{"id":642,"date":"2020-04-13T21:27:34","date_gmt":"2020-04-14T01:27:34","guid":{"rendered":"http:\/\/web.colby.edu\/coronaguidance\/?p=642"},"modified":"2020-07-22T09:59:21","modified_gmt":"2020-07-22T13:59:21","slug":"ccar-brit-milah","status":"publish","type":"post","link":"https:\/\/web.colby.edu\/coronaguidance\/2020\/04\/13\/ccar-brit-milah\/","title":{"rendered":"CCAR: B\u2019rit Milah During COVID-19 Pandemic"},"content":{"rendered":"

Question
\n<\/strong>What should be the proper procedure regarding\u00a0b\u2019rit milah<\/em>\u00a0during the COVID-19 pandemic?
\n(submitted by Rabbi Julie Pelc Adler, Director, Brit Milah Program of Reform Judaism)<\/p>\n

Response
\n<\/strong>In the midst of the current pandemic, it is understandable that parents and\u00a0mohalim\/ot<\/em>\u00a0are confused and frightened.\u00a0 We will examine the issues here carefully, one by one.<\/p>\n

1. The importance of\u00a0b\u2019rit milah<\/em><\/p>\n

In emphasizing the importance of\u00a0b\u2019rit milah\u00a0<\/em>the Talmud equates it to all the other\u00a0mitzvot<\/em>\u00a0and, indeed, credits it with preserving the very existence of the world.<\/em>[1]<\/sup><\/a>\u00a0 In Christian lands it was an unmistakable, permanent marker of Jewishness; in Muslim lands, it marked Jewish male children.\u00a0 Its complex psychological significance in a classically male-centered Jewish spirituality cannot be overstated.[2]<\/sup><\/a>\u00a0\u00a0<\/em>It is true that the first generations of Reformers were deeply ambivalent about it; Kaufmann Kohler, for example, called it \u201ca barbarous cruelty,\u201d and recommended its abolition.[3]<\/sup><\/a>\u00a0 It is quite likely that most Reform Jews would have ceased to practice circumcision had it not been for the view that gained currency in the early 20th<\/sup>\u00a0century, that circumcision conveyed hygienic and health benefits.[4]<\/sup><\/a>\u00a0\u00a0Before World War II, lengthy post-partum hospital stays for middle- and upper-class women and their infants made it easy to arrange a hospital circumcision, with or without ritual. In the postwar era, however, shortened hospital stays led to numerous inquiries about the acceptability of circumcision before the eighth day, or the reality of Jews simply ignoring\u00a0b\u2019rit milah\u00a0<\/em>in favor of medical circumcision. While Responsa Committee chair Israel Bettan authored a strenuous objection to that widespread practice in 1954,[5]<\/sup><\/a>\u00a0Solomon Freehof was far more accommodating in 1960.[6]<\/sup><\/a>\u00a0 All Reform responsa since then, however, have followed R. Bettan in insisting on the importance of\u00a0milah<\/em>\u00a0on the eighth day as a religious rite.[7]<\/sup><\/a>\u00a0 As a movement we have encouraged Reform Jews to choose\u00a0b\u2019rit milah\u00a0<\/em>on the eighth day, and have facilitated this by training Reform\u00a0mohalim\/ot<\/em>.<\/p>\n

2. Circumstances for delaying\u00a0b\u2019rit milah<\/em><\/p>\n

We are forbidden to endanger ourselves. As Maimonides writes: \u201cThe Sages prohibited many things because they are life-threatening.\u00a0 And anyone who ignores their words, and says, \u2018I can go ahead and endanger myself; what business is it of anyone else what I do to myself?\u2019 or \u2018I pay no attention to that\u2019 \u2013 they are to flog him for rebelliousness.\u201d[8]<\/sup><\/a>\u00a0 We are obligated to preserve ourselves from danger (and, as parents, we are responsible for preserving our children from danger). There is, therefore, unanimous agreement among all halakhic authorities that we delay\u00a0b\u2019rit milah<\/em>\u00a0if the infant is not healthy enough to undergo it.[9]<\/sup><\/a><\/p>\n

