Metzitzah B'peh Circumcision Ritual Inconsistent With Jewish Principles

In recent weeks, a controversial Jewish circumcision practice gained the national spotlight after the Centers for Disease Control and Prevention reported that between 2000 and 2011, at least 11 New York infants contracted genital herpes following ritual circumcision. Two of the babies died. This is distressing news to all who are concerned about the health and welfare of children.

The practice, called metzitzah b'peh, or oral suction, is used by a small number of Orthodox mohels (Jewish ritual circumcisers). Many assume this practice is a hallmark of strict religious observance -- for better or worse, the ultimate in adherence to Jewish tradition. What's rarely considered is the way in which metzitzah b'peh conflicts with basic Jewish principles.

Metzitzah b'peh is uncommon even among those Jews who opt for religious circumcision of their sons. Following the circumcision, the mohel takes a sip of wine and quickly removes the blood from the penis through the wine, using his mouth. He then spits the mixture out. Instituted in Talmudic times, long before the germ theory of disease was understood, metzitzah b'peh was once thought to disinfect the wound.

Now that we understand that metzitzah b'peh violates basic sanitary precautions, we must question it from the point of view of Jewish principles. It is a basic tenet of Judaism that human life is infinitely valuable, to be preserved at all costs, even if that means failing to fulfill some aspects of religious observance. Additionally, hazardous medical procedures are strictly forbidden in Judaism unless necessary for preservation of life.

Metzitzah b'peh is clearly hazardous and has no life-saving purpose. And herpes is only one of many diseases that we know can be transmitted orally.

Jewish law is constantly evolving. Our practices change as we learn. If we discover that a previously accepted Jewish tradition is dangerous -- or if we simply learn that there's a more compassionate way to act, one that is more consistent with Jewish principles than the previous interpretation -- it's incumbent on us to modify or discontinue the tradition.

There is ample precedent in Jewish law for change based on new insights. In Talmudic times, for example, the rabbis prohibited deaf Jews from participating fully in Jewish life. Today, deaf people are considered completely equal even among the most observant Jews. That is, Talmudic laws about the deaf are no longer honored even by the Orthodox. Our understanding increased, and our traditions changed.

The practice of Jewish circumcision has evolved over time. Most observant Jews have adopted a modified version of metzitzah, in which blood is removed from the circumcision site with a sterile pipette rather than through oral contact. Another example is the fact that over the last 25 years, many mohels who are also physicians have started administering local anesthesia. This is in response to current data establishing that infants feel pain acutely, as measured by heart rate, respiratory rate and cortisol levels. In both examples, circumcision practice has been modified to accommodate what we've learned.

The last few decades have brought revelations about the drawbacks of circumcision in general. Researchers are beginning to understand the physiological purpose and erogenous nature of foreskin tissue; many argue that the foreskin is a valuable and functioning part of normal male anatomy. Additionally, even without metzitzah b'peh, circumcision carries the risk of complications and death from sepsis, hemorrhage and other causes. All this has led a small number of Jews to question not only how circumcisions are performed, but the very act itself.

It may be tempting for some to defend metzitzah b'peh. Recently, an editorial appeared in EmaxHealth.com suggesting that anti-viral medicine should be considered for the infant as a prophylactic measure. This proposed solution, involving a risky and unnecessary intervention on a newborn, is no substitute for an honest reappraisal of metzitzah b'peh.

To suggest that we should never make changes based on new information is to imply that Judaism cannot withstand inquiry, that it cannot grow. Judaism has evolved and thrived over thousands of years. May it continue to do so.