דעת תורה בענין שערורית מצות מילה כהלכתה

Following Baby's Death, Orthodox Group Urges Followers to Drop Disputed Ritual
By Eric J. Greenberg
March 4, 2005

In response to the death of a New York baby boy from herpes, the top union of Modern Orthodox rabbis is urging Jews to abandon the ancient ritual practice of suctioning the blood by mouth directly from the baby's penis during circumcision.

The Rabbinical Council of America, representing more than 1,000 rabbis, issued a policy statement this week arguing that instead of direct oral suction the tradition known as metzitzah be-peh could be fulfilled with the use of a tube. The statement came following the death of a New York baby from herpes, which officials suspect might have been transmitted from the mouth of a Hasidic mohel during the circumcision process.

The RCA stated that a traditional Jewish circumcision, or brith milah, involves extracting blood from the wound or the surrounding tissue, using the mouth as the source of suction. But RCA declared that this requirement could be fulfilled through the use of a sterilized tube, eliminating the transmission of infectious diseases to the newly circumcised infant.

"It is the position of the RCA that the requirement of metzitzah is fulfilled completely and unambiguously by the use of oral suctioning through a tube, as practiced by many mohelim in our communities," the organization declared, adding, "The RCA urges its member rabbis, their congregants, synagogues and institutions, as well as the larger Jewish community, to encourage, and where possible necessitate, that metzitzah be-peh be fulfilled via a tube."

Experts said most Modern Orthodox ritual circumcisers already use latex gloves and a sterilized glass tube for suction, taking precautions not to come into contact with the baby's blood. But the practice of direct oral suction continues to be standard in many ultra-Orthodox communities.

RCA's statement is expected to upset Hasidic sects and other ultra-Orthodox communities. Leaders of these Orthodox camps have been vigorously defending the practice of direct oral suction since it came under attack last month, after New York City health officials announced that Rabbi Yitzchok Fischer, a prominent Hasidic mohel from Monsey, N.Y., was suspected of transmitting the herpes virus to three infants he had circumcised. One of the infants died this past October.

Fischer is suspected of passing the oral herpes virus, which generally produces cold sores but can be passed to another person's genital area.

Government or religious attempts to ban the direct oral practice were denounced in a pointed February 18 editorial, by Rabbi Pinchos Lipschutz, editor and publisher of Yated Neeman, an ultra-Orthodox newspaper.

"Will we become like our Russian brethren in the past century who were forced under the Communists to conduct sacred bris [circumcision] in underground bunkers with sentries standing guard," Lipschutz wrote. "Are we about to revisit those days in our own country?"

Dozens of ultra-Orthodox rabbis signed a full-page Hebrew advertisement that ran in the February 25 issue of Yated Neeman, defending the practice.

A prominent Orthodox medical ethicist, Rabbi Moshe Tendler of Yeshiva University, already has come under fire from ultra-Orthodox critics, for an article in the August 2004 issue of the medical journal Pediatrics that he co-wrote, arguing against the practice. Tendler has been outspoken in recent weeks, as well.

The RCA's executive vice president, Basil Herring, said that while Tendler was not directly involved in formulating the policy statement, he was consulted and gave his approval.

The Commentator - Features
Issue: 3/8/05

'Metzitzah Be Peh': The Dangers of a Custom Intended to Heal
By Ryan Nadel

The death of a child from herpes, allegedly contracted from a mohel performing direct oral suction during circumcision, has left a permanent scar on the Jewish community. In recent weeks, the fallout from the tragedy, and the rift it has generated within the Orthodox community, has only worsened. As New York City health officials investigate the case, debate within the Jewish community surrounding the issue of metzitzah be peh, direct oral suction, has erupted. Rabbi Dr. Moshe Tendler, of Yeshiva University, is at the forefront of the controversy and has been vilified by the Chasidic community for his position on the issue.

The Mishnah in Masechet Shabbat (133a) records the practice of metzitzah as a secondary aspect of the circumcision process, and states that metzitzah must be performed at the end of the circumcision. The Gemara explains (ibid 133b) that refraining from performing metzitzah endangers the baby. The commentators elaborate that metzitzah is performed in order to hasten the healing of the wound. The implication of the Gemara is that metzitzah functions as a medical procedure and not a religious one.

In August of 2004, a team of twelve researchers published a study in the medical journal Pediatrics. The study documented a correlation between circumcised Jewish babies infected with herpes and the custom of metzitzah be peh. The study claims that mohelim infected with herpes represent a potential source of the disease to the infants through physical contact between the wound and the lips of the mohel.

