to a controversial oral suctioning technique employed during ritual circumcision, New York City’s Department of Health and Mental Hygiene has reported.

I frankly do not completely understand why anyone continues using the procedure of metzitza b’peh (suctioning with the mouth – MbP). Even more perplexing is opposition to a New York City Health Department requirement to sign a consent form before allowing that procedure to be performed on their newborn immediately after the milah (circumcision).

I am not going to go through the reasoning as to why this procedure is not Halachicly mandated. Been there and done that more than once. Suffice it to say that suctioning blood from the circumcision wound was understood by Hazal to be a requirement for medical purposes.

That it is mandated in the Gemarah makes it a Halachic requirement. But it does not make it part of the actual milah. The Talmud also does not say how that suctioning should be done. Nowhere does it say that it must be done directly by mouth.

But for reasons not completely clear to me, many Hassidim say suctioning the blood by mouth is an essential part of the circumcision itself – without which the circumcision would be invalid. I suppose they base it on a mimetic tradition. This is how they saw their ‘fathers’ do it. And this is how it’s always been done. It therefore must be a requirement.

What about babies that have contracted herpes? They reject completely any evidence that is has been transmitted by a Herpes infected mohel. How, they ask, could it be that a Torah requirement would cause a danger to a child? The truth is not what we see but what ‘God says it is’ (or as I prefer to characterize it – what they THINK God says).The babies who have contracted it post circumcision could not have possibly gotten it from an infected mohel no matter what the evidence shows.

What is even more perplexing is how common MbP is even among non-Hasidim. And the fact that Agudah wastes political capital fighting even the requirement that a consent form be signed. Their response has been that this is a church/state issue. And that tampering in any way with any part of milah is an attack against milah itself.

What’s worse is that in their zeal to protect this procedure they have compared government concerns about the health of the baby to anti-bris campaigns of ancient Greece – where a bris milah was outlawed so as to Helenize their Jewish subjects taking them completely out of the Torah’s orbit.

There are many mohalim here in Chicago. Some do MbP and some do not – using a sterile pipette for suction instead. Those who do MbP are the most popular mohalim among Haredim. Even those who are not Hasidim. It’s almost as if they did not know that MbP is an issue. Or don’t care.

How can a father not care what happens to his baby? How can he say that it’s probably going to be OK? True – it probably will since the incidence is of an infected mohel transmitting the disease is very low. But why do they insist on these moahlim? And why do these mohalim insist on using MbP anyway? They are not Chasidic. And yet MbP is automatic with them. (Although my understanding is that some of them will not use if if asked not to… still – MbP is their default.)

Most people know that R’ Moshe Tendler is vehemently opposed to MbP. He has been publicly called a Hellenizer for his efforts by some members of the right. But according to the Forward so too is R’ Hershel Shachter. From the Forward:

In a public lecture last February in London, Schachter, who is a rosh yeshiva, or senior chief rabbinic authority, at Y.U.’s Rabbi Isaac Elchanan Theological Seminary, claimed that his daughter’s hospital treated three cases per year of Hasidic babies infected with herpes. The infections were “obvously because of metzitzah b’peh,” Schachter told his audience, citing his daughter r.

Schachter also cited his daughter as claiming that there are, in fact, about 15 such cases per year in the city, including the three cases or so she claimed per year at her own hospital. Schachter said his daughter explained that the hospitals do not report these cases because Hasidic clients would not return if they were made public. Schachter’s remarks were first posted March 14 on the website Failed Messiah and authenticated by the Forward.

Is Consent for Metzitza B’Peh Really about Banning Circumcision?

Wednesday, February 6th, 2013

The welfare of Klal Yisroel will be upheld. This is how I see the new regulation requiring informed consent before performing Metzitza B’Peh (MbP).

For those not up to speed about this ritual procedure – it involves suctioning off the blood by mouth from a circumcision wound. The Gemarah, in its description of the very important Mitzvah of Bris Milah, explains the procedure for that in relative detail.

As has always been the case throughout Jewish history, the rabbis understood that the Torah always put the health of the individual above just about all else. So they mandated what was a safety feature of the bris – the suctioning of the blood (metzitza) off the wound so that it would not become a source of infection. In fact that is clearly how metzitza is stated in the Gemarah. As a safety precaution.

So according to the Gemarah even though it does not invalidate the actual bris if metzizah is not done, it is nonetheless a Halachic requirement to do so.

The Gemarah does not describe the method of suction one must use. It just says “metzitza” – suction. Historically the most efficient method was to simply suction it off quickly by mouth. For thousands of years that is how every bris was done. Until the 19th century. At that time many of the greatest poskim of the era allowed alternative methods of suctioning after there were some deaths attributed to a possibly infected mohel.

