Israel Pediatric Association Calls to End Blood-sucking Ritual During Circumcision

The Israel Pediatric Association has declared war on metzitza b'peh, a portion of the ritual that doctors deem medically harmful but ultra-Orthodox rabbis deem obligatory

Brit milah, the ancient Jewish ritual of circumcision, has been making headlines worldwide recently: A German court declared it illegal, prompting the German government to promise legislation permitting it again; some Swiss hospitals announced they would no longer perform it; and legislation to restrict it was proposed in Denmark. Now, even Israel is entering the fray: The Israel Pediatric Association has declared war on metzitza b'peh, a portion of the ritual that doctors deem medically harmful but ultra-Orthodox rabbis deem obligatory.

Metzitza, the final stage of the circumcision, involves extracting blood from the incision. Today, it is usually done with a sterile tube. But some Haredi (ultra-Orthodox ) communities still use metzitza b'peh, in which the mohel, or ritual circumciser, uses his mouth to suck out the blood.

The practice was originally mandated by the rabbinic authorities because medical science at that time thought it helped prevent infection. But doctors today believe metzitza b'peh can actually cause infection, as diseases can be transmitted in this way from the mohel to the baby.

The pediatric association is therefore urging the Health Ministry to instruct hospital maternity wards and well-baby clinics to inform parents that metzitza b'peh isn't necessary.

The Chief Rabbinate responded that even now, mohels are careful to inform parents of the risks and let them choose. And most choose the tube rather than metzitza b'peh, said Rabbi Moshe Marciano, director of the rabbinate's brit department.

"It's true that Haredi mohels refuse to abolish [metzitza b'peh], but they don't refuse to ask," he stressed.

The pediatric association is actually taking its cue from the city of New York, whose municipal health department recently set up a special committee to decide whether to pass municipal bylaws outlawing metzitza b'peh. The committee was established following a criminal investigation in Brooklyn into the death of a baby in September 2011. The baby died of herpes, and the suspicion arose that he contracted the disease from the mohel via metzitza b'peh, since the herpes virus lives in the mouth.

The New York health department later reported that from 2000 to 2011, 11 circumcised babies had contracted herpes, of whom two died. It therefore strongly advised mohels not to perform metzitza b'peh.

Here in Israel, there are three to four cases every year of babies who may have contracted herpes from a mohel, out of 60,000 to 70,000 brits performed annually.

The argument over whether metzitza b'peh is actually obligatory under Jewish law, or whether a sterile instrument can be used instead, has been raging among rabbis for more than 150 years. Many leading rabbinic authorities - including the 19th-century European luminary Rabbi Moses Sofer, better known as the Chatam Sofer, and former Chief Rabbi Abraham Isaac Kook in the 20th century - permit use of a tube. Some rabbis - such as Yaakov Ariel, the chief rabbi of Ramat Gan and president of Tzohar, an organization of moderate religious Zionist rabbis - even hold that use of a tube is not only permissible, but mandatory. But many Haredi rabbis continue to insist that only metzitza b'peh is ritually valid.

Two months ago, a joint task force set up by the Health Ministry and the Chief Rabbinate issued a position paper upholding metzitza b'peh. In it, Rabbi Prof. Avraham Steinberg of Jerusalem's Shaare Zedek Medical Center and Dr. Moshe Westreich wrote that "in the view of the poskim [rabbinic authorities] who think metzitza b'peh is an integral part of performing the commandment of circumcision, there's no place for abolishing this act in light of modern-day knowledge."

The chances of a baby contracting herpes are low, they argued, and in any case, there is no "clear scientific proof" that any baby has ever gotten herpes via metzitza b'peh.

Nevertheless, they added, mohels should take precautions to prevent infection - for instance, by rinsing their mouths with disinfectant before performing the metzitza.

The Chief Rabbinate's position is that metzitza b'peh is permissible as long as mohels warn parents of the possible risks beforehand.

"There's no compulsion," said Rabbi Chaim Moshe Weisberg, the rabbinate's national overseer for mohels. "Only if a parent requests metzitza b'peh, as people have done for 3,000 years, do we do it at his request. I'm opposed to compulsion. Why do you want to prevent a Jew from Mea She'arim from upholding the traditions of his forefathers, if he knows what the risk is? Why not respect him?

"I'm afraid of something else - that those who talk about the welfare of the child aren't really aiming at that," he continued. "That after they're finished with metzitza, perhaps they'll come out against the whole idea of brit milah because it's barbaric. Or perhaps they'll require it to be done only in an operating room?"

"If Israel prevents metzitza b'peh," he added, "why should we be surprised if Europe or New York forbid it?"

Limor Edry