The nature of the herpes contracted by these babies was not the more common genital herpes virus type 2, but herpes simplex virus type 1. When left untreated, 95 percent of survivors suffer from severe neurological effects. 30 percent of victims develop neurological impairments, which often manifest before two or three years of age. However, death from herpes type 1 is uncommon.

Based on their findings, the researchers concluded that the custom of metzitzah be peh should be modified to adhere to modern standards of hygiene, thus altering the custom from its ancient form. To support their recommendation from a religious perspective, the study cites the decision of rabbinic authorities in the late 18th century who ruled that metzitzah can be performed using instrumental suction. Using an instrument, in lieu of direct physical contact between the mohel and the baby, would eliminate any chance of infection of the baby by the mohel and still fulfill the halachic requirements of metzitzah.

In the last few months, the concern regarding direct oral suction climaxed with the infection of twin boys in October of 2004. Both boys were circumcised on October 16, and both of them contracted the disease. Soon after being infected, one of the twins died from the disease. On November 3, 2004, another case of herpes was discovered. The same mohel who performed the circumcision on the twin boys in October performed the circumcision in this case. In reaction to these cases the New York City Health Department issued an order against the mohel, Rabbi Yitzhok Fischer of Rockland County, demanding that he cease oral suction, use sterile gloves, and present himself for a blood sample. On December 22, the health department filed against Rabbi Fischer in court because he failed to comply with the order.

In a phone interview with The Commentator, Gabriel Taussig, Chief of Administrative Law Division at the New York City Department of Law, stressed that the investigation into Rabbi Fischer is ongoing and no conclusions have been made. However, the city's lawyers have presented a lawsuit on behalf of the Department of Health, demanding Fischer's cooperation with the investigation and obedience with the order issued to modify his practices. The degree of Fisher's cooperation is not clear. Taussig would not speculate regarding any steps the city might take in the future to regulate the matter.

The story of the incident was picked up by a local newspaper and quickly spread. On February 2, 2005 the story was carried by most major news sources. The New York Daily News contacted Rabbi Dr. Moshe Tendler, professor of Biology and Jewish Studies at Yeshiva, to comment on the situation. Rabbi Tendler, a contributor to the study published in Pediatrics, remarked that direct oral suction is not required and posses a risk to the baby.

Rabbi Tendler's comments were pounced upon by the right wing newspaper, Yated Neaman. The newspaper attacked him for being an 'informer' (mesir) on the Jewish community. The paper claimed that Rabbi Tendler reported Rabbi Fischer to the health department and blamed him for governmental interference with ritual circumcision. The situation erupted and pamphlets were published claiming that Rabbi Tendler wants to abolish ritual circumcision in America, resulting in the vandalism of Rabbi Tendler's synagogue in Monsey, New York.

In an exclusive interview with The Commentator, Rabbi Tendler explained his involvement with the controversy. He claimed that he never contacted the New York City Health Department, and had no knowledge of the death of the baby on October 26 from Herpes. He further explained that he did not speak to the officials at the hospital where the baby died; rather, the hospital reported the death to the Health Department.

Rabbi Tendler expressed grave concern regarding the involvement of the Health Department with religious practices. He pointed out that the constitutional separation between Church and State has allowed Orthodox Judaism to thrive in America. Rabbi Tendler also posited that the only way to solve the problem is to create a system of self regulation, a system where the Jewish community regulates mohelim. Rabbi Tendler recounted that there used to be a Milah Board, of which he was a member. The board regulated and licensed mohelim in order to maintain a basic standard of expertise and knowledge. However, the board disintegrated upon the retirement of its head and has never been revived. Rabbi Tendler stressed the necessity of such a body, stating that such an organization's existence is imperative in maintaining religious autonomy. Rabbi Tendler called on community organizations, such as the Orthodox Union (OU) and Rabbinical Council of America (RCA), to respond to the situation. He explained that these organizations should set up a licensing agency to instruct and train mohelim.

On March 2, the RCA released a statement approving and recommending the use of an instrument when performing metzitzah. However, the statement is simply a recommendation, not a demand for revised procedures.