By contrast, there is far less consideration of whether\u00a0b\u2019rit milah<\/em>\u00a0might risk the well-being of an otherwise healthy infant.[10]<\/sup><\/a>\u00a0 However, there is a faint thread running through the halakha that is worth examining in detail.\u00a0 It begins with this Talmudic passage:<\/p>\n

Rav Pappa said:\u00a0 Therefore, on a cloudy day or on a day when a south wind is blowing, we do not circumcise\u00a0[an infant]<\/sup>, nor do we draw blood.\u00a0 But nowadays, when people are accustomed to ignore\u00a0[these strictures, we rely on the assurance that]<\/sup>\u00a0Adonai preserves the simple<\/em>\u00a0(Ps. 116:6)\u00a0[and we proceed on the assumption that no harm will follow]<\/sup>.[11]<\/sup><\/a><\/p><\/blockquote>\n

This statement was never codified in the later halakha, but the Nimukei Yosef cites it approvingly:<\/p>\n

The Ritba wrote in the name of his teacher\u00a0[with reference to this passage]<\/sup>:\u00a0 From here we learn that whoever does not wish to circumcise on a cloudy day has permission to do so, and is acting with clear justification in not relying on\u00a0Adonai preserves the simple<\/em>.\u00a0 And similarly it is appropriate not to circumcise on Shabbat if it is cloudy.[12]<\/sup><\/a><\/p><\/blockquote>\n

The discussion of this issue by the Arukh Ha-Shul\u1e25an makes abundantly clear that the underlying concern is whether conditions are such that performing the rite could endanger the infant:<\/p>\n

\u2026But Rabbenu Yeruham wrote that neither a cloudy day nor a south wind delays the\u00a0b\u2019rit milah<\/em>, because\u00a0Adonai preserves the simple<\/em>. However, the strain of a journey\u2014meaning that the infant is ill from the strain of having made a journey, does postpone the\u00a0b\u2019rit<\/em>, until he is well. Another authority wrote that anything other than some illness in the infant himself\u2014such as having to go on a journey\u2014does not delay the\u00a0b\u2019rit<\/em>, just as we do not delay it for the sake of blowing winds.<\/p>\n

Obviously, we do not delay the\u00a0b\u2019rit<\/em>\u00a0for the purpose of going on a journey, but rather we carry it out.\u00a0 But it seems to me that it is obviously forbidden to take the infant on a long journey until he has recovered from the circumcision, lest he be endangered. However, it may be permissible to take him in a wagon, since in that case he is placed in one spot and appropriately covered with blankets and pillows. Also, one can see, when they have brought him on a journey by wagon, whether any weakness appears in him. This requires examination by experts in the body and face of the infant.\u00a0 Indeed, we have never heard what the Nimukei Yosef wrote, that on cloudy days it is permitted to delay the\u00a0b\u2019rit<\/em>. In fact, it is because\u00a0Adonai preserves the simple<\/em>\u00a0that we are lenient on optional matters such as drawing blood on the eve of Shabbat\u2026and thus all the more so with regard to an important commandment such as circumcision. And the proof of this is that not a single one of the authorities saw fit to mention this. So we learn that we do not use its guidance in fulfilling our obligation. Thus has the custom spread, and there is no changing it.[13]<\/sup><\/a><\/p><\/blockquote>\n

It is quite obvious that the original authority, Rav Pappa, was expressing a genuine medical concern, based on his best knowledge. As subsequent generations\u2019 medical knowledge changed, however, they dismissed these concerns as nonsense\u2014but did not replace them with their own medical concerns. This may reflect the tacit trend toward stringency evident in the halakha over time, as seen in other practices such as the discontinuation of\u00a0hafka\u2019at kiddushin<\/em>as a way of preventing\u00a0agunot<\/em>, or the Ashkenazic invention of \u201cglatt kosher.\u201d<\/p>\n

