אסיפת הרבנים במאנסי-מילה כהלכתה

Circumcision tragedy shines spotlight on rituals of ultra-Orthodox community

by Johanna Ginsberg
NJJN Staff Writer

Accusations that an infant died after contracting herpes from the man who performed his ritual circumcision have highlighted sharp differences in practices between some haredi, or ultra-Orthodox, Jewish communities and other Jewish factions.

According to a complaint filed in Manhattan Supreme Court by the state's health department and publicized on Feb. 2 in the New York Daily News, Rabbi Yitzhok Fischer, a hasidic mohel in Monsey, used his mouth to draw blood from the penis during the ritual circumcision of twins last October. One of the babies died from herpes. The other tested positive for the virus caused by herpes.

While a spokesman for a haredi group said the practice of using the mouth to draw blood is ''normative'' among the ultra-Orthodox, Conservative mohalim call the practice one of ''extremists'' and ''fanatics,'' and Modern Orthodox authorities also say they reject the procedure, and that it is ''very, very rare, even in other communities.''

Avi Shafran, director of public affairs for Agudath Israel of America, an advocacy group for haredi Judaism, called the practice, known as metzitza bapeh, ''normative'' among all haredi Jews, who include hasidic and non-hasidic movements. ''In the yeshivish haredi world, it is de rigueur to do metzitza bapeh,'' Shafran told the New Jersey Jewish News. ''I have seen it at all of the brisim [circumcisions] I have been to, including my own sons and one of my grandsons. There's never anything to talk about. It's just done.''

But Rabbi Elazar Teitz, a leader of the Jewish Educational Center in Elizabeth and its affiliated congregations, who said he feels equally at home among modern Orthodox and haredi camps, said that ''in a good part of the haredi community, metzitza bapeh is not used.''

Conservative and Modern Orthodox mohalim say the practice was dropped from Judaism long ago.

''The mohalim I know perform circumcision in strict compliance with medical standards that assure that the procedure is safe and sterile,'' said Rabbi Mark Cooper of the Conservative Oheb Shalom Congregation in South Orange, who is a mohel.

''It is not a custom used in modern Orthodox communities,'' said a spokesperson from the Orthodox Union. ''Mohalim in modern communities use latex gloves and a glass tube for suction, and they take every precaution so they do not come into contact with the baby's blood and the baby does not come into contact with their blood.''

And Teitz said, ''I have seen the practice being done, but if I were asked, I would tell a mohel not to do it. The tube is used virtually exclusively [in our community]. This is something I learned from my father, and he was certainly accepted [as an authority] in the haredi world.''

At the heart of the controversy is the third of three steps in a circumcision required under Halacha, or rabbinic law. After the removal of the foreskin and removal of the inner membrane underlying the foreskin, the mohel must draw out a drop of blood. The practice is known as metzitza, from the Hebrew ''to suck.'' Many Conservative mohalim perform metzitza with gauze, while Orthodox mohalim use a sterilized glass tube filled with gauze to prevent direct contact. Health officials in New York said the mohel performing the fatal circumcision performed the practice bapeh, or by mouth.

''The kind of mohel that did this is someone who lives in a different world, who ignores the evidence of medical reality,'' said Cooper. ''For example, he may not wear gloves, preferring to focus on the religious and theological aspects of the ceremony and overlook matters of hygiene.''

Of the four Conservative mohalim in the local area, only one uses a tube. The rest use gauze. ''The Halacha is to have a drop of blood,'' said Cantor Menachem Toren of the Pine Brook Jewish Center Chevra Agudas Achim Anshy in Montville. ''You only need to touch the penis and it starts to bleed. I use a piece of gauze. It's just the extremists of the extremists that do metzitza [orally], and only the ultra-Orthodox that use the tube.''

Cantor Richard Nadel of the Conservative Temple Beth Ahm in Springfield also uses gauze. He said the traditional reason for metzitza was to ensure the baby's health, a justification rendered moot by modern medical knowledge. ''In antiquity, the mohel would suck the blood from the penis to draw out infection and then spit the blood into a plate of dirt.''

Before the modern era, however, mohalim were unaware that the mouth is full of bacteria.

''This is the best way to communicate disease,'' said Nadel. ''They recognized from time to time a baby would get an infection. They did not know what caused it. They felt if they drew the blood, they would prevent infection.''