Regarding the attacks in Yated, Rabbi Tendler expressed surprise and disappointment. He suggested that the article attempted to shift interest from Fischer to himself by labeling him an halachic 'informer' to the Health Department. Rabbi Tendler ironically noted, "if I had had all the information that Fischer had been involved in three cases of herpes and continued to perform direct oral suction, I would have been halachically required to report him to the authorities. But I did not have to do that, the hospital did". Rabbi Tendler went even further, remarking "classifying this as a matter of mesirah (informing) reflects a primitive understanding of halacha."

In response to rumors that he had been uninvited from the Agudath Israel sponsored Siyum HaShas on March 1, Rabbi Tendler explained that he decided not to go independently, because he realized the kind of social primitiveness of the people involved in the matter, which could have resulted in some form of disturbance or distraction from the ceremony.

Even though Rabbi Tendler's position of performing oral suction using a sterile instrument instead of direct oral contact has firm halachic support, Rabbi Yosef Shalom Elyashiv has publicly stated that, unlike AIDS, herpes does not pose a real threat to the baby and therefore the custom of direct oral suction is permitted. Rabbi Tendler pointed out that although Rabbi Elyashiv permits using an instrument to perform oral suction when there is a concern that the mohel might contract AIDS from the baby, which has never occurred, Rabbi Elyashiv does not allow an instrument to be used to protect the baby from herpes, a substantive and documented concern.

w w w . h a a r e t z . c o m



Freedom of circumcision v. health hazard
By Nathan Guttman

WASHINGTON - The tragic death of an infant in New York's Haredi ultra-Orthodox community has put brit milah (Jewish ritual circumcision) in the spotlight over the past few weeks. The debate, which includes rabbis, mohels (ritual circumcisers) and American health authority representatives, centers on the question of how the mohel should draw blood after performing a circumcision, and whether it is prudent in modern times to permit direct contact between the mohel's mouth and the baby's sex organ. Beyond the issue of this practice itself, the discussion has extended to questions of freedom of religion versus the intervention of authorities and the sanctity of ancient practices versus scientific innovations.

The tragedy in question occurred last year in the Haredi community of Monsey, New York. The mohel, Rabbi Yitzchok Fischer, circumcised twins in a double ceremony. The circumcision was performed in the traditional manner accepted among many Haredim, and consists of three stages - incision of the foreskin, its retraction and removal, and drawing of blood. According to ultra-Orthodox practice, this is done directly, with the mohel's mouth on the site of the incision.

Ten days after the brit, one of the babies died, and an examination revealed that the cause of death was herpes. The second twin also tested positive for herpes, and after New York City health authorities opened an investigation, they discovered the virus in another baby who had been circumcised by Fischer.

The public health department's initial conclusion was that there was a reasonable suspicion that all three babies had been infected by Fischer when he drew blood with his mouth. The authorities immediately forbade Fischer from performing any more oral procedures, ordered him to work only while wearing sterile gloves, and filed a complaint against him at the New York Supreme Court in Manhattan, demanding that he cooperate with the investigation and refrain from drawing blood orally until the matter is resolved.

A dangerous custom

Fischer was to report to the courthouse for a hearing on the matter yesterday, but even before it can receive full legal attention, all of the parties already are raising their claims. Fischer's lawyers, attorney Mark Kurzmann and his son Hillel Kurzmann, say that their client has been fully cooperating with the investigation, so any legal action against him is superfluous.

"The city apparently has a much broader agenda, beyond the actual investigation," says Mark Kurzmann, noting that according to his understanding, the debate is not over the medical question concerning the transmission of herpes, but the broader issue of freedom of religion. To prove his point, Kurzmann notes that even before completion of the investigation, the New York health commissioner declared that the oral drawing of blood "constitutes a threat to the public health."

Fischer, who declined to be interviewed for this article on his lawyers' advice, underwent a series of medical tests to detect the herpes virus, and is continuing to perform circumcisions in New York, for the time being without oral suction. Even before the current incident made headlines, Fischer would use a glass tube if the baby's parents requested it.

The Jewish community is divided on the question of the continued practice of direct oral contact during the brit. While many in the Haredi and Orthodox community believe direct contact between the mohel's mouth and the site of the cut foreskin is necessary, many others have adopted the more modern approach in which the blood is drawn through a small, sterilized glass tube that ensures no direct oral contact in order to avoid the risk of infection.

The Rabbinical Council of America (RCA), America's largest Orthodox rabbinical organization, issued a statement supporting the use of the glass tube two weeks ago.

