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Abridged and adapted from a piece that originally appeared in Midstream magazine (1992). Used with the author's permission.
In the medical world, circumcision is the subject of fierce controversy. Its proponents say the practice is safe and painless, and that it dramatically reduces the risk of medical problems ranging from urinary tract infections to AIDS. Its opponents, on the other hand, have called circumcision a painful mutilation of the body, an unnecessary medical risk, and a violation of the child's rights.
From the perspective of halacha (Jewish law), medical arguments for and against circumcision are irrelevant, because brit milah is simply "the covenant of circumcision"--the sign of the agreement between God and the Jewish people. Nonetheless, evidence of the possible benefits of circumcision is often seized upon in the Jewish community as proof of the rite's continuing appropriateness.
As for the arguments against circumcision, many Jews find them exaggerated and inflammatory, and thus easy to dismiss. Yet paradoxically, all of these anti-circumcision arguments stem from Jewish principles. Concern about babies' suffering echoes Hillel's admonition, "What is hateful to you, do not do to any person." Opposition to bodily mutilation is based on the Torah's denunciation of such pagan practices as tattooing and cutting the flesh. Concern for medical risk, too, has roots in halacha: any medical procedure that involves even the possibility of a risk to life is halachically forbidden. And the idea of protecting children's rights brings to mind the Jewish principle that the poor and weak should be treated equally with the rich and mighty.
Clearly, if even the most inflammatory anti-circumcision arguments reflect ideas originating in Judaism, we ought to address current concerns about the practice.
Although it was believed for centuries that infants don't feel pain, or feel it less keenly than adults do, there is now concrete evidence to the contrary. According to a statement issued by the American Academy of Pediatrics in 1987, infants' pain response to surgery is similar to that of adults. In fact, an August 1990 editorial in Pediatric News asserts that infants may feel pain more intensely than adults. That circumcision pain is still widely dismissed conflicts both with common sense and with Judaism, as halacha strictly forbids causing pain to any living creature. Given the new information about infants and pain, it is our Jewish obligation to address this issue.
Brit milah is intended as a religious event symbolizing the infant's entry into a life of Jewish observance. But many Jews today see circumcision as an end in itself. Hospital circumcisions are far more common among contemporary Jews than awareness of the covenant. While halacha demands the fulfillment of obligations such as circumcision even if these actions are not accompanied by spiritual intent, it should also be noted that Judaism frowns upon thoughtless fulfillment of commandments. As the great Chasidic rabbi Menachem Mendl put it, "sometimes a mitzvah (commandment) becomes idol worship." Thus, might a thoughtful decision not to circumcise one's son be considered Jewishly valid?
The possibility of death and serious complications from circumcision appears to be relatively small. But it is noteworthy that neither the medical profession nor the Jewish community has ever compiled the data needed to establish the risk with any precision. Isolated cases of death and serious complications have been documented throughout history. Though they appear to be quite rare, they should be factored into any discussion of brit milah, since halacha strictly forbids hazardous medical procedures.
The Newborn as Stranger (or, I Wouldn't Do It to My Five Year Old)
As Jews and as Americans, we have been conditioned to look upon the circumcision of older children and adolescents (as is practiced in some other cultures) as deeply offensive. Many of us, thinking surgery is easier on infants than on older children or adults, would find it impossible to subject an older child to such an ordeal. But current research suggests that while infants' tissue seems to heal faster, early painful and traumatic experiences are far more difficult for infants than was previously imagined.
One reason we may have difficulty grasping our infants' suffering during circumcision is that our initial bond with them is generally not as strong yet as it becomes over time. Indeed, 12th century physician and rabbi Moses Maimonides urges us to circumcise our sons as infants, lest we neglect to do so as we get to know them better and love them more deeply. But in encouraging us to call upon our natural indifference to our newborns, Maimonides is telling us, in effect, to do to a "stranger" what we could not do to one we know well. This thinking contradicts one of the most significant of all Jewish principles: the commandment to love the stranger. Rabbi Herbert S. Goldstein of Yeshiva University writes that the early rabbis interpreted this commandment as an admonition "first of all not to pain or annoy [the stranger]." The question is, if we might be unable to subject an older child to brit milah, is it Jewishly ethical to subject our infants to it?
Facing the Dilemma
There are powerful Jewish reasons to fulfill the brit milah commandment. Jewish law requires it, Jews have died for the right to practice it, and thousands of years of tradition reinforce its significance as a primary emblem of Jewish identity. Nonetheless, there are also compelling Jewish reasons to question brit milah. As we have learned from the case of the cheresh (the deaf-mute, classified in Talmudic times with the mentally incompetent but treated by modern rabbis as an equal Jew in every respect), Judaism incorporates new insights into practice. We must confront the fact that brit milah is now known to cause our infants pain. And we must have confidence that Judaism will withstand a reappraisal of the rite.
At the very least, the use of local anesthesia for brit milah should be widely accepted (it is currently in use by the physician-mohels trained through the Brit Milah Board of Reform Judaism). The most effective form of anesthesia currently available, the dorsal penile nerve block, has been shown to reduce crying and distress during circumcision, and appears to be extremely safe. However, it involves two painful injections, and does not mitigate either post-surgical pain or the pain that the baby may experience during the healing process following the removal of healthy tissue.
As for the safety of circumcision, anecdotal evidence should no longer be tolerated. Brit milah certification boards should meticulously follow up on every ceremony and document all perfect circumcisions, as well as all complications. With this policy, we will set an example for the medical profession while fulfilling a Jewish responsibility.
We must also address the reality that Jewish parents are questioning circumcision more than ever before. Some find the pain and risks problematic, some question the ethics of forcing an infant into a covenantal agreement, and some take issue with brit milah in light of their own lack of spiritual conviction about it. This reality is far from bleak; each of these concerns reflects a deep regard for Jewish values. Jews are questioning circumcision for Jewish reasons.
Some Jews are adopting a symbolic interpretation of brit--that is, holding covenant ceremonies without the circumcision. Does this solution unfairly deny the infant his birthright? It seems to me that a symbolic interpretation of brit does not deprive an infant of his Jewish identity any more than a literal interpretation guarantees it. Indeed, a heartfelt, carefully reasoned decision to observe brit symbolically may ultimately do more for Judaism than unthinking adherence to the ritual for its own sake.
Traditionalists will worry that in the face of intermarriage and assimilation, we cannot afford to "water down" Judaism any further by questioning brit milah. I would argue that we cannot afford to force parents to do their questioning outside the faith. If it is our goal for Judaism to flourish, a fresh and honest reappraisal of brit milah will be a significant contribution. Let us approach this task with an open mind and a Jewish heart.