Several of those interviewed for this story also indicated that, in today's world of HIV and other diseases, there is a danger posed not only to the baby, but to the mohel as well. The OU spokesperson said that one prominent rabbi of an OU-affiliated community who is also an ''experienced'' mohel would only use the procedure on his own children. ''They are the only ones he can vouch for'' in terms of their health.

Calls to Rabbi Yeheskel Lebovic, a mohel from the local Lubavitch Hasidic community, were not returned.

A study that appeared in the August 2004 issue of Pediatrics concluded that the practice of metzitza bapeh places newborns at risk of contracting the herpes virus from the mohalim who perform it and should be discontinued. Rabbi Moshe Tendler of Yeshiva University was among those conducting the study.

But Shafran of Agudath Israel insists that there is not enough evidence to reject the practice. ''Show me the money — show me the sampling of cases,'' he said. ''If the transfer of virus was likely, we'd be seeing a large number of babies from the haredi communities showing up in hospitals. But they're not….If there is no evidence, then the guesswork about the danger is just that. This is a terrible tragedy. But to leap from an isolated instance to say there's a problem with a practice going on from time immemorial, when worldwide there are only a handful of cases where this is even a suspect, it's not the monster people say it is.''

Cooper nonetheless suggests that parents gather information before hiring a mohel. ''I urge any parent who will be having a bris to be fully aware of the medical standards a mohel follows, including wearing gloves and sterilizing instruments. What this mohel did was extraordinarily irresponsible, and should not be condoned by Jewish law.''

But, he added, Jewish families should continue to have their babies circumcised by mohalim.

''Mohalim can and should perform this ritual, following high standards for proper medical care and safety. I follow such standards, as do all the mohalim I know.''

Johanna Ginsberg can be reached at jginsberg@njjewishnews.com.


Copyright 2004 New Jersey Jewish News. All rights reserved. For subion information call 973.887.8500.

Rockland orders rabbi to undergo a herpes test



By STEVE LIEBERMAN
THE JOURNAL NEWS
(Original publication: February 10, 2005)


The Rockland health commissioner has ordered a Monsey rabbi to stop performing oral-suction circumcisions and to take a herpes test.

Rabbi Yitzchok Fischer's ritual method also has come under scrutiny from the New York state and Orange County health departments, officials said yesterday. The rabbi's techniques are not illegal, but pose a potential health hazard, officials said.

The New York City Health Department has said three infants circumcised by Fischer contracted herpes and that one died.

Fischer uses his mouth to suction blood from the wound after he removes the foreskin. The centuries-old ritual, called metzizah bi peh, is used predominantly by Hasidic Jews. Many rabbis say Jewish law does not mandate mouth suction; defenders contend the spread of disease is rare.

New York City health officials have prohibited Fischer from performing circumcisions and ordered him to take a blood test for herpes simplex virus type 1. Lawyers for the city and Fischer have declined to discuss whether the rabbi took the test and the results if he did.

Dr. Joan Facelle, the Rockland health commissioner, issued the same prohibition this week and ordered the rabbi to take a blood test Monday.

"We're trying to ascertain if he carries the virus, which would make him capable of transmitting it to the population," Facelle said.

Facelle said she hoped the rabbi would comply and take the blood test. If not, she said, the county would take him to court.

Hillel M. Kurzmann, who represents Fischer with his father, Mark J. Kurzmann, said yesterday that the county's order was similar to New York City's.

"We are eager to learn the true source of the infection," Hillel Kurzmann said. "He is cooperating with the city. He will cooperate as much as possible with the county."

Mark Kurzmann has said the rabbi performed the traditional circumcision at the parents' request. He uses sterilized instruments and antiseptic mouthwash, Kurzmann said.

Most mohelim who perform that part of the ritual use a medical tube to suction the blood.

Fischer's methods came under scrutiny when a Manhattan newborn died of herpes in November and his twin was diagnosed with the virus a little more than two weeks after the rabbi performed their circumcisions in October. A Staten Island newborn also circumcised by Fischer was diagnosed with herpes in November.

The state Health Department is working with New York City, Rockland and other counties, spokesman Robert Kenney said yesterday.

"We're interviewing the two families," Kenney said. "One of our priorities is to ensure the infants and the families get appropriate medical attention."

