JERUSALEM- The Israeli Pediatric Association has come out publicly against the controversial practice of orogentital suction, known in Hebrew as Metzitzah B’peh, in which a ritual circumciser applies direct oral suction to a baby’s still open circumcision wound. The practice has come under increasing fire in the United States on the heels of a report by the Centers for Disease Control linking it to the deaths of several children. The practice has largely been discontinued and is mainly practiced in ultra-orthodox communities located in New York and Israel.

Proponents of the practice maintain that it is an integral part of the circumcision ritual and equate opposition to metzitzah to recent efforts in Germany to have childhood circumcision banned entirely.

However, this position has been challenged as historical revisionism by some leading American and Israeli Rabbis.

An alternative to direct oral suction is the use of a glass or plastic tube to suction the blood from the wound without direct oral contact. This practice, endorsed by the 19th-century founder of ultra-Orthodoxy, Rabbi Moses Schreiber, also known as the Hatam Sofer, came about in response to widespread worry over a rash of cases of infection caused by metzitza.

The Hatam Sofer believed that once opposition to a precept was expressed by other streams of Judaism or by the secular authorities that it was incumbent on devout Jews to raise that precept, no matter how trivial, to the level of a divine command.

While Schreiber himself saw the use of pipettes as legitimate, his students, acting in the context of opposition to the Reform movement, declared the use of oral suction to be an integral part of the commandment of circumcision, without which it would remain incomplete. To his students and later haredi leaders, any attack on metzitza was an attack on Judaism itself.

The haredi refusal to accept the original medical nature of metzitza is symptomatic of a larger rift between the modern and ultra-Orthodox camps, Rabbi Natan Slifkin believes. Slifkin, an expert on the conflict between science and tradition, especially as it relates to the haredim, recently explained in an essay that haredim are, for the most part, unwilling to believe that the sages of the Talmud could be mistaken regarding basic scientific facts and that any claims regarding nature included in the Talmud must be part of the Revelation from Sinai. This rift is the basis of the fight over metzitza.

Due to the deaths which have been linked to metzitzah, Rabbi Dr. Moshe Tendler, the son in law of Rabbi Moshe Feinstein, the late leader of American Orthodoxy, and a professor of medical ethics at Yeshiva University, stated that “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. Now we have several cases of herpes in the Metro area… all we are talking about is presumptive evidence, and on that alone it would be improper according to Jewish law to do oral suction.”

The Israeli Pediatric Association’s public opposition comes several weeks after the publication in the Jerusalem Post of an investigation by this correspondent on the role of the Israeli Ministry of Health in obstructing medical studies into the potential medical ramifications of metzitzah.

While the Ministry’s stated position has been that does not interfere in, or study, issues related to circumcision, it was learned by this correspondent that the Ministry did in fact have several representatives on an inter-ministerial board controlled by the Chief Rabbinate that oversees circumcision.

In a letter sent to Israeli mohelim half a year ago, and obtained by this correspondent, Rabbi Moshe Marciano, the head of the Inter-Ministerial Committee on Circumcision, instructed mohelim certified by the rabbinate to notify parents that they would be performing oral suction. Only if the parents refused, the letter stated, were the mohelim to explain that alternatives exist within the Jewish tradition.

In response to the CDC’s allegations, the Inter-Ministerial Committee drafted a counter-report, a copy of which was obtained by this correspondent, in which the committee contends with the New York Board of Health’s numbers and argues with the American researchers’ methodology.

“In general, there are situations in daily life, involving adults and children alike, that involve far greater risks than the assumed risks of MBP,” the report states.

“Examples of these are: parents allow cosmetic surgery for their children even when there is no real medical indication; parents allow their children to participate in dangerous competitive sports, parents allow children to cross busy streets, etc. In such instances there is no demand to eliminate these activities even though they have associated risks which are far greater than those associated with MBP.”

As such, “According to current medical and halachic information available to us, we are of the opinion that there is no need to ban metzitza b’peh for those halachic authorities [poskim] that consider this action a vital, integral part of the traditional observance of ritual Jewish circumcision.”

The report, which was written in part by Dr. Moshe Westreich, a Ministry of Health representative on the committee, and was reviewed prior to publication by Health Ministry chief medical ethicist Rabbi Mordechai Halperin, states that “without a general or specific halachic decision by one of the great contemporary halachic authorities,” later referencing the late Rabbi Shalom Elyashiv, “MBP should not be stopped.”

The report, which is non-binding as mohelim are not legally required to be licensed by the committee, states that in “appropriate circumstances the mohel should offer the parents the choice between MBP and suction by tube [pipette], and if the family prefers MBP the mohel should inform the family of the small risk of infection, including neonatal herpes, and obtain their informed consent.”

The report did not elaborate on what constitutes “appropriate circumstances.”

Responding to the Israeli Pediatric Association’s public opposition, Rabbi Marciano replied that the Rabbinate instructs ritual circumcisers to seek informed consent and not to perform the rite against the wishes of parents.


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