Fortunately, we are under no obligation to adhere to the codified halakha when a minority viewpoint has clear merit.\u00a0 And as we have stated before, we rely on medical expertise:\u00a0 \u201cAs rabbis, we are not competent to render judgments in scientific controversies. Still, we do not hesitate to adopt \u2018the overwhelming view\u2019 as our standard of guidance in this and all other issues where science is the determining factor.\u201d[14]<\/sup><\/a>
\nIt is clear to us that\u00a0b\u2019rit milah<\/em>\u00a0may be delayed when performing the rite would endanger an otherwise healthy infant.<\/p>\n

3. Does performing\u00a0b\u2019rit milah<\/em>\u00a0at this time endanger the infant?<\/p>\n

The reality in North America is that parents can take many steps to minimize the chances of infection, but under current circumstances it is virtually impossible to eliminate all possibility of infection. Asymptomatic individuals are not being tested; the incubation period can be lengthy; and the virus is extremely contagious.\u00a0 In many areas, by the time the infant reaches his eighth day, it is already highly probable that he has already been exposed to someone who is carrying the virus, unless he was born at home under conditions of strict isolation, and the medical practitioner(s) who delivered the baby were known to have tested negative for the virus. In other areas, it appears that this will be the case before too long.<\/p>\n

As of this writing, there is not enough science available to stand as definitive research on COVID-19 in infants. Anecdotal evidence continues to mount, however, indicating that infants do not appear to be seriously affected. Infant deaths from the virus are so rare that individual cases are being reported as news.\u00a0 It appears that in each case there were underlying health complications.[15]<\/sup><\/a>\u00a0\u00a0It seems counterintuitive, and understandably goes against parents\u2019 instinctive reactions, but so far the evidence is that babies, including newborns, are far less susceptible to COVID-19 than are older adults, unless the infants have some other health problem. It appears that the adults who would be present at a\u00a0b\u2019rit milah<\/em>\u00a0could be at greater risk than the infant himself.<\/p>\n

Furthermore, there is no guarantee that this virus will disappear soon. Experts are saying that it will continue to circulate until there is a vaccine to treat it, with some saying that we will, therefore, require social distancing for 12-18 months.[16]<\/sup><\/a>\u00a0 After that much time has elapsed, circumcision will be much more difficult and will carry its own set of risks.<\/p>\n

Medical literature regards \u201cnewborn\u201d circumcision as routine, requiring only local anesthesia, up to about age six weeks.[17]<\/sup><\/a>\u00a0 Beyond six weeks, or when the baby grows larger than twelve pounds, it may be advisable to wait until he is six months old and perform the procedure under general anesthesia. There is a small indication that bleeding is a more likely complication for an older baby. Furthermore, as the baby ages, the foreskin is thicker and less pliable, so it is more difficult from a technical point of view to perform the circumcision using the more traditional Mogen clamp.<\/p>\n

It would appear, then, that there is no absolute guarantee of safety for the infant; but he is no\u00a0more<\/em>\u00a0at risk in a\u00a0b\u2019rit milah<\/em>\u00a0performed on the eighth day, even during the pandemic, than he will be at any time in his first year of life. That assumes, of course, that the\u00a0b\u2019rit milah<\/em>\u00a0is carried out in a way that does not add needless risk. It should be in the home, and there should be no one present other than the parents and the\u00a0mohel\/et<\/em>. All standard procedures to minimize transmission should be followed, including wearing masks and gloves. It would be advisable to reduce danger to the parents by not having the rite performed by a\u00a0mohel\/et<\/em>\u00a0who has been working in a hospital or clinic where COVID-19 patients are being treated.<\/p>\n

Some parents will, doubtless, consider a medical circumcision immediately after birth, followed by\u00a0hatafat dam b\u2019rit<\/em>\u00a0at home. We would point out that the most significant risk factor for the virus is the number of people to whom one is exposed at close range. A hospital procedure will bring the infant into contact with at least as many adults as will a\u00a0b\u2019rit milah<\/em>\u00a0performed at home.<\/p>\n

