Metzitzah and the Halachic Process

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by Rabbi Yerachmiel Seplowitz

The Metzitzah controversy is nothing new.

In the 1800’s, in Germany, the elements of Reform sought to ban circumcision entirely, attacking the “barbaric” practice of Metzitzah b’peh (MBP), where a Mohel would suck the blood away from the circumcision site.

A little earlier history is in order. The Talmud requires that after a Bris is performed, the blood must be suctioned away from the wound. The reason given is for the safety of the baby. Presumably, the purpose of Metzitzah is to cleanse the wound area of any germs and prevent infection.

It is easy to understand the claim that using the Mohel’s mouth to clean the wound is counterproductive. Some children were becoming ill in the 1800’s and Metzitzah was being blamed. Due to the controversy over Metzitzah b’Peh, many of the Sages of that time permitted the use of a tube to suction the blood.

This innovation was controversial, but many of the greatest authorities of that time and more recent times accepted it.

The Chofetz Chaim quotes the opinion of the Yad Eliezer, who permitted blood to be pressed out of the wound with an absorbent cloth, such as a gauze pad. (Biur Halacha 331:1) This opinion has also been attributed to the Chasam Sofer. The Chazon Ish opposed that practice, preferring the use of a tube, which he considered to be the Halachic equivalent of MBP. (Told to me by Rav Eliyahu Glucksman, ZTZ”L, Dayan of K’hal Adas Yeshurun (Breuer’s), a student of the Chazon Ish, whose son was circumcised on the Chazon Ish’s lap, with the Mohel using a tube.) Rav Moshe Feinstein considered the tube acceptable. My colleagues and I have performed Brisses, using a Metzitzah tube, in the presence of many contemporary Halachic authorities, with their acceptance, and sometimes encouragement. The Rabbinical Council of America has encouraged its members to follow the rulings of those authorities who permit the use of the tube.

Over the years, my use of a tube has occasionally put me at odds with parents who had requested my services. When they have insisted upon actual MBP with direct oral suction, I have suggested that the father do it. Sometimes that has happened, and sometimes they have opted to use a different Mohel.

However, such cases represent the exception, rather than the rule. Most of my Bris clientele are Modern Orthodox or non-orthodox. Both of those groups are very happy to utilize the services of a Mohel who uses sterile instruments and gloves, and who doesn’t do MBP. As well, most “Yeshiva” families who ask me to be their child’s Mohel accept my policy of doing Metzitzah with a tube.

My use of a sterile tube is not a Halachic compromise. It is the tradition that I have received from my teachers, and it is acceptable to the Poskim — Halachic authorities to whom I turn for guidance. So for me, it is a non-issue. The use of the tube is 100% acceptable.

So why have I not joined the call for the abolition of Metzitzah b’peh? Why do I not congratulate the New York City Health Department for getting involved in Bris Milah? Why have I not contacted the non-Jewish and non-orthodox press to express my opposition to MBP? Why do I applaud the RCA and Agudath Israel in their opposition to the actions of the NYC Health department?

The reason is simple. Major Poskim support Metzitzah b’peh, and that reality is not going away.

Consider the following:

  • Much has been written about MBP and herpes. Some medical experts, such as Dr. Daniel Berman, writing in the journal Dialogue, have disputed the findings, and claim that the studies have been inconclusive. (Full disclosure: I am not a doctor. I make no claim as to the accuracy of either side of this dispute.)
  • In 1989 a proclamation appeared in various Orthodox publications in support of MBP. The proclamation was signed by many of the most respected authorities in the Yeshiva and Chassidic worlds. (Of course, the issue back then was HIV, not herpes. One can only speculate as to whether those authorities, many of whom are no longer living, would sign it today. I suspect that most of them would.)
  • A few years ago, I attended a speech where a Mohel and Halachic authority who is well respected by the Yeshiva and Modern Orthodox communities stated that he had informed the NYC Health Department that if they ban MBP, he will give them the address and time when he is doing a Bris, “so you can come and arrest me.”
  • The Chassidic world, by and large, rejected the original introduction of the Metzitzah tube over a century ago. They still reject it today. Whether you or I agree with that opinion is irrelevant; that is their position.

