Friday, March 09, 2012

Metzitza B’Peh - The Death of Another Infant

It’s a difficult issue. Metzitza - drawing blood from the wound caused by a circumcision is part of the procedure of this Mitzvah. Not for the purpose of the circumcision itself – the Gemarah tells us – but because the lack of doing so endangers to the life of the baby. It is therefore mandated by Halacha – Jewish law.

The Gemarah says elsewhere: Chamira Sakanta Me’Isura. Judaism considers transgression of its laws protecting human life more severe than transgression of its ritual prohibitions.

The way Metzitza has been done over the ages is through direct suction by mouth of the circumcision wound. This is called Metzitza B’Peh (MBP). What that does medically is that it ‘cleans the wound’ from an accumulation of blood - a possible source of infection. Rabbi Zev Farber has a good discussion about it here.

About 6 or 7 years ago a tremendous controversy arose about this practice. A baby had died after MBP was performed by a Mohel. The Mohel -perhaps unaware at the time- had the Herpes virus and it was widely assumed that he transmitted it to the baby who died as a result. This was an experienced Mohel who had done hundreds of problem free circumcisions.

There was much discussion and debate in Orthodox circles at the time about whether MBP was actually to blame for that baby’s death. There was talk of banning the procedure.

Those opposing a ban asserted that MBP was an age old tradition which is perfectly safe. In any case the baby had pre existing health issues and it was far from certain that MBP was the cause the baby’s death. Nonetheless state health agencies threatened to ask for legislation to ban MBP. They were immediately accused by the Chasidic community of Czarist like anti Semitism and compared banning MBP to banning circumcision altogether.

They argued that the statistical incidence of death from MBP was so low that it did not merit any legislation. MBP has after all been around for centuries – dating back to at least Mishnaic times. They also insisted that if Chazal mandated it, then it could not possibly be harmful. Witness the infrequent occurrence of any death attributable to it over the ages.

In Chasidic circles, MBP is standard operating procedure. It is unimaginable for them to have a circumcision without it. If I understand correctly they interpret MBP to be part of the actual circumcision - not done just for the health of the baby. Without it - the circumcision would not be valid.

Thus – getting them to accept alternatives to MBP would be tantamount to telling them to eat Treif or violate Shabbos. Although I don’t believe the Yeshiva world has quite the same approach as Chasidim they too insist on MBP in most cases.

On the other side of the issue was Rabbi Dr. Moshe Tendler. He advocated that MBP be banned and replaced by a safer method of drawing out the blood. These methods include the use of a pipette so there would be no direct contact with an infected mouth; or gauze to draw out the blood. Many Poskim say that these alternative procedures fulfill the requirement of ‘Metzitza’.

Chasidim went apoplectic – expressing anger at both the government for considering it and at Rabbi Tendler and others like him for supporting it. The Agudah sided with the Chasidim, mobilized its forces and fought any kind of ban on MBP - framing it as an assault on their religious freedom. They succeeded.

Meanwhile Rabbi Tendler and those rabbis who agreed with him were villainized by some rabbis of the right as “Misyavmin’ - Helenizers! ...for even suggesting that MBP be banned.

The following story is from a post I wrote on the subject at the time and is attributed to Rav Ahron Soloveichik:

During the time of his illustrious grandfather Rabbi Chaim Soloveichik when he was the Rav in Brisk, there was a certain Mohel who had a sore on his lip and performed a Bris Mila using his mouth for Metzitza. The child subsequently died. Reb Chaim immediately Assur’d Metziza B’Peh in Brisk. It never took place there again. The Mohel had this story confirmed by Rabbi Gedalia Schwartz, Av Beis Din of the RCA who knew another grandson of Reb Chaim, Rabbi Joseph B. Soloveitchik who had told Rabbi Schwartz the same exact story many years before. Two people each with independent testimony of the Psak of their grandfather, the great Rabbi Chaim Soloveichik Assuring Metzitza B’Peh.

I guess R’ Chaim was a Helenizer too.

To be clear, no one suggests doing away with Metzizah. It is a Halacha regardless of whether it constitutes part of the actual circumcision or it is being done for the safety of the child. But clearly there are many Poskim who say that doing so by direct placement of the mouth on the wound is not necessary.

And now tragically another child has died right after a circumcision. From the New York Times:

The cause of death of the 2-week-old boy, who died at Maimonides Hospital in Brooklyn on Sept. 28, was Type 1 herpes, caused by “ritual circumcision with oral suction,” according to the medical examiner’s office.

There have doubtless been thousands of circumcisions over the last six years utilizing MBP without incident. One mortality case every 6 years is a pretty low percentage. Except for the parents of this child. For them it was a 100% mortality rate.

There has been understandable outrage expressed by some about this. Most notably one blogger has called for prosecuting Agudah for involuntary manslaughter because they fought against legislation that would have prevented that baby’s death. Understandable though that outrage may be -it is really ridiculous to blame Agudah in any way for this. Besides - it is still very unlikely that any legislation against MBP will come about because of this. And even if it did, it would be completely ignored in the Chasidic world and probably the Yeshiva world too.

The question remains, what do we do? Should we try to get MBP banned? I take the Gemarah at its word: Chamira Sakanta Me-Isurah. I would therefore vote for the baby’s health as the priority. But as I said, banning it will never happen. It would be an exercise in futility to even try.

The only real solution is to educate the entire Orthodox public to both the dangers of MBP and the Halachicly legitimate alternatives to it. In addition I would mandate that every Rav of every Shul immediately inform the parents of any newborn baby boy about the serious health risks of MBP and the Halachicly acceptable alternatives. I would also mandate that if MBP is to be used, that the Mohel should undergo testing immediately prior to the Bris and be medically certified to be free of any disease. And then leave it up the parents.That seems to be the only rational way to resolve this issue.