Conclusions<\/u><\/p>\n

    \n
  1. B\u2019rit milah\u00a0<\/em>on the eighth day is a\u00a0mitzvah<\/em>\u00a0that we as Reform Jews take extremely seriously.<\/li>\n
  2. We take seriously the obligation of\u00a0sh\u2019mirat ha-guf<\/em>, preserving our well-being, and we therefore recognize danger to an otherwise healthy infant as a valid reason for postponing a\u00a0b\u2019rit milah<\/em>.<\/li>\n
  3. In keeping with our commitment to taking into account the best scientific and medical advice, given what we know about COVID-19, its transmission, and the danger it poses to infants, we do not find that performing the\u00a0b\u2019rit milah<\/em>\u00a0on the eighth day, with appropriate precautions, poses a more significant risk to the infant than delaying it until the pandemic has passed.<\/li>\n<\/ol>\n

    As we wrote recently, the COVID-19 pandemic constitutes a genuine emergency situation (sha\u2019at had\u2019<\/em>\u1e25<\/em>ak<\/em>).\u00a0 \u201cIn an emergency situation a\u00a0bet din<\/em>\u00a0is responsible for taking action for the welfare of the community, and may issue a temporary ruling (hora\u2019at sha\u2019ah<\/em>) to prevent the\u00a0kahal<\/em>\u00a0from going astray.\u201d[18]<\/sup><\/a>\u00a0 People can \u201cgo astray\u201d in all sorts of ways, including by allowing self-preservation and concern for our families to turn into irrational fear and panic. We pray that this pandemic will pass, and that as many lives as possible will be spared, and that people\u2019s livelihoods will not be destroyed; but in the meantime we will\u2014we must\u2014continue to live our lives.<\/p>\n

    Joan S. Friedman, chair
    \nHoward L. Apothaker
    \nDaniel Bogard
    \nCarey Brown
    \nLawrence A. Englander
    \nLisa Grushcow
    \nAudrey R. Korotkin
    \nRachel S. Mikva
    \nAmy Scheinerman
    \nBrian Stoller
    \nDavid Z. Vaisberg
    \nJeremy Weisblatt
    \nDvora E. Weisberg<\/p>\n

     <\/p>\n

    \n

     <\/p>\n

    [1]<\/a>\u00a0Nedarim 32a.<\/p>\n

    [2]<\/a>\u00a0See Lawrence A. Hoffman,\u00a0Covenant of Blood: Circumcision and Gender in Judaism<\/em>\u00a0(Chicago: University of Chicago Press, 1996), and Shaye J.D. Cohen,\u00a0Why Aren\u2019t Jewish Women Circumcised? Gender and Covenant in Judaism<\/em>\u00a0(Berkeley: University of California Press, 2005).<\/p>\n

    [3]<\/a>\u00a0\u201cAuthentic Report of the Proceedings of the Rabbinical Conference Held at Pittsburg, Nov. 16, 17, 18, 1885,\u201d in Walter Jacob, ed.,\u00a0The Changing World of Reform Judaism:\u00a0 The Pittsburgh Platform in Retrospect<\/em>\u00a0(Pittsburgh:\u00a0 Rodef Shalom Congregation, 1985), 101.<\/p>\n

    [4]<\/a>\u00a0See David Gollaher, \u201cFrom Ritual to Science: The Medical Transformation of Circumcision in America,\u201d\u00a0Journal of Social History<\/em>\u00a0vol. 28, no. 1 (Autumn 1994): 5-36.<\/p>\n

    [5]<\/a>\u00a0ARR<\/em>\u00a0#55, \u201cCircumcision on a Day Other Than the Eighth Day of Birth.\u201d<\/p>\n

    [6]<\/a>\u00a0RR<\/em>\u00a0#21, \u201cCircumcision Before Eighth Day.\u201d<\/p>\n

    [7]<\/a>\u00a0ARR<\/em>\u00a0#56, \u201cCircumcision Prior to the Eighth Day\u201d (1977);\u00a0CARR\u00a0<\/em>#28, \u201cBerit Milah\u201d (1978);\u00a0CARR<\/em>\u00a0#100, \u201cThe Pressured Mohel\u201d (1988).<\/p>\n

    [8]<\/a>\u00a0Yad, H. Rotze\u2019a\u1e25 11:5. See also Isserles\u2019 gloss to ShA YD 116:5.<\/p>\n