"The requirement [of drawing blood] is fulfilled completely and unambiguously by the use of oral suctioning through a tube," declared the RCA, adding, "One absolutely fulfills the precept whilst placing the infant and mohel at no additional risk."

Executive VP of the RCA, Rabbi Dr. Basil Herring, who initiated the declaration, says the organization felt the need, in light of the current debate, to clarify that from a halakhic (Jewish legal) and health perspective, and for the sake of appearances, it is preferable to use the tube rather than the direct oral contact method.

This approach is also in line with a study conducted and published by the Pediatrics medical magazine last year. The 12 researchers who prepared the report concluded that oral contact with the baby constitutes a risk of the transmission of herpes from the mohel to the baby. The researchers reached this conclusion after examining eight cases in which babies contracted herpes two weeks after their brit. Among the signatories of the report is Rabbi Dr. Moshe Tendler, who teaches biology at New York's Yeshiva University.

Tendler stressed in interviews granted to the U.S. Jewish media that herpes is much more common than many people think, and direct oral suction of blood is certainly a dangerous custom. Tendler added that even after this fact became well known, and after studies were published proscribing that adherence to the custom of oral suction needlessly endangers a baby, some parents still insist that the mohel follow the custom, and there are mohels who still continue with this hazardous practice.

Not everyone accepts this approach, even when it is presented by an Orthodox authority.

"For tens of thousands of believing Jews in the New York area, this practice is an integral part of the fulfillment of the circumcision commandment; to them it is not optional," Kurzmann says, noting that only part of the Jewish community has adopted the changes instituted in the suction method in the past 150 years.

No one has data on the proportion of circumcisions that use direct oral suction, but Orthodox community sources estimate that thousands are performed annually.

Furthermore, certain circles that had displayed lenience toward the use of the glass tube are now returning to direct oral suction and have banned the tube.

No fears

While in the United States, the Orthodox community is trying to present a creative approach to the issue of oral suction, the Orthodox neighborhoods of Jerusalem have been plastered with posters clarifying that the position of the Chief Rabbinate of Israel remains firm on maintaining the ancient tradition. The posters quote a ruling by Rabbi Yosef Shalom Elyashiv, the leader of the Degel Hatorah party and today's most important Ashkenazi Jewish legal authority, according to which there is nothing to fear from direct oral suction. Elyashiv states that when a mohel has a sore in or on his mouth, he should let someone else perform that part of the ceremony.

Degel Hatorah's newspaper, Yated Neeman, defined the Fischer affair as outrageous, "an attempt to harm one of the foundations of the existence of the Jewish people," and "informing (tale bearing) to the gentiles." The newspaper stated that notifying the American media regarding the spreading of herpes was "a modern form of the libel that Jews had poisoned the wells" during the time of the Black Plague.

Herring responded that the RCA "has great respect for Rabbi Elyashiv," but noted that other esteemed rabbis see things differently. "We are not the Catholic Church," he said, adding that the RCA "recognizes there are other viewpoints out there, and they have the right to follow their own way."

The dispute over the manner in which the brit should be performed, however, may have more far-reaching ramifications. Extensive media interest in the affair, which was covered not only by the Jewish newspapers, but also by local newspapers throughout the country, has placed Jewish customs in a problematic light. The reports portray the brit as a custom that belongs to a bygone era, and which should be modernized in keeping with contemporary medical and public practices.

Some members of the Jewish community also expressed fears that the baby's death would lead to increased state involvement in circumcisions. At this point, such intervention has stopped at the decision by New York state health officials to limit Fischer's activities, but the fear of regulatory intervention by state or federal authorities in brit procedures constantly lurks in the background.

Kurzmann claims that the zeal of state authorities in handing the issue over to the courts attests to the desire to intervene, and poses a real threat to the freedom of religious expression for Jews who want a brit performed traditionally.

At this point, the legal debate is not touching on that aspect, but if Fischer's case reaches the higher courts, and if New York City authorities take sweeping measures against the practice of oral suction, the courts could find themselves deliberating the principle question of freedom of religion versus health concerns.

Herring says there is another problem regarding non-Orthodox Jews. "I am more worried about what regular Jews will think, that perhaps they will suddenly say they do not want brit milah, that they are afraid of the consequences. That is my concern."

For now, that fear is unfounded. The current assessment is that all Jewish parents in the United States have their baby boys circumcised, and most of them do so according to tradition, with only a small minority opting for a surgical circumcision without a religious ceremony.


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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."


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