Herpes is not a reportable disease in New Jersey, a state Health Department spokeswoman there said yesterday. There is no inquiry there involving the rabbi.

County health departments in New York state don't license mohelim or oversee circumcision because it's a religious ritual.

Fischer, 66, is a respected mohel in the region and in Israel and was trained in circumcisions by the British Milah Society, a rabbinical group.

The Orange County health commissioner, Dr. Jean M. Hudson, said yesterday that her department would meet with the Jewish community, specifically the Satmar Hasidic community of Kiryas Joel in Monroe.

"We're preparing to alert the Hasidic community," she said, "that this circumcision practice is not hygienic and has potential risks."


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OF RITES AND RISKS

Rabbi Avi Shafran

Not long ago, a Jewish family in New York suffered a terrible tragedy, the death of one of their infant twin boys. The cause was determined to be an infection of herpes simplex type 1, the virus that causes cold sores - and for which, according to the National Institutes of Health, antibodies are present (indicating at least a one-time infection) in up to 90% of adults. The HSV-1 virus causes only discomfort in adults, but in a baby, with its undeveloped immune system, the infection can be more dangerous, even fatal on rare occasions. This case, sadly, was one of those rare occasions.



The tragedy, however, did not remain a private one. It became the focus of media reports around the world, because of the possibility, raised by New York City health authorities, that the infant may have contracted the virus from the ritual circumciser who performed his bris, or Jewish ritual circumcision. Since the circumciser, or mohel (plural: mohelim), applied oral suction to the wound, which is a part of the bris-procedure in many Jewish communities, the suspicion arose that the virus may have been present in the mohel, at least in a dormant stage, and may have thus passed on to the baby during the procedure.



The mohel in question, who is widely respected and experienced (he has reportedly performed over 12,000 circumcisions), is currently under order to refrain from the oral suctioning procedure and to undergo tests for the herpes virus. He is cooperating with health authorities.



Many Jewish ritual circumcisers, particularly in the haredi community, consider the time-honored - and, for most of Jewish history, universal - oral method to be an indispensable religious requirement. Others, though, address the Jewish religious law of applying suction to the wound (itself, interestingly, based on a health concern, the drawing of infectious agents away from the wound) by employing an intervening glass tube. Some use gauze compresses and dispense with the suction altogether.



And so calls have been issued to insist that all mohelim hew to those approaches.



Two doctors, for example, in a study in The Pediatrics Infectious Disease Journal urged that "public health officials and leaders of the Jewish community should act to modify the part of the circumcision ritual that involves direct oral contact with the blood... of neonates."



Rabbi Dr. Moshe Tendler, an Orthodox rabbi and biologist, is even more adamant. "I'm particularly disturbed," he told a reporter, "that once this information becomes available, the mohelim don't do what they're told," namely dispense with the oral suctioning procedure.



In a medical paper in Pediatrics, a group of medical doctors and researchers, including Rabbi Dr. Tendler, assert, without evidence or citation, that "the great majority of ritual circumcisions" are performed without oral suction. They further declare that Orthodox religious authorities who insist on the traditional method (a list that includes some of the most distinguished rabbinic leaders of recent decades) have done so only because they "have felt threatened by criticism of the old religious customs."



Scientists should certainly offer the results of their research. They are perfectly welcome, too, to take positions on medically related matters. But when they begin to wax derisive of rabbinic authorities, impugning their motivations and challenging their religious decisions, expertise threatens to morph into arrogance.



To be sure, were infections like the one that took the life of the New York infant to be proven likely, or even common, results of oral suctioning, medical authorities would have the right to do what was necessary to protect the public - and religious authorities would be no less concerned. Indeed, even in Talmudic times, when a risk was perceived by the deaths of a baby's brothers after their circumcisions (implying hemophilia), the newborn was not to be circumcised at all unless it became clear that he was healthy.



But the evidence of material risk as a result of traditional circumcision is far from persuasive. In fact, a number of pediatricians and pediatric urologists with scores of years of experience between them serving communities in which countless baby boys were circumcised in the traditional manner - have reported that they have never seen even one case of circumcision-related herpes infection in newborns.



So if there is a risk in the age-old method, it does not appear at present to be a great one. And while our first reaction might well be to righteously insist that "any risk is too great," we might pause to consider: Is there no risk at all to circumcision itself? Or to any of myriad activities that society happily sanctions without any pang of conscience - not only things like bungee-jumping and motorcycle riding (or SUV driving), but prosaic activities, too, like high school football, cosmetic surgery and crossing city streets?