    [9]<\/a>\u00a0Yad, H. Milah 1:16-17; ShA YD 262:2, 263:1.<\/p>\n

    [10]<\/a>\u00a0This question did arise in connection with\u00a0metzitzah b\u2019feh<\/em>. The majority opinion is that\u00a0metzitzah<\/em>\u00a0is a hygienic matter, not an integral element of the\u00a0mitzvah<\/em>, and therefore any technique that makes it safer is permitted. Isaac Klein,\u00a0A Guide to Jewish Religious Practice<\/em>\u00a0(NY: Jewish Theological Seminary, 1979), 424.<\/p>\n

    [11]<\/a>\u00a0Yev. 72a.<\/p>\n

    [12]<\/a>\u00a0Nimukei Yosef, Yevamot 24a, s.v.\u00a0ve-ha-id\u2019na.<\/em><\/p>\n

    [13]<\/a>\u00a0Arukh Ha-Shul\u1e25an YD 263:4-5.<\/p>\n

    [14]<\/a>\u00a0RR21<\/em>, vol. 2, 5759.10, \u201cCompulsory Immunization.\u201d<\/p>\n

    [15]<\/a>\u00a0For example, see this news story:\u00a0https:\/\/www.theguardian.com\/world\/2020\/mar\/29\/coronavirus-illinois-governor-announces-rare-death-of-baby<\/a>, accessed 10 April 2020.<\/p>\n

    [16]<\/a>\u00a0See, e.g.,\u00a0https:\/\/abcnews.go.com\/Politics\/federal-government-18-month-plan-life-return-normal\/story?id=70046439<\/a>, accessed 10 April 2020.<\/p>\n

    [17]<\/a>\u00a0For the research that provided the information in this paragraph I thank Dr. Bryan Hecht, M.D., Division Director of Reproductive Endocrinology, Obstetrics and Gynecology, MetroHealth, Cleveland, board certified in Obstetrics and Gynecology and Reproductive Endocrinology and Infertility, and a certified Reform\u00a0mohel<\/em>.<\/p>\n

    [18]<\/a>\u00a0Yad H. Mamrim 2:4, cited in 5780.2, \u201cVirtual Minyan in Time of COVID-19 Emergency<\/a>.\u201d<\/p>\n

    [April 13]<\/p>\n","protected":false},"excerpt":{"rendered":"

    Question What should be the proper procedure regarding\u00a0b\u2019rit milah\u00a0during the COVID-19 pandemic? (submitted by Rabbi Julie Pelc Adler, Director, Brit Milah Program of Reform Judaism) Response In the midst of the current pandemic, it is understandable that parents and\u00a0mohalim\/ot\u00a0are confused and frightened.\u00a0 We will examine the issues here carefully, one by one. 1. The importance […]<\/p>\n","protected":false},"author":1764,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"ngg_post_thumbnail":0,"footnotes":""},"categories":[514272,524373],"tags":[],"_links":{"self":[{"href":"https:\/\/web.colby.edu\/coronaguidance\/wp-json\/wp\/v2\/posts\/642"}],"collection":[{"href":"https:\/\/web.colby.edu\/coronaguidance\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/web.colby.edu\/coronaguidance\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/web.colby.edu\/coronaguidance\/wp-json\/wp\/v2\/users\/1764"}],"replies":[{"embeddable":true,"href":"https:\/\/web.colby.edu\/coronaguidance\/wp-json\/wp\/v2\/comments?post=642"}],"version-history":[{"count":2,"href":"https:\/\/web.colby.edu\/coronaguidance\/wp-json\/wp\/v2\/posts\/642\/revisions"}],"predecessor-version":[{"id":1634,"href":"https:\/\/web.colby.edu\/coronaguidance\/wp-json\/wp\/v2\/posts\/642\/revisions\/1634"}],"wp:attachment":[{"href":"https:\/\/web.colby.edu\/coronaguidance\/wp-json\/wp\/v2\/media?parent=642"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/web.colby.edu\/coronaguidance\/wp-json\/wp\/v2\/categories?post=642"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/web.colby.edu\/coronaguidance\/wp-json\/wp\/v2\/tags?post=642"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}