AIDS and Circumcision

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Rabbi J. Simcha Cohen (z’l)

Question: Does the current widespread occurrence of AIDS in any way affect the performance of circumcision?

Response: Yes. At the Brit Milah, the Mohel (person who performs the circumcision) is required to suction the blood of the open wound. This process is called metzitzah. Traditionalists insist that the Mohel actually place his mouth on the wound and physically ingest blood, which is subsequently discarded. This is termed metzitzah b’peh. A modern method, sanctioned by a number of Halachic scholars, is to utilize a tube or gauze so that the process of suctioning blood takes place without the Mohel putting his mouth on an open wound or taking any blood into his mouth. Most Hasidic scholars decry this process as an unwarranted change in the traditional ritual of circumcision.

In Los Angeles recently, a noted scholar met with the rabbinate to discuss a variety of Halachic issues. The first question was posed by a Hasidic Rav who is a Mohel. The issue was whether metzitzah b’peh was still operational due to the AIDS epidemic.

At present there is no cure for AIDS. Once afflicted with the sickness, it is comparable to a sentence of death. It is also well established that the ingestion of liquids, especially blood, is a primary means of transferring AIDS. Accordingly, a frum Mohel may himself get AIDS as a result of metzitzah b’peh. This question, the Hasid noted, is particularly pressing at the circumcision of children of Baalei Teshuvah and nonreligious families. A secondary question relates to the fact that the Mohel may, if he is a victim of AIDS, contaminate the children of the community at large. This, in turn, could generate a widespread public denouncement of circumcision altogether.

The Rav’s response was that metzitzah b’peh is an ancient ritual that some authorities contend may even be a biblical mitzvah. To the extent that most people, certainly most Jews, do not have AIDS, the Mohel should not alter the traditional practice. He should be guided by the principle that “whoever observes [a] commandment will not experience evil [shomair mitzvah lo yaida davar ra]” (Kohelet 8:5). Accordingly, whoever is apprehensive over contracting AIDS “should simply cease being a Mohel.”

With reverence to this pious rabbi, I humbly submit that sources indicate a different Halachic position.

HaGaon R. Baruch HaLevi Epstein (author of Torah Tmimah) ruled that the concept of shomair mitzvah is applicable only in an occasional, accidental endeavor. It is not operational as a regular, permanent principle to safeguard performance of Mitzvot. In such conditions, the rule is that “one does not rely on miracles” (see Tosefet Beracha, Parshat VaAyra, Shemot). One simply cannot apply the concept of shomair mitzvah to guide the actions of a Mohel on a regular basis.

The following analogy may shed insight into the issue. In years 1832, 1849, and 1867, an
epidemic of cholera devastated the city of Vilna and thousands died. In 1849, in the midst of such an epidemic, a remarkable incident occurred. HaGaon Rav Yisrael Salanter publicly announced that due to the epidemic, no one should fast on Yom Kippur. Reliable historians record that R. Yisrael Salanter went up to the bimah after Shacharit on Yom Kippur and in front of the entire congregation publicly made Kiddush on wine and drank, and then ate cookies. His rationale was that physicians had ruled that fasting induces a physical weakness that makes one susceptible to contracting cholera. He himself ate publicly on Yom Kippur to serve as a role model for the community. He felt that by his eating, others would follow suit and have no qualms about violating the sacred, holy fast.

Of interest is that his action was not lauded by the rabbis of the community. In fact, just the converse transpired. HaGaon R. Betzalel haKohen in the mane of the rabbinic judges of Vilna issues a public rebuke. These rabbis proclaimed that it was prohibited to issue a blanket, general permission for all to eat on Yom Kippur because of the epidemic. Each person should have been assessed personally by a doctor to determine whether fasting was a life-threatening condition.

Their argument was that tens of thousands of Jews did, indeed, fast on Yom Kippur during the epidemic and did not contract cholera or die. Accordingly, they believed Rav Yisrael made a grievous error in Halachah.

HaRav R. Isar Yehudah Unterman, former Chief Rabbi of Israel, was concerned over the
rationale of the rabbinic judges who opposed R. Yisrael (Responsa, Shaivet Yehudah). It appears as if they ruled against the accepted principle that mandates violating mitzvoth in cases of even doubtful dangers to life. This rule is derived from an overt Mishneh which says: “Every danger to life suspends the [laws of the] Shabbat. If debris falls on someone, and it is doubtful whether or not he is there, or whether he is alive or dead, or whether he be a Jew or a heathen, one should [even on Shabbat] open the heap of debris for his sake” (Yoma 83a).

The cholera epidemic that killed thousands of people was definitely a potential (safek) life-threatening situation. Indeed, in cases where life-threatening factors are present, it is even prohibited to be stringent. Yet, the rabbinic judges simply refused to sanction permission to eat publicly on Yom Kippur in such a circumstance. Why? It certainly was not due to their assessment that cholera did not manifest a sakkanah (danger).
Perhaps, suggests Rav Unterman, the debate hinged on the definition of the principle of a “doubtful danger to life” (safek sakkanah).

Assume a person is healthy, not sick at all. Thus, the person in question in his own view is not in present danger. Yet, there is a possible life-threatening condition that affected a minority of the community. Is such a circumstance to be viewed as a doubtful peril to life or not?

The rabbinic judges believed that all consideration of life-threatening factors relates only to circumstances when the person in question or the majority of the community has been somewhat personally affected by the condition. Then, one violates Yom Kippur even if the danger is not certain. Since the majority of the Jews had never contracted cholera, no general permission to violate Yom Kippur could be issued.

Reb Yisrael’s position was that in the midst of an epidemic, one does not take into account the fact that most are healthy. He viewed it as if a plague had befallen the community and even if just a minority were afflicted, it should be deemed a life-threatening situation and everyone may, therefore, definitely eat on Yom Kippur (R. Unterman, pp. 70, 71, 73, 74; see also R. B. Cohen, Responsa, Raishit Bikurai).

Accordingly, one may, at first glance, compare the AIDS problem to the rabbinic debate relating to cholera.

Those who refuse to sanction any Halachic changes may side with the dayanim of Vilna. Those who do insist upon precautions would follow the ruling of R. Yisrael Salanter.

Three considerations must be noted:

1. Rav Unterman contends that history verified the position of R. Yisrael Salanter
(R. Unterman p.74).

2. Metztitzah b’peh is different from the cholera case. Here the Mohel is actually
performing an action that increases the likelihood of contamination. Also, even
without an epidemic, many rabbis rule that tube may be used in metzitzah. Thus,
no real violation of Halachah takes place (see S’dai Hemed, Kuntrus, Metzitzah).

3. Indeed, it is reliably retold that the sage HaGaon Rav Yosef Dov Soloveitchik
verbally instructed his students to refrain from using any Mohel who did not use
precautionary devices. (This ruling was made prior to the outbreak of AIDS.)

Consequently, as a precaution, halachic sources positively support a general policy for metzitzah b’peh to be discontinued during the present AIDS dilemma.