And so the questions must be asked: Should religious practices be more subject than entertainment or vanity to governmental or societal coercion? Does that really square with our nation's commitment to religious freedom?



They shouldn't, of course, and it doesn't.


© AM ECHAD RESOURCES



[Rabbi Shafran is director of public affairs for Agudath Israel of America]

State gets rabbi's herpes test
By JAMES WALSH
THE JOURNAL NEWS
(Original publication: February 16, 2005)

The state Health Department has received the herpes test results of a Monsey rabbi suspected of passing on the virus to infants during a circumcision ritual.

State health officials subpoenaed the test results Friday, "but at this point in time, they're for internal use only," said Robert Kenney, a state Health Department spokesman.

Rockland County, Orange County and New York City health officials have prohibited Rabbi Yitzchok Fischer, 66, from performing a portion of the ritual that entails sucking blood from the wound.

Three infants circumcised by Fischer, including one who died, had contracted herpes, according to the New York City Health Department.

Fischer's attorney, Mark Jay Kurzman of Pearl River, was upset yesterday that word of the subpoena had reached the media.

"I have no comment on what ought to be a confidential, discreet governmental investigation," Kurzman said.

He also would not comment on a court session scheduled for today regarding the prohibition against Fischer's performing the full circumcision ritual.

Gabriel Taussig, chief of the administrative law division of the New York City Law Department, confirmed yesterday that the city had complied with the subpoena but declined to discuss the test results.

Taussig said today's court session in Manhattan was to be a conference among all the parties. The city is seeking a preliminary injunction that would prohibit Fischer from performing the full ritual until the case is resolved.

The ritual, which involves the sucking of blood, is predominantly used by Hasidic Jews.

The circumcisions by Fischer drew the attention of public health officials after a Manhattan newborn died of herpes in November, and his twin was diagnosed with the virus, about two weeks after their circumcisions. A third infant, from Staten Island, also was diagnosed soon after his bris.

County health departments do not regulate the religious ritual.



Reach James Walsh at jawalsh@thejournalnews.com or 845-578-2445.Reach James Walsh at jawalsh@thejournalnews.com or 845-578-2445.

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Rabbi Targeted After Call for Bris Change
By Steven I. Weiss
March 18, 2005

A prominent Orthodox rabbi and medical ethicist says he is the target of a harassment campaign following his calls to abandon a circumcision-related ritual that may have resulted in an infant's death.

Rabbi Moshe Tendler, a bioethics expert and Talmud instructor at Yeshiva University, was criticized by ultra-Orthodox leaders and newspapers after he was quoted in the press as saying that the practice of metzitzah b'peh, or oral suction of the circumcision wound, should be conducted with a sterile tube. In many ultra-Orthodox circles, especially within certain Hasidic sects, the ritual is performed by having the mohel suck blood from the wound with his lips directly on the baby's penis.

Tendler spoke out against the practice following reports last month that a Jewish infant had died of herpes and that several other babies had contracted the virus after being circumcised by mohel Rabbi Yitzchok Fischer, who practiced direct oral suction. Tendler co-authored an article in the August 2004 issue of the medical journal Pediatrics, which asserted that the risks of herpes infection should outweigh any ritual benefits of using direct oral suction.

In recent weeks, ultra-Orthodox newspapers have condemned Tendler and accused him of reporting Fisher to health officials — a claim that Tendler vehemently denies.

The baby's death is reportedly being investigated by the New York City Health Department.

According to Tendler, prank callers have inundated his home phone and vandals have struck at the synagogue in Monsey, N.Y., where he serves as religious leader.

Tendler cited the alleged harassment when he explained why he skipped the March 1 ceremony at New York City's Madison Square Garden that celebrated the completion of the cycle of daily Talmud study. "Because of the harassment, I realized that it could very well be that there would be a few crazies there," Tendler said. He avoided the event, which was organized by the ultra-Orthodox group Agudath Israel of America, "not out of physical fear, but because I felt it would detract from the really majestic event, and that the newspapers like yours would pick on that element."

Tendler painted the controversy as a wider theological conflict, extending beyond the issue of metzitzah b'peh. The real target, Tendler said, is what he represents as a rabbi and scientist working at Y.U., the flagship institution of Modern Orthodoxy.

