Thursday, January 21, 2010

Does Religious Ritual Outweigh Health Risks?

Rabbi Shlomo Brody has written a very informative article in the Jerusalem Post on the subject of Metzitza B’Peh.

There is a common perception among many Charedi Jews that A Bris Milah – ritual circumcision - is invalid if there is no Metziza P’Peh – oral suction of blood from the area of the wound made by removing the foreskin.

But it’s not true.

The Gemarah that deals with circumcision talks about its various components. The first two are required as part of the actual Bris Milah. It is invalid without them. There is no dispute about that.

The third component is Metzitza – drawing out the blood from the wound. It is discussed in terms of the health benefit. Medical experts of that day understood that if blood was allowed to accumulate at the area of the wound it could turn into puss and kill the infant. Because of this the blood must be ‘drawn out’. Though it was never considered part of the Milah itself it was nonetheless considered even more important to do this procedure than the actual Milah because of the concept of ‘Sakanta Chamira Me’Isrua’ . This is the Halachic principle that it is more important to prevent dangerous situations than it is avoiding sin.

Drawing out the blood at the source of the incision of a Bris Milah is in that category. That’s why Chazal deemed it so important.

Additionally I would note that in requiring observance of it laws the Torah says V’Chai Bahem - and live by them! That is interpreted by the sages to mean we must live by them - and not die by them. In life threatening situations that require violating Torah law we may– indeed we must violate it.

Besides that very important Halacha - the Gemarah does not even tell us how to do Metzitza. However the it was widely adopted procedure was that it would be orally suctioned - by placing the mouth directly on the wound. That has been the practice over the millennia.

The question arises, what if one discovers that there are potential serious health issues involved in this very procedure. We now know that microscopic bacteria and viruses cause infections and disease. A Mohel may be carrying bacteria or viruses and by oral contact transfer the deadly disease to the infant. Can we change a millennia old practice?

The most recent manifestation of this issue came up several years ago when an infant died shortly after his Bris. The Mohel – a widely respected one who had done hundreds if not thousands of circumcisions had contracted herpes. Once contracted herpes remains in the system. When dormant it is not transmitted. The problem is that one is not always aware of whether it is dormant at any given time. It was widely believed by the medical community that infant died of a herpes infection transmitted by the Metzitza B’Peh of Mohel who admitted he had herpes but believed it was dormant at the time of the Bris.

Health officials became involved and there were immediate calls for abandoning Metzitza B’Peh… to the pint of outlawing the procedure. There are after all other more sterile ways of doing it, among them using gauze or a pipette – a straw-like implement where there is no direct contact between the mouth and the wound.

Why not simply do it that way? Wouldn’t it be prudent to adopt these safer methods of Metzitza? I would think that this is a no brainer. And yet the Charedi world mostly insists on it. And The Chasidic world won’t even hear of not doing Metzitza B’Peh. Apparently they consider a Bris done any other way to be invalid.

But is it? I would think that the very principle that requires suctioning the blood out of the wound in the first place should be the one that requires changing the procedure - Sakanta Chamira Me’Isurah. The danger of transferring serious illness to an infant surpasses the importance of doing Metzitza B’Peh.

Rabbi Moshe Tendler felt this way. He advocated outlawing Metzitza B’Peh. For this he was vilified by Charedi critics. He was widely compared to the great anti Semitic ancient Greeks who wanted to do away with Bris Milah in an attempt to completely assimilate all Jews and eradicate all vestiges of Judaism.

Was Rabbi Tendler guilty of that? Of course not. But that didn’t bother those who accused him of it.

The fact is that the alterantive procedures are not new. They date back to 1837 - the era of the Chasam Sofer. Because of a series of deaths to newborn infants he - like Rav Tendler - realized that ‘Sakanta Chamira Me’Isura’ and permitted gauze to be used. Was he alone? No. The Maharatz Chajes endorsed this alternative procedure because it did not contradict the Gemarah in any way. It just slightly altered the adopted method of drawing blood from the wound in a safer way.

What about later Poskim? How did they feel about it? In 1885 Rav Shamshon Raphael Hirsch adopted the pipette method of Metzitza for his community. This method was endorsed by some of the greatest Poskim of that era including Rav Yitzchak Elchanan Spector, R’ Chaim Soloveichik, and more recently Rav Tzvi Pesach Frank.

And yet the suggestion that this be made mandatory in our day is vilified as anti-Semitic. Why? Because Chasidm believe that a Psak by the Maharam Schick is the authoritative one. He forbids any deviation from Metzitza B’Peh – calling it integral to the actual Bris. Of course they ignore that Maharam Schick’s Psak was done in the context of a real challenge to Bris Milah itself by the Reform Movement.

Nonetheless they argue that they have a right to follow whomever they believe. Besides... since transmission of disease has been miniscule and statistically insignificant over the Millenia - why tamper with tradition?

Rav Tendler has always contended that his insistence on outlawing Metziza B’Peh was solidly based in Halacha. That some one who is ‘Machmir’ in this issue in our day is inherently violating the Torah’s mandate of V’Chai BaHem or V’Shomartem Meod Es Nafshosechem. He argued that the danger of transmitting disease is real and that many Poskim over the ages have permitted these slight variations of Metzitza.

I think Rav Tendler is probably right. Tradition pales in comparison to protecting lives, no matter how slight the risk. Why have any risk at all?