A word about “changes” in Jewish Law. Your average rabbi can’t just wake up one morning and decide to modify religious practice. Questions of this nature must be ruled upon by a Poseik – an expert in all facets of Talmud and Halachah. He must be a very learned person – recognized by his teachers and his contemporaries as qualified to rule on such complex matters. He must be able to insure that his ruling will be consistent with Halachic standards and values. He must carefully weigh every nuance against the backdrop of Jewish Tradition, going all the way back to Sinai. (“Don’t try this at home, folks.”)

It is well and good that many of us follow the rulings of those authorities who permit the use of the tube. But let us not forget that there are other Poskim who insist that only direct contact will suffice. It is easy for me to say that I have a policy not to do MBP. But do I have a right to tell someone who has a tradition from his teachers to only do MBP that he must follow the rulings of MY Poskim?

There is a Halachic process. Poskim take into account the original sources of Laws and Customs. They also take into account the facts on the ground. These factors led many 19th Century Poskim to accept an innovation; similar factors have led many contemporary Poskim to the same conclusion.

But other Poskim have come to different conclusions. And for people who are not qualified to act as Poskim to call upon these authorities to change their rulings is preposterous. And the unfortunate decision to publicly issue these calls in the secular press is ill-advised and not at all helpful.

By all means, let the debate continue. Rabbis who oppose MBP are free to insist that it not be done in their synagogues. Doctors should continue to make their case as to the health issues, and bring their concerns to the Poskim. And many Mohalim like myself will continue to use Metzitzah tubes.

But using newspapers and health departments to try to influence Halachic rulings is not the way of Orthodox Judaism.

Rabbi Yerachmiel Seplowitz is a Mohel (BrisRabbi.com) and a member of the Executive Committee of the Rabbinical Council of America. His observations on the Weekly Torah Portion can be read at TorahTalk.org

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Yisrael Asper
2 years 10 months ago

Corrected spelling typo.

“Natan Slifkin

This post presents a beautiful description of what a posek SHOULD do. But I’m not so sure that it accurately describes what poskim actually do.”

The author of this piece wrote:He must be a very learned person – recognized by his teachers and his contemporaries as qualified to rule on such complex matters. He must be able to insure that his ruling will be consistent with Halachic standards and values. He must carefully weigh every nuance against the backdrop of Jewish Tradition, going all the way back to Sinai. (“Don’t try this at home, folks.”)”

You may question the reasoning of a posek but the fact is we rely on them and not on our perceptions of their rulings. A posek certainly feels he is ruling correctly in accordance “with Halachic standards and values” and weigh “carefully weigh every nuance against the backdrop of Jewish Tradition, going all the way back to Sinai.” If we in questioning what their psychology is in deciding a ruling, make that our guide to decide if we are to listen to them we shouldn’t hold back. Let’s question Hillel and Shammai as well. Rabbis of lesser stature than a posek who don’t understand distinctions between them and poskim so well, certainly have a hard time fighting their biases in evaluating Halacha. We have better luck with poskim who devote their whole lives to Torah.

dr. bill
2 years 10 months ago

Moshe Gluck, I would leave this to poskim, but imho your examples differ in one critical dimension.

MBP is not a sakanah unless the mohel is infected. we know this has caused death and the halakha does not allow you to endanger another life.

as far as your own life, i heard from the Rav ztl in discussing a tosefot in BM – on makom shemishtamair ktzat a discussion of the right of an individual to make choices for himself but not others. i suspect that is relevant. how far that goes in terms of sakanah, was unclear.

my guess is that it does not include smoking. as is reported about a great Gadol who died recently and smoked – he said he feared being being judged as a meabaid atzmoh le-daat.

Yerachmiel Seplowitz
2 years 10 months ago

A brief response to some of the comments on my above article.