But that did not stop the hardcore traditionalists from insisting that doing so by mouth was not only preferable but required! Those who argued saying that there were legitimate poskim who permitted non-oral suction methods were rebuffed with claims that these poskim never intended their kulos (leniencies) to be permanent.

They insist that MbP is an integral part of the bris. Here is the way the Forward put it in the name of one of the most prominent mohalim, Rabbi Avrohom Cohn who heads the American Board of Ritual Circumcision and who is in the forefront of fighting this new regulation:

[T]he ultra-Orthodox minority who do use metzitzah b’peh, including members of Cohn’s group, avow that this technique must be part of the circumcision ritual in order to fulfill divine commandments set out in the Torah and the Talmud. Personally I don’t know how they can make that claim. If there were ever circumcisions done without MbP, they would be invalid by this definition. Which would make those poskim guilty of being machti es haRabim (causing the public to sin). Besides – what would those poskim gain by omitting MbP? Why bother doing it at all?! If MbP is integral then there was no point to doing a bris! Furthermore they are casting aspersions on every circumcision that does not do MbP.

Nonetheless they feel that any interference with that practice violates their right to practice their religion as they see fit. Even New York city’s Department of Health and Mental Hygene (DOHMH) requirement to sign an informed consent form stating they have been made aware of the possible risk of infection to the child.

One may ask, “What is the big deal?” “Let them sign the forms and they can do what they want!” That’s how I feel about it. But they feel they cannot sign a document that would in effect be saying that Halacha as they understand it is dangerous to your health.

They claim is that there is no danger to a child that has MbP. That’s the way it has been done for millennia. And that there is no poof that the few babies that died were because of infections transferred by mouth from the mohel. And that even if it were proven in one or 2 cases – the statistical probability of it happening is negligible considering the tens of thousands of times each year MbP was done without incident.

The Department of Health obviously disagrees and points to studies that have show a strong likelihood of several babies being infected by a mohel with the herpes virus. From the Forward:

More recent DOHMH studies have revealed 12 area infants who have contracted herpes after circumcision. with two of the infants dying soon after.

And since herpes can be asymptomatic, the risks are real, small though they may be. Hence the regulation. Which carries financial penalties if not followed.

The Proper Performance of Bris Milah

Tuesday, September 4th, 2012

Note from Harry Maryles: The following post was submitted to me by someone who is close to Rabbi Zuriel. It is a footnoted and well sourced Halachic analysis of the Mitzvah of Bris Milah and Metzitza B’Peh.

Rabbi Zuriel lives in Bnei Brak and was a close talmid of Rav Ruderman famed founder and Rosh HaYeshiva of Ner Yisroel in Baltimore. He has written well over 30 Seforim on subjects ranging from Shas to Tanach to Mussar to Kabbalah.

After moving to Israel, Rabbi Zuriel learned with – and became very close with many Gedolei Torah including Rav Sraya Deblitzky, Rav Shmuel Toledano, and Rav Friedlander – the famed mashgiach of Ponovezh.

He also learned with Rav Zvi Yehuda Kook, and was the Mashgiach in Shalavim. He is very knowledgeable in all areas of the Torah, and very well informed regarding current events and history . His approach is an independent one and is solely guided by his understanding of the the Torah.

His words follow. 

It is always sad to see dispute and bickering amongst brethren. It is even more aggravating to see anger and emotional outbursts, bitter accusations and personal attacks in the public domain. The present controversy regarding how to do the metzitzah of blood during Bris Milah, if by mouth or by tube, is a case in point.

If we check the Gemarah source[1] and so too the Rambam[2] , and the Shulchan Aruch[3] , we see no mention of the “Peh,” the mouth. The Hebrew word for suction is “motzetz” and this can be performed also by the use of a tube using mouth suction. It is important to precede all discussion on this topic by “putting everything on the table”. We are not discussing a Biblical Commandment, nor are we referring to a Rabbinical enactment from the Gemarah’s time. We are referring to a hallowed Minhag from days of yore to use the mouth only.

Certainly the withdrawal of blood is a Rabbinical enactment, but the direct application of the mouth is only a Minhag. Beyond that, using a tube by mouth suction is also a utilization of the mouth and should not to be considered as abolition of the use of the mouth[4]. This understanding is important to know before we clarify what a parent should decide in cases of doubt.

The world famous Chasam Sofer wrote a responsum to permit using other methods than the mouth (“Bris Olam”, page 216)[5]. The great Rabbi Shimshon Raphael Hirsh permitted the use of a short tube (Shemesh Marpeh, page 70). Rabbi Yitzchok Herzog wrote[6] that since the medical experts claim that there is a danger of infection in many cases, it is advisable to use a tube. He adds that those who insist adamantly that the withdrawal should be done by direct application of the mouth “are mistaken and so too cause others to make a mistake”.

