http://www.nytimes.com/2005/08/26/nyregion/26cir***cise.html?fta=y
City Questions Cir***cision Ritual After Baby Dies
By ANDY NEWMAN
Published: August 26, 2005
A cir***cision ritual practiced by some Orthodox Jews has alarmed city
health officials, who say it may have led to three cases of herpes - one
of
them fatal - in infants. But after months of meetings with Orthodox
leaders,
city officials have been unable to persuade them to abandon the practice.
The city's intervention has angered many Orthodox leaders, and the issue
has
left the city struggling to balance its mandate to protect public health
with the constitutional guarantee of religious freedom.
"This is a very delicate area, so to speak," said Health Commissioner
Thomas
R. Frieden.
The practice is known as oral suction, or in Hebrew, metzitzah b'peh:
after
removing the foreskin of the *****, the practitioner, or mohel, sucks the
blood from the wound to clean it.
It became a health issue after a boy in Staten Island and twins in
Brooklyn,
cir***cised by the same mohel in 2003 and 2004, contracted Type-1 herpes.
Most adults carry the disease, which causes the common cold sore, but it
can
be life-threatening for infants. One of the twins died.
Since February, the mohel, Rabbi Yitzchok Fischer, 57, has been under
court
order not to perform the ritual in New York City while the health
department
is investigating whether he spread the infection to the infants.
Pressure from Orthodox leaders on the issue led Mayor Michael R. Bloomberg
and health officials to meet with them on Aug. 11. The mayor's comments on
his radio program the next day seemed meant to soothe all parties and not
upset a group that can be a formidable voting bloc: "We're going to do a
study, and make sure that everybody is safe and at the same time, it is
not
the government's business to tell people how to practice their religion."
The health department, after the meeting, reiterated that it did not
intend
to ban or regulate oral suction. But Dr. Frieden has said that the city is
taking this approach partly because any broad rule would be virtually
unenforceable. Cir***cision generally takes place in private homes.
Dr. Frieden said the department regarded herpes transmission via oral
suction as "somewhat inevitable to occur as long as this practice
continues,
if at a very low rate."
The use of suction to stop bleeding dates back centuries and is mentioned
in
the Talmud. The safety of direct oral contact has been questioned since
the
19th century, and many Orthodox and nearly all non-Orthodox Jews have
abandoned it. Dr. Frieden said he hoped the rabbis would voluntarily
switch
to suctioning the blood through a tube, an alternative endorsed by the
Rabbinical Council of America, the largest group of Orthodox rabbis.
But the most traditionalist groups, including many Hasidic sects in New
York, consider oral suction integral to God's covenant with the Jews
requiring cir***cision, and they have no intention of stopping.
"The Orthodox Jewish community will continue the practice that has been
practiced for over 5,000 years," said Rabbi David Niederman of the United
Jewish Organization in Williamsburg, Brooklyn, after the meeting with the
mayor. "We do not change. And we will not change."
David Zwiebel, executive vice president of Agudath Israel, an umbrella
organization of Orthodox Jews, said that metzitzah b'peh is probably
performed more than 2,000 times a year in New York City.
The potential risks of oral suction, however, are not confined to Orthodox
communities. Dr. Frieden said in March that the health department had
fielded several calls from panicked non-Orthodox parents who had hired
Hasidic mohels unaware of what their services entailed.
Defenders of oral suction say there is no proof that it spreads herpes at
all. They say that mohels use antiseptic mouthwash before performing oral
suction, and that the known incidence of herpes among infants who have
undergone it is minuscule. (The city's health department recorded cases in
1988 and 1998, though doctors in New York, as in most states, are not
required to re****t neonatal herpes.)
Dr. Kenneth I. Glassberg, past president of the New York section of the
American Urological Association and director of pediatric urology at
Morgan
Stanley Children's Hospital of New York-Presbyterian, said that while he
found oral suction "personally displeasing," he did not recommend that
rabbis stop using it.
"If I knew something caused a problem from a medical point of view," said
Dr. Glassberg, whose private practice includes many Hasidic families, "I
would recommend against it."
But Rabbi Moshe Tendler, a microbiologist and professor of Talmud and
medical ethics at Ye****va University, said that metzitzah b'peh violates
Jewish law.
"The rule that's above all rules in the Torah is that you cannot expose or
accept a risk to health unless there is true justification for it," said
Dr.
Tendler, co-author of a 2004 article in the journal Pediatrics that said
direct contact posed a serious risk of infection.
"Now there have been several cases of herpes in the metro area," he said.
"Whether it can be directly associated with this mohel nobody knows. All
we're talking about now is presumptive evidence, and on that alone it
would
be improper according to Jewish law to do oral suction."
The inconsistent treatment of Rabbi Fischer himself indicates the
confusion
metzitzah b'peh has sown among health authorities, who typically regulate
cir***cisions by doctors but not religious practitioners.
In Rockland County, where Rabbi Fischer lives in the Hasidic community of
Monsey, he has been barred from performing oral suction. But the state
health department retracted a request it had made to Rabbi Fischer to stop
the practice. And in New Jersey, where Rabbi Fischer has done some of his
12,000 cir***cisions, the health authorities have been silent.
Rabbi Fischer's lawyer, Mark J. Kurzmann, said that absent conclusive
proof
that the rabbi had spread herpes, he should be allowed to continue the
practice. Rabbi Fischer said through Mr. Kurzmann that the twin who died
and
the Staten Island boy both had herpes-like rashes before they were
cir***cised and were seen by a pediatrician who approved their
cir***cision.
The health department declined to comment on its investigation.
http://www.youtube.com/watch?v=fpDsajIoSr0&feature=related
"There are three stages required for the performance of a ritually
correct cir***cision in Jewish law: the removal of the foreskin; the
tearing
of the underlying membraene so as to expose the glans completely; and the
sucking away of the blood, m'tsitsah." Roger V. Pavey. The Kindest Cut of
All. Bognor Regis, W. Sus***: New Horizon. 1981. pp. 87-88.
"The traditional practice of metzitzah b'peh, which has its roots in
the
earliest history of the Jewish people and has survived unchanged to the
present time, should be viewed with great respect. It is spoken of very
positively in the Jewish literature on cir***cision both as an essential
part of the ritual and as a health measure which prevents infection and
promotes healing." Henry C. Romberg, M.D. Bris Milah: A book about the
Jewish ritual of cir***cision. Jerusalem/New York: Feldheim Publishers.
1982. pp. 57-58.
http://www.***uallymutilatedchild.org/mohel.htm
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