A number of posters commented disagreemant with Dr. Berman. As I stated, I am not a doctor, and I am not qualified to take sides in this dispute. My point was that people are going to continue to do MBP because not everyone agrees that it is dangerous. My own opinion on the medical issue is irrelevant.

Nowhere in the article did I state that the NYC Board of Health is trying to ban MBP.

One poster quoted from my article: “This opinion has also been attributed to the Chasam Sofer” and asked, “Doesn’t the author know that the Chasam Sofer’s teshuvah was published?”

Yes, I am aware that it was published. The reason I wrote it that way is because there are those who claim — incorrectly, I believe — that the Chasam Sofer never wrote it, and that it is a forgery. To pre-empt someone else writing with that challenge, I decided to use that wording.

Most importantly, there is no reason why anyone who feels — based upon the above, or any other arguments — that there are good reasons to oppose MBP shouldn’t convey their concerns to Poskim. My main point is that this is not a discussion that the Jewish community should be conducting in the secular press.

Observer
2 years 10 months ago

For all the people who are claiming that NY is not trying to ban MBP, this is not true. They have actually made it very clear that this is what they would rally like to do. However, they CANNOT do so at this point, so they are trying to shut down this practice in any way that they know how. In fact, the original form was designed to scare parents into not allowing the Mohel to do MBP. It was changed because they were faced with a lawsuit that they had no hope of winning. The new form uses somewhat less inflammatory and absolutist language, thus giving the government a chance to win the inevitable lawsuit, they hope.

I’d like to make another point. There is, at this point, absolutely no scientific evidence that MBP poses any real health threat. One of the prominent medical experts who has written against the practice admitted as much – there have been no studies showing risk but “it’s just logical” that this practice poses a risk.

What of the most recent CDC study? Well, to start with, correlation does not mean causation even when there is a strong correlation. Here the numbers are simply too small for any statistical correlations anyway so, what do we have? We have 5 cases of Herpes in 20,000 brisim that were “presumably” done with MBP. In once case the Mohel tested negative for antibodies, meaning that he could not have been the source of the infection. In one case, the mother actually had herpes (“cold sores”) around her mouth, and she was unaware that her habit of biting her thumbnail could be dangerous to her baby. (For some reason no one bothered to warn her to wash her hands with soap before diapering the child.) And in once case there was a 2 year old older sibling with cold sores who (as toddlers tend to do) tried to stuff her pacifier in the baby’s mouth on more than one occasion. Which leaves 2 cases of herpes where it is unknown what the vector was (the Mohalim were not tested.) 2 cases in 20,000 Brisim.

Going to the hospital for any reason is more risky than that…

Tal Benschar
2 years 10 months ago

there are a number practices that great poskim considered darckhiei he’emori that other poskim allowed and others refined. How MBP is “…precisely the situation you have with kapparos..” discounts the safek sakaneh element.

Dr. Bill, you misunderstood my post. The point of which is that there are other areas where you have a wide spectrum of views — from a practice is completely forbidden, to optional, to mandatory. Yes, I know that safeik sakanah is not the same thing as darchei ha emori. The latter is still an issur Torah and not something to be trifled with.

and BTW poskim have at best limited and more than likely no standing in deciding what is a safek sakaneh. as far as i know, poskim ask an expert and in a case of sahkaneh a fortiori follow the majority of experts

I could not disagree more. Whether there is some level of danger in something might be a question for experts. But whether that reaches a sufficient level to impact the halakha, and how it impacts, IS a matter for poskim. We don’t just say that because there is a slight risk in something then it is forbidden. If that were the case, we would ban milah itself. One important issue in MBP is whether the risk (which appears to be very slight, but not non-existent) is significant enough to cause a deviation from prior practice. Without giving a psak, such principles as shomer pesaim Hashem — for which we rely on for a large number of low-risk activities — might be applicable. Don’t know why you think poskim have no say in that analysis.

Of course, the other issue with MBP is what is the religious significance, if any, of MBP versus other methods, such as a tube or gauze. That clearly is an issue for poskim.