Monday, April 02, 2012

Rav Shmuel Kamenetsky on MBP

The controversy over MBP (Metzitza B’Peh – oral suction by mouth of the blood of the circumcision wound by the Mohel) was re-awakened recently when it was determined by medical examiners that an infant died because he contracted herpes from the Mohel.

The question still remains as to whether it should be banned. Or if not - whether it should be the preferred method of circumcision. Is it required by Halacha? If so - what is the exact basis for the requirement? Are there circumstances that would discourage using this procedure?

There are many facts and beliefs to consider.

Just to review - the crux of the issue is whether Metzitza (drawing out the circumcision blood) is considered an actual part of the Bris or a medical precaution. Chazal tell us that Metzitza is a Halachic requirement. But they clearly say that it is for health reasons. They do not tell us how Metzitza is performed. Over the centuries the method of extracting circumcision blood has always been via sucking it out of the wound by mouth. In recent times Poskim have permitted using alternatives of a pipette of gauze to do Metzitza.

The Chasidic world apparently believes that in spite of this explanation given by Chazal, Bris Milah – ritual circumcision - without Metzitza is invalid. Furthermore they seem to believe that the ‘tried and true’ method of oral suction is the only legitimate way to do Metzitza. Not doing MBP is tantamount to not doing a Bris Milah at all.

The non Chasidic Yeshiva world accepts Chazal’s explanation and do not consider it an actual part of the Bris. Just a required health procedure. They acknowledge that the alternatives accomplish the required Metzitza. But most of them still prefer MBP.

The Modern Orthodox world seems to prefer the alternatives of using a pipette or gauze to do Metzitza - draw out the circumcision blood.

In light of all this Agudah Moetzes member, Rav Shmuel Kamentsky has come out with an amazing statement. From the Jewish Week:

In a phone conversation with The Jewish Week, Rabbi Kamenetsky noted that in his community “as far as I know, they do metzitzah with a tube [a sterile pipette that prevents the mouth from directly touching the wound].”

When asked about rabbis who believe that using a tube is not valid under Jewish law, Rabbi Kamenetsky replied, “Nobody holds like that.” Told of those who make this claim, the apparently incredulous rabbi said only, “I don’t think there’s a response to them.”

The rabbi also expressed disbelief about those who would insist on the practice despite its links to the transmission of disease to infants.

“Chas v’shalom [God forbid], if [children are] getting sick [from oral suction], [you] wouldn’t do it,” under Jewish law, he said.

I’m pretty sure this rankled the Chasidic community. Their attitude remains firm. They will continue to do MPB no matter what.

It appears that Rav Kamenetsky has now qualified his original statement. From the Baltimore Jewish Life:

The practice is indeed time honored and is followed by the majority of the Orthodox Jewish community today around the world, as it has been for thousands of years. To my knowledge, it has not been proven that the practice leads to contraction of illness.

Acknowledging that Halacha is extremely sensitive to health issues he then states:

In my view, there has been no demonstration of an inherent danger associated with metzitzah b’peh.

The statement, “I don’t think there is a response to them,” referred specifically to those who allegedly said that it would be invalid to use a tube where there are demonstrable health issues present regarding either the mohel or the child.

The statement, “I don’t think there is a response to them,” referred specifically to those who allegedly said that it would be invalid to use a tube where there are demonstrable health issues present regarding either the mohel or the child.

Similarly, my comment that in my community “as far as I know they do metzitzah with a tube” refers to a case where a health concern has been established. In no manner was it intended to suggest that I believe that it should be universally adopted.

In no way should what I said be misconstrued as supporting the curbing of, or outside interference with, metzitzah b’peh. In fact, we have very effectively self-regulated the practice over the past 3,500 years.

Ok. Nice save. But then he says something which seems to contradict what he intended it to say:

Jews have made tremendous sacrifices over the millennia to properly observe our religious obligations and traditions. It would be a shame to return to the days when parents and circumcisers feared performing the hallowed bris, which enters every Jewish male into a covenant with G-d.

If we want to protect Bris Milah shouldn’t the opposite be the case? Shouldn’t we do what we can to assure that Bris Milah does not come under fire? If there is the slightest danger and it raises concern among public health officials… would it not be prudent to adopt procedures that obviate MPB? If we want to preserve Bris Milah we need to abandon the things we don’t need which are deemed dangerous even in the slightest.

This is not to say that I would like to see government interference. I would not. But in order to prevent that we should self regulate MBP to the best of our ability and mimimize its use. That would have the salutary effect of eliminating any possibility - no matter how remote - of an infant contracting disease from the mouth of the Mohel. Additionally it would make it more attractive to secular Jews who are beginning to question the need for a Bris altogether. Certainly the health issues with respect to MPB would be an additional turn off to them. We want to encourage Jews to circumcise their sons, not discourage them.

What about Chasidim? As I said the procedure should remain legal. The risk is indeed small and if they wish to continue using MBP let them. But for the rest of us it seems to me that advantages of using the alternatives outweigh the advantages of using MBP. We ought to therefore opt for those alternatives whenever we can. They have been approved by major Poskim of both the past and present. Besides - even though the risk is very small, why have any risk at all?