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Jewish World Review March 16, 1999 / 28 Adar, 5759
Ari Z. Zivotofsky
NEONATAL CIRCUMCISION is no longer a routinely recommended procedure. That is
the conclusion of the American Academy of Pediatrics in its first new statement
on the issue in a decade.
How do we as Jews react to this report? We, who have been circumcising newborn
males for some 4,000 years, may find it disconcerting to be told it is no
longer encouraged. On the other hand, circumcision has historically been
uncommon in most of the world; in fact, the United States is the only country
in which it is routinely performed.
Circumcision has come in and out of favor with the pediatric establishment over
the years. In the 1950s and '60s, 90 percent of American newborn males were
circumcised because of the presumption of medical benefit. In 1971 the AAP
stated that "there was no valid medical indication for circumcision." But then,
based on a plethora of new data, in 1989 the AAP reversed itself by stating:
"New evidence has suggested possible medical benefits" and the chairman of the
task force further stated that the benefits far exceed the risks. He added that
it may be considered a preventive health measure analogous to immunization.
With the current statement, the AAP is reversing its approach to circumcision
once more.
I am well acquainted with the medical literature detailing the myriad health
benefits of neonatal circumcision. Numerous studies have shown that
circumcision decreases the risk of urinary tract infections in the first year
of life by up to 90 percent.
Cancer of the penis is a rare but serious condition that occurs in less than
one per 100,000 males in the United States. However, in countries where
circumcision is not routinely performed the rate is five to ten times higher.
Studies also indicate a four-fold higher risk of cervical cancer in women whose
sex partner is uncircumcised. Finally, while the greatest risk factor for
acquiring HIV infection, syphilis and other sexually transmitted diseases is
unquestionably irresponsible behavior, studies have shown that circumcised men
are at lower risk than uncircumcised men.
It would have been reassuring to be told that the benefits of neonatal
circumcision are enough to recommend the procedure for all newborns. After all,
if we were commanded by G-d to circumcise all males, it is not unreasonable to
assume that there is some health benefit?
Bris milah is more than a surgical procedure known to the world as
circumcision. This rite was given to Abraham as one of the first commandments
in the Torah. It was part of the ritual required before the Exodus from Egypt
and the receiving of the Torah. It was the first act performed by the Jews upon
entering the Land of Israel under Joshua. It is a religious rite signifying the
entry of the newborn into the Jewish fold. It has traditionally been an
integral part of the conversion process.
For two very important reasons, knowledge of the medical benefits of
circumcision plays little role as far as Jews are concerned, other than as an
affirmation of Divine wisdom. Firstly, Jews never have performed circumcision
as a medically indicated procedure, but rather as a Divine imperative.
Secondly, Jews have never advocated general circumcision for the non-Jewish
public. In reality, the opposite has been true. Jewish tradition has viewed
circumcision as a distinguishing feature of the Jewish people. It is a badge of
pride worn by the Jew to separate him from the non-Jew.
Circumcision as a discriminator may have been a two-way street. Some historians
believe that Paul's success in making Christianity a world religion was
achieved by abolishing the circumcision requirement of Judaism. Hellenized Jews
of the Greek period, sought to assimilate into the majority culture by
attempting to surgically reverse their circumcisions. Closer to our times, the
Nazis treated circumcision as a defining mark of a Jew.
The AAP reviewed the benefits, but also noted the risks and pain of
circumcision, which are recognized by Jewish law. Post-circumcision, the
infant is considered sick and the Sabbath may be violated on his behalf. And
while at happy occasions, the joyous blessing of Shehechiyanu is usually
recited, many Jews do not recite this blessing at a bris because the joy is
tempered by the knowledge that the infant has experienced pain. In the Jewish
communal mind, however, the benefits of circumcision have since time immemorial
been viewed as sufficient justification for the pain of the bris. Also, if the
parents so desire, Jewish law does not proscribe the use of modern
analgesics.
I was very conscious of the small risk and the certain pain involved in
circumcision when a little over two years ago I personally circumcised my own
son. I partially alleviated the pain with an application of a topical
anesthetic. But the knowledge that there was no compelling medical reason to
subject him to this procedure, and that I was doing what Jewish fathers had
done for generations simply because G-d had so commanded, greatly enhanced the
religious significance of the event.
While the AAP is not suggesting to ban this tradition, it can have an impact on
the marginal Jew. If there is a downside to the AAP report, this is it. And
this is not merely theoretical. This past week over lunch, a Jewish secretary
at work asked if anyone had information she can use to convince her pregnant
daughter to circumcise the expected son. Clearly, here is a young, Jewish,
mother-to-be who is not moved by tradition to give her son a bris milah. But if
the AAP were to strongly recommend it, she most likely would.
Thus, this report will result in fewer Jews being circumcised. That is probably
the most significant effect of this report and it leaves me
saddened.
Will golden chain of Jewish history be broken by medical report?
A National Institutes of Health (NIH) neurophysiologist
examines the bris controversy
As a committed Jew who is trained in ritual circumcision, my first reaction was
disappointment.
JWR contributor Ari Z. Zivotofsky is a suburban-D.C. writer who works in neurophysiology at the
National Institutes of Health in Bethesda, Maryland.