To prove his point, Tendler said that vandals covered the floor of his synagogue with posters

containing various anti-Tendler messages, including the term dokter-rabiner. Literally meaning "doctor-rabbi," the term was employed by right-wing Orthodox activists a century ago in Germany to attack rabbis with ordination from liberal Orthodox seminaries and with academic degrees from secular universities.

Tendler noted that in addition to his Orthodox rabbinic credentials, he has a "reputation as a trained scientist."

"That's a no-no in [the ultra-Orthodox] community," Tendler said.

In another sign of the controversy evolving into an intra-Orthodox battle, the main union of Modern Orthodox rabbis, the Rabbinical Council of America, issued a statement two weeks ago urging that the direct suction practice be abandoned.

Officials at Agudath Israel, which is headed by a council of Hasidic and non-Hasidic ultra-Orthodox rabbis, have defended direct oral suction. The organization's longtime, late religious leader, Rabbi Moshe Feinstein, was Tendler's father-in-law.

Tendler said that Feinstein, who was the most respected arbiter of Jewish law in non-Hasidic Orthodox circles, had endured harassment after issuing a then-controversial statement approving artificial insemination. According to Tendler, Feinstein's critics "would knock on his door, [at] 2 [or] 3 o'clock in the morning."

Tendler denied that he was asked by Agudath Israel officials not to attend the Madison Square Garden event, saying that he actually had been invited. After he decided not to attend, Tendler said, the organization sent him a letter "thanking me for my sensitivity."

"Jewish law does recognize that there is a danger, and therefore compels them to use the tube," Tendler told the Forward. He noted that herpes is not a danger in adults, 90% of whom carry antibodies that indicate they've been exposed to the virus, but that it is dangerous to infants, who have undeveloped immune systems.

His public comments on the issue have drawn harsh condemnations from at least two major New York-based ultra-Orthodox media outlets, Yated Ne'eman, a non-Hasidic newspaper, and Der Yid, the Satmar Hasidic sect's newspaper. Both publications have attacked Tendler and vowed that members of their communities will continue to practice the controversial ritual, even if doing so lands them in prison.

Yated Ne'eman published a three-page editorial condemning Tendler, claiming that he had reported Fischer to health authorities. The editorial accused Tendler of mesirah, or handing over a Jew to an antisemitic state government that could do harm to the Jew in question. The newspaper subsequently ran a letter from Tendler in which he strongly denied the claims and stated that he had "the highest regard for Rav Fischer."

Fischer could not be reached for comment.

Tendler told the Forward that he was receiving prank phone calls at the rate of one "every three minutes."

The callers will "giggle, laugh shout; 'Tendler is an antisemite' is the usual line, or 'Tendler wants to abolish circumcision,'" he said.

A renowned expert on medical ethics and Judaism, Tendler said that he normally receives 10 to 20 calls a day dealing with serious health-related questions. But as a result of the prank calls, he's had to disconnect his phone.

"People know my number; rabbis give it to them," Tendler said, referring to those in urgent need of rabbinic guidance on fertility issues and life-and-death medical matters. "That's been cut off."

In addition to the calls, Tendler said that his synagogue has been struck by vandals, who "broke off the American and Israeli flags" from the facade of the building.

Tendler said he has notified the police about the vandalism and harassment. The Ramapo police said they would not answer questions from the media, except in response to a Freedom of Information Act request.

Rabbi Hillel Weinberger, chief rabbi of the kashrus division of the Satmer-run Monsey-based Central Rabbinical Council, told the Forward that Tendler "went against [Fischer], and went to the authorities against him."

Weinberger said that Tendler "didn't handle [the situation] like a rabbi is supposed to do." The Satmar leader also said that he has seen test results, which indicate Fischer is free of herpes.

The revelation of Tendler's Pediatrics article has people convinced that Tendler has conducted a long-running effort against direct oral suction, Weinberger said.

In response to Tendler's allegations of harassment and vandalism, Weinberger said: "I don't know if it's true... we never encourage vandalism."

"This is a fight that he will not win, because the community will not give up," Weinberger said. "This is a tradition that we're practicing from thousands of years... and we're going to stick to this."


Steven I. Weiss is editor & publisher of CampusJ.com.

http://www.forward.com/main/article.php?ref=weiss200503161045

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