Thursday, July 26, 2012

Which is the More Slippery Slope?

Last year there was much publicity surrounding a non binding referendum placed on a San Francisco ballot that would have banned circumcision – even for religious purposes. Very few people took this seriously and of course it never passed. Even if it had passed it no government in the US would seriously consider banning circumcision – certainly not if it is done for religious purposes.

While the motives for those placing this referendum on the ballot were likely anti Semitic – one of the issues they raised was by itself not anti Semitic. Circumcision - they claimed - was an unnecessary mutilation of the body and therefore performing it on an infant who had no say in the matter was a denial of his right to decide this for himself. At the very least - it was argued – circumcision should not be performed until the age of consent. Which is typically around 18 years of age.

The counter arguments came fast and furiously. Among them the fact that circumcision is widely considered beneficial to health and that performing it when one is an infant (as Judaism requires) spares him any memory of the pain he may feel.  As an adult, the pain most certainly will be felt and remembered. In fact about 50% of all American males are circumcised. There was also the fact that at least 2 major faiths considered it an integral part of their religion. Indeed, until relatively recently I believe all denominations of Judaism required children to be circumcised upon the 8th day after their birth.

Needless to say circumcision was not banned. But the arguments made by proponents of the ban did not go unnoticed by at least one court in Cologne, Germany (of all places!). Agreeing with the notion that circumcision constituted bodily harm the court banned all circumcisions.

This has caused an outcry by Jews, Muslims (both of whom require it by religious law) and even Christians (who dont) all over the world – including German Chancellor Angela Merkel. To ban a defining ritual of both Judaism and Islam (practiced since biblical times in the case of Judaism) was seen by many as anti Semitic and anti Muslim.

My personal belief is that this ban will not stand. German Jewish community leaders do not seem worried about it and plan to continue circumcising all their children. And from JTA:
The Conference of European Rabbis will lobby against recent circumcision bans by advocating legislation supporting the practice. (Nonetheless) This week, hospitals in Switzerland and a province of Austria announced that they would stop allowing ritual circumcision.
There is a lesson to be learned here. Even in democratic countries like the United States circumcision is not an untouchable right. Although it is highly unlikely that circumcision will ever be banned here it is not out of the realm of possibility. A lot depends on how we treat some of the more controversial aspects of it. I am of speaking about Metzitza B’Peh (MbP) whereby a Mohel extracts blood from the circumcision wound directly by mouth.

To review the pertinent Halacha – our sages mandated that for purposes of health, one must ‘draw out’ the blood of circumcision. Not doing so would be in violation of the law since it would put the infant in mortal danger to leave that blood in place. So the circumcision procedure outlined in the Mishna lists Metzitzah as the ‘health portion’ requirement of a Bris. Throughout the millennia the method for doing this was by direct suction of the wound by mouth.

In more the recent times various Gedolim banned MbP in their communities because of cases of infants dying from infection transmitted that way. Although Metzitza is still a requirement those Gedolei HaPoskim Paskined that it need not be made directly by mouth. Instead blood may be drawn through a pipette or even a sterile piece of gauze.

But Metzitza B’Peh is still widely practiced in our era. Chasidim believe that only this procedure may be used. Other ways of drawing out the blood would invalidate the Bris. Many non Chasidim prefer this method even though they may concede that it does not invalidate the Bris if they use the more sterile methods. They feel that since MbP was the exclusive method used over the millenia and so few deaths have ever been attributed to it the danger is statistically insignificant. Suction by the mouth of the Mohel is therefore a preferable and  perfectly safe method of drawing out the blood.

However as recently as this year there have been cases where infants became infected with the Herpes virus and have died. The Center for Disease Control (CDC) has determined that those infections had a high probability of coming from a Mohel who unknowingly had this virus. This was not the first time this happened. If one combines these tragedies with the Psak of those earlier Gedolim - one should conclude that using a more sterile form of Metziitza is the right way to go today. That is in fact what the Rabbinical Council of America (RCA) recommends – based on the advice of Rav Yoshe Ber Soloveitchik.

Chasidim remain firm in their conviction that MbP is a must! They have therefore threatened to do MbP even if it were to be banned. Because of sensitivity to the Chasidic point of view - New York health officials have decided not to ban the practice - but to require every parent to be informed about the risk of a Herpes transmission from a possibly infected Mohel.

This is being fought by the Agudah and others who feel that even a warning violates their religious rights. Perhaps even seeing this as a slippery slope toward banning circumcision altogether.

I could not disagree more. My own view on this issue – which I have stated in the past – is that we should self regulate and discourage MbP on our own as much as we can – much like the RCA does. This is a far better alternative than a government ban. Health concerns of New York health officials should not be ignored – much less fought.

To fight even a requirement of informed consent – arguing that MbP is integral to Bris Milah is to play a dangerous game. Once we obfuscate the difference between MbP and an actual Bris we give the anti circumcision crowd all the ammunition they need to say that circumcision itself is dangerous because of the possibility of Herpes being transmitted by the Mohel.  That’s hard to argue against when one insists a Bris would be invalid without it.

In a western style democracy where health concerns and individual rights are paramount, it should be no surprise that a government may override a religious practice they see as dangerous… or ban one that it considers a denial of human rights. It is therefore my considered opinion that all attempts to fight informed consent ought to be abandoned. Fighting it has produced the following response reported on VIN from Mayor Bloomberg:
“There are certain practices that doctors say are not safe and we will not permit those practices to the extent that we can stop them. You don’t have a right to put any child’s life in danger, and this clearly does.”
It sounds like he now wants to do even more than just require informed consent. Do we really want to go down that road?