The illustrious Rabbi Avraham Kook permitted the use of a tube when in doubt of infection (Da’as Kohen, 142) [also, see the words of the Aruch Hashulchan[7] and Rabbi Chaim Berlin[8]]. Rabbi Zvi Pesach Frank claimed[9] that since the entire purpose of the Rabbinical enactment of withdrawing the blood from the wound is to avoid infection, this act being done by the tube is part and parcel of that healing process. May we add that this would even be a “hiddur Mitzva” since this is even safer than the personal physical contact of the Mohel to the open wound.

But why is there such a vehement outcry against the usage of the tube? The answer is that for nearly two hundred years there is fear of Gentile government intervention making the essential circumcision ritual illegal. This started in Paris in 1843, reached Germany and Poland and today in California a small group of “humanists” appealed to the State Legislature to ban the practice. This move was defeated.

The fear is that if we ourselves admit that this mitzvah could be damaging to the child, the Department of Health might make capital of our admission. The second cause of the great emotional outbursts of resistance to any change in the ceremony is the worry to keep intact all of Jewish way life, to stay as close as possible to the customs of our forefathers; to forestall all reforms.

Informed Consent

Thursday, August 16th, 2012

http://haemtza.blogspot.co.il/2012/08/informed-consent.html

“There’s nothing about filing a consent form that is inherently in conflict with [Jewish law]”

This statement by Agudah Executive Director, Rabbi Dovid Zweibel  should be the beginning and end of a conversation about a proposed law requiring written informed consent to do MbP (Metzitza B’Peh) – oral suction of blood from the wound during a ritual circumcision (Bris Milah).

The controversy continues however. I am not going to rehash the arguments made in previous posts about the danger of a Mohel unknowingly transferring to the infant the sometimes deadly herpes simplex virus (HSV–1) via this method of Metzitza. Nor do I want to debate whether the low statistical probability of MbP justifies continuing a centuries old practice. The statistical chances for infection are indeed very low.

Despite the fact that major Poskim spanning several generations declare that the lack of MbP does not invalidate Bris Milah – some even requiring alternative safer methods – the fact remains that there is a strongly held view mostly among Chasidim that MbP is an absolute requirement of Bris Milah. They even go so far as to say that it is forbidden to substitute other methods like a sterile pipette or gauze to withdraw blood from the wound – that it must be done by mouth!

There is no point in trying to convince them out of this notion.  Much as I would like to, it’s not going to happen. They would do MbP underground if it were outlawed. And my personal opinion is that the government should not be passing laws that interfere with Bris Milah in any way including a ban on MbP. I would rather see our own Poskim banning it or at least discouraging it. But that’s not going to happen either.

The bottom line for me – which I believe to be the most pragmatic approach – is to educate the public about the dangers in an honest fashion and not exaggerate them.  To clearly explain that they do exist and that opting out of MbP will eliminate any possibility – no matter how remote – of a Mohel ever transferring the disease.

But the government does want to get involved in a way, with which I have no issue… a way that may in fact get more people to look toward those Poskim who permit or even encourage more sterile method of MbP.  New York City’s Board of Health is set to vote on a proposal that would require parents to sign a consent form before subjecting their children to it. I think this is a good idea. In this way the government can inform people of the dangers without any actual interference in the practice of MbP itself.

But that is not the way the Chasidic world sees it. They see it as a declaration of war. They see it as an assault on Bris Milah itself. From the Forward:

“Unless the city is ready to subpoena mohels or break the doors in of synagogues around the city, I don’t really think they understand what they’re trying to do,” said Michael Tobman, a political consultant who is working as spokesman for a coalition that includes Agudath Israel, the large umbrella group that advocates for ultra-Orthodox organizations, and various Hasidic sects. “This is a community absolutely committed to resisting this ill-considered effort, up to and including civil disobedience.”

As noted – Agudah is helping them out in this cause.  In light of the opening line of this post I cannot understand why they would do this. If there is nothing Halachicly problematic with signing a consent form, why are they opposing it? Rabbi Zweibel has even gone so far as to say that if the law is passed the Agudah Moetzes will not call for outright civil disobedience. In my view they should go further and require all Jews to follow the law of the land.

If a consent form is required, not signing it would not only violate Dina D’Malchusa it would prevent people from knowing that there are dangers. People have a right to know that – even if those dangers are remote. What benefit is there to not knowing? What benefit would there be to defying the law by not signing a consent form? Is it any worse than signing any medical consent form where there are dangers involved?

Printed from: http://www.jewishpress.com/blogs/haemtza/informed-consent/2012/08/16/

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